Background: Adverse Childhood Experiences (ACEs) are serious within-household events occurring during childhood (ages 0-17) that are associated with worsened physical and mental health outcomes. However, the estimated risk of these outcomes has not been assessed longitudinally. The goal of this project was to assess the extent to which ACEs can be used to predict incidence of mental illness, psychological distress, and substance use disorders in young adulthood.

Methods: A longitudinal retrospective analysis of ACEs and 3 mental health and substance use outcomes was performed using 2007-2017 data from the Transition to Adulthood Supplement of the Panel Study of Income Dynamics, a nationally representative dataset. The data was weighted to represent the US population in 2017 and for the complex survey design. ACEs were assessed numerically by categories (0, 1-2, and 3+) and individually. Individual ACEs were sexual abuse, physical abuse, emotional abuse, emotional neglect, parent mental illness, parent drug use, parent household violence, parent incarceration, & parent divorce/single parent. Outcomes were mental illness diagnosis, Kessler K6 Psychological Distress, and drug use in the past 12 months. Outcomes were measured in a young adult population (ages 17-28). Logistic regressions, adjusted for sociodemographic factors, were performed between categorical ACEs and outcomes, and between individual ACEs and outcomes. Covariates were gender, race, age, income, education, parental education, insurance, and healthcare access. Absolute outcome risk estimates and outcome risk ratios were collected.

Results: Estimated risk of each outcome increased as ACE score increased and over time, though much of the risk accumulated within 2 years. ACEs with the highest estimated risk of poor outcomes at 2-, 4-, and 6-year follow up were parent mental illness, sexual abuse, emotional neglect, and household violence.

Discussion: This study is important in demonstrating that ACEs have a compounding effect in predicting mental health risk 2-6 years after childhood, with much of the accumulation occurring within 2 years. Additionally, different ACEs carry different risks of mental illness, psychological distress, and drug use incidence in young adulthood. This study carries clinical implications for physicians to conceptualize risk from specific ACEs, rather than solely using an ACE score, at different time points in young adulthood.