The prevalence and profiles of adverse childhood experiences and their associations with adult mental health outcomes in China: a cross-sectional study

Peilin Xu; Zhaorui Liu; Yifeng Xu; Tao Li; Guangming Xu; Xiangdong Xu; Limin Wang; Yongping Yan; Shuiyuan Xiao; Lingjiang Li; Tingting Zhang; Jie Yan; Yaqin Yu; Xiufeng Xu; Zhizhong Wang; Bo Wang; Wanjun Guo; Yueqin Huang

doi:10.1016/j.lanwpc.2024.101253

The prevalence and profiles of adverse childhood experiences and their associations with adult mental health outcomes in China: a cross-sectional study

Lancet Reg Health West Pac. 2024 Dec 5:53:101253. doi: 10.1016/j.lanwpc.2024.101253. eCollection 2024 Dec.

Authors

Peilin Xu¹, Zhaorui Liu¹, Yifeng Xu², Tao Li^{3

4}, Guangming Xu⁵, Xiangdong Xu⁶, Limin Wang⁷, Yongping Yan⁸, Shuiyuan Xiao⁹, Lingjiang Li¹⁰, Tingting Zhang¹, Jie Yan¹¹, Yaqin Yu¹², Xiufeng Xu¹³, Zhizhong Wang¹⁴, Bo Wang⁸, Wanjun Guo^{3

4}, Yueqin Huang¹

Affiliations

¹ Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100091, China.
² Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China.
³ Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310058, China.
⁴ Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
⁵ Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin 300222, China.
⁶ The Fourth People's Hospital in Urumqi, Urumqi 830002, China.
⁷ National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
⁸ Department of Epidemiology, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China.
⁹ Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan 410078, China.
¹⁰ Mental Health Institute, The Second Xiangya Hospital, Central-south University, Changsha, Hunan 410011, China.
¹¹ Institute of Social Science Survey, Peking University, Beijing 100871, China.
¹² Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin 130021, China.
¹³ Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
¹⁴ Department of Epidemiology and Statistics, School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia 750004, China.

Abstract

Background: Adverse childhood experiences (ACEs) are common and associated with mental disorders. However, the prevalence and co-occurrence of ACEs and their association with mental health outcomes among Chinese adults have not been well demonstrated.

Methods: China Mental Health Survey, a cross-sectional nationally representative survey consisting of 28,140 adults, was conducted from July 2013 to March 2015. Twelve ACEs and mental health outcomes, including mood disorder, anxiety disorder, substance-use disorder, and suicide were measured using the Composite International Diagnostic Interview (CIDI) 3.0 in a weighted representative subsample of 9378 respondents. Latent class analysis was used to identify the co-occurrence profiles of ACEs, and logistic regression was applied to examine the association between ACEs and mental health outcomes. Population-attributable fractions (PAFs) were calculated to quantify the attribution of ACEs to these outcomes.

Findings: Among the 9378 respondents, the weighted count (proportion) of females was 4642 (49.5%), with a weighted mean (SD) age of 43.0 (15.8) years. In this study, 27.1% of respondents showed at least one ACE, with multiple ACEs common (37.6%) among those affected. Neglect was the most prevalent ACE (11.3%), followed by physical abuse (9.1%). Latent class analysis identified four co-occurrence profiles: low risk of ACEs, maltreatment, caregiver's maladjustment and parental loss. The strongest association with mental health outcomes was found in the caregiver's maladjustment group (OR, 4.9; 95% CI, 3.2-7.6). Estimates of PAFs indicated that all ACEs together explained 39.4% (95% CI, 31.3%-47.4%) of observed mental health outcomes. Gender differences were noted in prevalence and associations with outcomes.

Interpretation: ACEs are highly prevalent and interrelated in China, attributing to over one-third of the mental disorder burden. In resource-limited settings, prioritizing the reduction of the most prevalent and impactful ACEs through education and policy can more effectively alleviate the disease burden.

Funding: The National Twelfth Five-Year Plan for Science and Technology Support from the Chinese Ministry of Science and Technology (grant numbers 2012BAI01B01 & 2015BAI13B00), and the National Key R&D Program of China (grant numbers 2017YFC0907800 and 2017YFC0907801).

Keywords: Adverse childhood experiences; Latent class analysis; Mental health outcomes; Population-attributable fractions.