Chronic mental health problems and use of mental health services among adults with and without adverse childhood experiences: a 6-year longitudinal population-based study

Figures & data

Table 1. Characteristics Dutch population and respondents.

	Dutch	T2 (2011)			T3 (2013)			T4 (2015)			T5 (2017)
	Popul. 2010	No- ACE	Single ACE	Multiple ACE	No- ACE	Single ACE	Multiple ACE	No- ACE	Single ACE	Multiple ACE	No- ACE	Single ACE	Multiple ACE
	%	%	%	%	%	%	%	%	%	%	%	%	%
Age
18–34 years	25.8	26.3	23.2	20.9	23.6	17.8	20.7	19.8	13.6	18.7	17.1	11.7	14.1
35–49 years	28.2	27.8	29.6	35.2	24.7	28.5	32.6	25.6	30.0	29.7	24.2	28.5	30.4
50–64 years	25.7	25.3	28.6	27.5	27.3	32.4	26.1	26.8	30.7	29.7	26.7	30.2	31.5
65 years or older	20.2	20.6	18.6	16.5	24.4	21.4	20.7	27.8	25.7	22.0	32.1	29.5	23.9
Sex
Man	49.1	50.5	41.8	40.2***	50.5	41.8	40.2***	50.5	41.8	40.2***	50.5	41.8	40.2***
Woman	50.9	49.5	58.2	59.8	49.5	58.2	59.8	49.5	58.2	59.8	49.5	58.2	59.8
Employed
No	45.8	45.7	43.9	55.4	47.7	44.1	56.5	46.6	50.0	66.3***	45.6	45.7	63.0***
Yes	54.2	54.3	56.1	44.6	52.3	55.9	43.5	53.4	50.0	33.7	54.4	54.3	37.0
Married
No	49.7	49.1	49.5	65.2**	48.9	47.0	62.0*	48.2	46.6	59.3	46.4	46.8	56.5
Yes	50.3	50.9	50.5	34.8	51.1	53.0	38.0	51.8	53.4	40.7	53.6	53.2	43.5
Education level
1 Prim. educ.	n.a.	26.8	27.8	19.6	25.8	27.1	19.6	25.1	26.8	17.6	24.7	27.0	17.6
2 Higher gen. sec.	n.a.	9.0	6.4	12.0	7.7	5.7	12.0	7.0	5.7	12.1	6.8	4.6	12.1
3 Inter. prof. educ.	n.a.	24.1	28.1	25.0	24.7	28.2	25.0	25.1	27.9	22.0	24.5	27.4	22.0
4 High. prof. educ.	n.a.	25.9	24.9	33.7	26.2	26.1	33.7	26.8	26.8	36.3	27.7	27.8	34.1
5 University	n.a.	14.2	12.8	9.8	15.6	12.9	9.8	16.1	12.9	12.1	16.4	13.2	14.3
Physical illness
No	n.a.	83.5	73.9	71.7***	80.7	72.2	69.6***	79.7	71.1	64.1***	78.0	71.4	60.4***
Yes	n.a.	16.5	26.1	28.3	19.3	27.8	30.4	20.3	28.9	35.9	22.0	28.6	39.6

ACE: confronted with one or more of the following adverse childhood experiences: sexual abuse; physical abuse; emotional abuse; sexual violence; rape; violence; and/or death of parent or sibling during childhood. Popul.: population. Education level: prim. educ: primary education, preparatory intermediate vocational education; higher gen. sec.: higher general secondary/pre-university educ; inter. prof. educ.: intermediate professional education; high. prof. educ: higher professional education. N.a.: not available for all Dutch residents. Results are based on weighted data and due to weighting numbers may slightly differ. n_{Single ACE} = 280. n_{Multiple ACE} = 92. n_no-ACE = 2055.

*p < 0.05. **p < 0.01. ***p < 0.001.

Table 2. Adverse childhood experiences among single and multiple ACE group.

	Single ACE (n = 280)	Multiple ACE (n = 92)
	n (%)	n (%)
Incest/sexual abuse as a child	27 (9.6)	33 (35.9)
Physical maltreatment as a child	11 (3.9)	47 (51.1)
Psychological (emotional) maltreatment as a child	59 (21.0)	81 (88.0)
Sexual violence (not rape) by a known person^a	12 (4.3)	12 (13.2)
Sexual violence (not rape) by a unknown person^a	2 (0.7%)	6 (6.5)
Rape by a known person^a	3 (1.1)	4 (4.3)
Rape by a unknown person^a	2 (0.7)	5 (5.4)
Physical violence by a known person^a	13 (4.6)	16 (17.4)
Physical violence by a unknown person^a	17 (16.1)	4 (4.4)
Death of sibling/parent^a	134 (47.9)	14 (15.2)
	M (SD)	M (SD)
Number of ACE	1 (0)	2.42 (0.92)

Results are based on weighted data and due to weighting numbers may slightly differ.

^aBefore the age of 18.

Table 3. Mental health problems and services use.

	Problems and services use
	2011 (T2)		2013 (T3)		2015 (T4)		2017 (T5)
	n	%	n	%	n	%	n	%	AOR^ace	(95% CI)	p-value
Anxiety and depression symptoms
No-ACE group (Ref.)	270	13.1	280	13.6	275	13.4	272	13.2
Single ACE group	61	21.8	65	23.2	64	22.9	48	17.1	1.62	(1.30- 2.01)	<0.001
Multiple ACE group	32	34.8	27	29.7	36	39.1	36	39.1	3.04	(2.22-4.24)	<0.001
Fatigue
No-ACE group (Ref.)	589	29.1	589	28.7	608	29.6	624	30.4
ACE group	98	35.0	111	39.6	119	42.5	113	40.4	1.41	(1.14-1.75)	0.002
Multiple ACE group	47	51.1	54	58.7	51	55.4	49	53.8	2.53	(1.77-3.63)	<0.001
Sleep problems
No-ACE group (Ref.)	367	18.0	384	18.7	402	19.6	414	20.2
Single ACE group	70	25.0	79	28.3	87	31.1	78	27.8	1.58	(1.26- 1.98)	<0.001
Multiple ACE group	43	46.7	49	53.3	45	48.9	46	50.0	3.61	(2.53-5.15)	<0.001
Contact with a psychiatrist, psychologist, or psychotherapist
No-ACE group (Ref.)	98	4.8	101	4.9	117	5.7	129	6.3
Single ACE group	24	8.6	36	13.0	24	8.6	23	8.2	1.72	(1.32- 2.25)	<0.001
Multiple ACE group	17	18.5	15	16.3	16	17.6	19	20.7	3.10	(2.17-4.41)	<0.001
Use medicine for anxiety or depression
No-ACE group (Ref.)	72	3.5	79	3.8	79	3.8	86	4.2
Single ACE group	12	4.3	11	3.93	14	5.0	14	5.0	1.13	(0.68- 1.87)	0.647
Multiple ACE group	7	7.8	7	7.6	10	10.9	9	9.9	2.20	(1.14-4.24)	0.019

ACE: confronted with one or more of the following ACEs: sexual abuse; physical abuse; emotional abuse; sexual violence; violence; rape; and/or death of parent or sibling during childhood. AOR^ACE: odds ratio (OR) of predictor ACE in repeated measures (GEE), adjusted for the covariates sex (2011), age, being employed, education level, marital status, and physical illness at each corresponding surveys. 95% CI: 95% confidence interval. Results are based on weighted data and due to weighting numbers may slightly differ. n^{Single ACE} = 280, n^{Multiple ACE} = 92, n^no-ACE = 2055.

Table 4. Prevalence of chronic mental health problems and services use.

	Chronic problems and services use
	n^chronic MHP	%^chronic MHP	AOR^A^CE	(95% CI)	p-value
Chronic anxiety and depression symptoms
No-ACE group (Ref.)	154	7.5	1
Single ACE group	38	13.6	1.87	(1.26–2.78)	0.002
Multiple ACE group	24	26.1	3.40	(2.00–5.77)	<0.001
Chronic fatigue
No-ACE group (Ref.)	549	26.7	1
Single ACE group	105	37.5	1.46	(1.11–1.92)	0.007
Multiple ACE group	50	54.9	2.82	(1.80–4.40)	<0.001
Chronic sleep problems
No-ACE group (Ref.)	335	16.3	1
Single ACE group	71	25.4	1.50	(1.10–2.05)	0.010
Multiple ACE group	45	48.9	4.14	(2.62–6.55)	<0.001
Chronic contact with a psychiatrist, psychologist, or psychotherapist^a
No-ACE group (Ref.)	23	1.1	1
Single ACE group	6	2.1	1.68	(0.66–4.30)	0.278
Multiple ACE group	9	9.8	7.83	(3.45–17.80)	<0.001
Chronic use of medicine for anxiety or depression
No-ACE group (Ref.)	72	3.5	1
Single ACE group	9	3.2	0.77	(0.38–1.57)	0.472
Multiple ACE group	7	7.6	1.52	(0.66–3.51)	0.329

ACE: confronted with one or more of the following ACEs: sexual abuse; physical abuse; emotional abuse; sexual violence; rape; violence; and/or death of parent or sibling during childhood. Chronic = reported problem at 3 or 4 surveys. AOR^ACE: odds ratio (OR) of predictor ACE adjusted for the covariates sex, age, being employed, education level, marital status, and physical illness at T2. 95% CI: 95% confidence interval. Results are based on weighted data and due to weighting numbers may slightly differ. n^{Single ACE} = 280, n^{Multiple ACE} = 92, n^no-ACE = 2055.

^aDue to cell counts age was omitted from the list of predictors.