Adverse Childhood Experiences (ACE) Within a Social Disadvantage Framework: Distinguishing Unique, Cumulative, and Moderated Contributions to Adult Mental Health

Abstract

The deleterious impact of adverse childhood experiences (ACE) may be confounded with frequently co-occurring social disadvantage. In this analysis we test the effects of ACE on adult mental health within a social disadvantage framework, using a population-based survey (n = 7,444; mean age = 55.2 years) from Washington State. We also examined the protective effects of socioemotional support, and the distinct and combined contribution of the measured ACE factors. Results demonstrated sustained impact of ACE on mental health many decades later, even net of social disadvantage and demographic contributors. Protective factors provided both direct and moderating influences, potentially masking the elevated effects of ACE for those with few resources. Toxicity examination of ACE items evinced differential effects of ACE experiences on mental health. These results demonstrate that interventions ameliorating the effects of ACE and bolstering protective resources such as socioemotional support may be effective toward augmenting mental health even late in life.

KEYWORDS:

• adverse childhood experiences (ACE)
• mental health
• poverty
• victimization

Acknowledgments

This research was supported in part by a grant from the National Institute on Mental Health grant 5 T32 MH20010 “Mental Health Prevention Research Training Program” and NCRR Grant TL1 RR 025016.

Notes

Note. All models control for demographics (age, sex, race, ethnicity). β = standardized betas; OR = odds ratios.

^a R²equivalents are not available.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.

Note. All models control for demographic and social disadvantage variables. β = standardized betas in linear regressions; ORs = odds ratio in logistic regression.

^a For sake of parsimony, the F and R ²of each separate ACE item regression is not reported.

*p ≤ .05. **p ≤ .01. ***p ≤ .001.