Research suggests a strong, dose–response relationship between adverse childhood experiences (ACEs) and poor adult mental health outcomes. This systematic review and meta-analysis aimed to systematically investigate the existence and strength of prospective associations between ACEs and adult mental health outcomes: anxiety, depression, psychotic-like experiences, post-traumatic stress disorder (PTSD), self-harm, and suicidality. We searched 12 electronic databases for publications after 1990. A narrative synthesis of included studies and random-effects meta-analyses with moderation were completed for all outcomes, excluding self-harm. In total, 62 studies from 15 countries were included. Most studies were from the United States; 95% of publications ( N = 59) came from high-income countries (HICs) and 5% ( N = 3) from upper-middle-income countries. Pooled associations between ACEs and adult mental illness were strongest for PTSD (OR = 2.26; 95% CI 1.75, 2.77), followed by anxiety (OR = 1.78; 95% CI 1.45, 2.11), depression (OR = 1.61; 95% CI 1.45, 1.76), psychotic-like experiences (OR = 1.34; 95% CI 1.13, 1.54), and suicidality (OR = 1.28; 95% CI 1.13, 1.43). Moderation analyses suggested ACEs with a violence or maltreatment component were significant risk factors for adult depression compared to household ACEs, and that study location was a significant moderator in the depression, anxiety, and PTSD models. Further moderation effects will be discussed. Findings confirm ACEs are a significant risk factor for mental ill-health in adulthood. Our review highlights the urgent need for research exploring associations between ACEs measured in childhood and adult mental illness outside of HIC settings.
Thurston et al. (Sun,) studied this question.