Prevalence of adverse childhood experience items: a systematic review and meta-analyses

BACKGROUND: Adverse childhood experiences (ACEs), including abuse, neglect, and household dysfunction, are a substantial public health problem globally. The aim of this study is to synthesise the prevalence of ACE items in adults. METHODS: We searched MEDLINE, Embase, PsycINFO, and CINAHL between Jan 1, 1998, and June 18, 2025. Studies published in English that used a 6-item to 12-item ACEs measure and included an adult sample were included. 26 945 non-duplicate records were screened for inclusion and 5373 underwent full-text review. Meta-analyses were done to estimate the pooled prevalence for each ACE item. FINDINGS: A total of 1002 studies comprising 2 592 879 adults across 102 countries were included (mean age 35·0 years SD 12·3; mean percentage of female participants 62·4% SD 29·5). The pooled prevalence for each ACE was as follows: 28·0% (95% CI 21·8-34·5) for emotional abuse, 22·1% (17·8-26·7) for emotional neglect, 18·2% (13·9-22·7) for physical abuse, 11·6% (8·9-14·5) for physical neglect, 10·9% (8·0-14·0) for sexual abuse, 24·0% (17·7-30·5) for parental divorce or separation, 21·7% (16·2-27·3) for household member with substance abuse, 17·2% (12·3-22·5) for a household member with a mental illness, 15·2% (11·4-19·1) for witnessing intimate partner violence, and 8·0% (5·2-11·1) for household member incarceration. Moderation analyses revealed that the prevalence of ACEs items varied by demographic factors, geographical location, and assessment method. INTERPRETATION: ACEs are common, but their distribution is not uniform, with marked variations across adversity types and population subgroups. These findings underscore the global burden of ACEs and point to the need for structural and child-rights approaches to prevention, paired with societal shifts in how children are protected and supported. FUNDING: Alberta Children's Hospital Research Foundation, Calgary Health Foundation, Mathison Centre for Mental Health Research and Education, The Owerko Centre, and the Faculty of Arts and the Cumming School of Medicine at the University of Calgary.