Patterns of exposure to adverse childhood experiences and their associations with mental health: a survey of 1346 university students in East Asia

Soc Psychiatry Psychiatr Epidemiol. 2020 Mar;55(3):339-349. doi: 10.1007/s00127-019-01768-w. Epub 2019 Sep 9.


Introduction: Adverse childhood experiences (ACEs) constitute a significant global mental health burden. Prior studies typically investigated the impact of ACEs on mental health using a cumulative risk approach; most ACEs studies were also conducted in Western settings.

Purpose: This study aimed to examine ACEs using a pattern-based approach and assess their associations with mental health outcomes by early adulthood in East Asia.

Methods: The present study included measures of exposure to 13 categories of ACEs, depression, anxiety, maladjustment, and posttraumatic stress in a sample of 1346 university students from Hong Kong, China, Taiwan, and Japan.

Results: Latent class analysis indicated three distinct patterns of ACE exposure: Class 1: Low ACEs (76.0%); Class 2: Household Violence (20.6%); and Class 3: Household Dysfunction (3.4%). Those representing Class 3 had significantly more ACEs compared with those in Classes 1 or 2. Controlling for age and sex, those in Class 2 reported significantly higher depression and maladjustment symptoms compared with those in Class 1; both Classes 2 and 3 had significantly higher anxiety symptoms and odds for meeting diagnostic criteria for posttraumatic stress disorders compared with those in Class 1.

Conclusions: Study findings suggest that young adults' mental health, at least under certain contexts, is more closely linked with the nature and pattern of ACE co-occurrence, rather than the number of ACEs.

Keywords: Adverse childhood experiences; East Asia; Latent class analysis; Mental health; Young adults.

MeSH terms

  • Adolescent
  • Adverse Childhood Experiences*
  • China
  • Depression
  • Female
  • Hong Kong
  • Humans
  • Japan
  • Male
  • Mental Disorders
  • Mental Health*
  • Students* / psychology
  • Surveys and Questionnaires
  • Taiwan
  • Universities
  • Violence
  • Young Adult