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Childhood Adversities and First Onset of Psychiatric Disorders in a National Sample of US Adolescents
Open accessAbstract
CONTEXT: Although childhood adversities (CAs) are known to be highly co-occurring, most research examines their associations with psychiatric disorders one at a time. However, recent evidence from adult studies suggests that the associations of multiple CAs with psychiatric disorders are nonadditive, arguing for the importance of multivariate analysis of multiple CAs. To our knowledge, no attempt has been made to perform a similar kind of analysis among children or adolescents. OBJECTIVE: To examine the multivariate associations of 12 CAs with first onset of psychiatric disorders in a national sample of US adolescents. DESIGN: A US national survey of adolescents (age range, 13-17 years) assessing DSM-IV anxiety, mood, behavior, and substance use disorders and CAs. The CAs include parental loss (death, divorce, and other separations), maltreatment (neglect and physical, sexual, and emotional abuse), and parental maladjustment (violence, criminality, substance abuse, and psychopathology), as well as economic adversity. SETTING: Dual-frame household-school samples. PARTICIPANTS: In total, 6483 adolescent-parent pairs. MAIN OUTCOME MEASURES: Lifetime DSM-IV disorders assessed using the World Health Organization Composite International Diagnostic Interview. RESULTS: Overall, exposure to at least 1 CA was reported by 58.3% of adolescents, among whom 59.7% reported multiple CAs. The CAs reflecting maladaptive family functioning were more strongly associated than other CAs with the onset of psychiatric disorders. The best-fitting model included terms for the type and number of CAs and distinguished between maladaptive family functioning and other CAs. The CAs predicted behavior disorders most strongly and fear disorders least strongly. The joint associations of multiple CAs were subadditive. The population-attributable risk proportions across DSM-IV disorder classes ranged from 15.7% for fear disorders to 40.7% for behavior disorders. The CAs were associated with 28.2% of all onsets of psychiatric disorders. CONCLUSIONS: Childhood adversities are common, highly co-occurring, and strongly associated with the onset of psychiatric disorders among US adolescents. The subadditive multivariate associations of CAs with the onset of psychiatric disorders have implications for targeting interventions to reduce exposure to CAs and to mitigate the harmful effects of CAs to improve population mental health.
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“Evidence from population-based epidemiological studies indicates that childhood adversity is common and associated strongly with the subsequent onset of psychopathology not only in childhood, but also in adolescence and adulthood (Cohen et al., 2001; Green et al., 2010; Kessler et al., 1997; McLaughlin et al., 2012).”
From Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience (2014) · cites this paper as McLaughlin et al., 2012
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“The exposures that give rise to experiences of deprivation and threat co-occur at high rates in children and adolescents”
From Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience (2014) · cites this paper as McLaughlin et al., 2012
In the citing paper
“exposure to childhood adversity has been shown to explain more than 30% of mental disorders in the U.S. population (Green et al., 2010; McLaughlin et al., 2012)”
From Childhood adversity and neural development: Deprivation and threat as distinct dimensions of early experience (2014) · cites this paper as McLaughlin et al., 2012
In the citing paper
“White matter changes have also been observed, consistent with evidence from animal models, including reduced volume of the posterior corpus callosum(129, 136), and reduced FA in white matter tracts linking the PFC with the temporal lobe (e.g., uncinate fasiculus, superior longitudinal fasciculus) and striatum (e.g., internal and external capsule).(136–138)”
From Neglect as a violation of species-expectant experience: neurodevelopmental consequences (2017) · cites this paper as [138]
In the citing paper
“Consistent with our hypotheses and prior studies on child trauma (Lansford et al. 2002; McLaughlin et al. 2012), we found strong associations between physical, sexual, and emotional abuse and both internalizing and externalizing symptoms in the sample of youths for whom maltreatment exposure was more prevalent.”
From Childhood maltreatment exposure and disruptions in emotion regulation: A transdiagnostic pathway to adolescent internalizing and externalizing psychopathology (2016) · cites this paper as McLaughlin et al. 2012
In the citing paper
“Greater exposure to ELA is associated with elevated risk of a wide range of mental and physical health outcomes across the lifespan, including depression, anxiety, substance abuse, cardiovascular disease, cancer, type 2 diabetes, respiratory diseases, chronic pain, gastrointestinal and metabolic disorders, and neurological and musculoskeletal problems,4–14 as well as premature mortality.15,16”
From Early life adversity and health-risk behaviors: Proposed psychological and neural mechanisms (2018) · cites this paper as [4]
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“Although our finding that internalizing disorders are best represented by separate fear and distress dimensions is consistent with previous research,(25,26) it is unclear how these dimensions will map onto the domains recently proposed in the National Institute of Mental Health research domain criteria.(27) Parents pr…”
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“To evaluate this possibility, we conducted a more detailed analysis examining the associations of CAs with individual disorders and found that the CAs considered herein generally have the strongest associations within DSM-IV disorder classes with the disorders that have early ages at onset.(53) For example, within the…”
Self-citationValidity of adult retrospective reports of adverse childhood experiences: review of the evidence
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“However, the use of retrospective reports of CAs in these studies could have introduced systematic recall bias into the results.(4,17,18) To our knowledge, no attempt has been made to perform a similar kind Author Affil of General P Children’s H McLaughlin) of Health Ca (Mr Gruber, Drs Zaslavsk Harvard Med School of E…”
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“Several multivariate models were estimated using the modeling approach developed in earlier work on this topic.(4,16) Each model included dummy predictor variables for CAs and controls.”
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“However, despite this evidence of co-occurrence, most research has focused on single CAs(7-9,14) or on a count of the number of CAs as predictors of mental disorders.(1,3,15) This has led to an overestimation of the effects of individual CAs and to the neglect of potentially important multivariate CA profiles.”
Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.186 · Cited by 2,323 · cited 3×
“Several multivariate models were estimated using the modeling approach developed in earlier work on this topic.(4,16) Each model included dummy predictor variables for CAs and controls.”
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Self-citationKorgaonkar, M. S., Tobler, C., Felmingham, K. L., Williams, L. M., Bryant, R. A., & Breukelaar, I. A. (2026) · Molecular Psychiatry · doi:10.1038/s41380-026-03511-9 · Cited by 3
Zhang, Z., Liu, Z., Ye, F., Mo, D., Shi, Y., Tao, P., Xie, C., Chen, L., Li, Y., Gu, Q., et al. (2026) · BMC Public Health · doi:10.1186/s12889-026-27061-5 · Cited by 3
“Epidemiological data suggest that over half of the world’s population has experienced at least one ACEs, and about 15 to 20% have been exposed to 4 or more ACEs [5, 6].”
Koslouski, J. B., Jones, M. E., Patil, P. A., Chan, F., Roulier, R. C., & Porche, M. V. M. (2021) · Journal of Education · doi:10.1177/00220574211016399 · Cited by 2
“2% of all onsets of psychiatric disorders (McLaughlin et al., 2012).”
InfluentialKalubi, J., Riglea, T., Wellman, R. J., O’Loughlin, J. L., & Maximova, K. (2023) · Health Promotion and Chronic Disease Prevention in Canada · doi:10.24095/hpcdp.43.7.02 · Cited by 3
Papalia, N. L., Simmons, M., Trood, M. D., McEwan, T. E., & Spivak, B. (2024) · BMC Public Health · doi:10.1186/s12889-023-17570-y · Cited by 5
Uzun, B., Orman, A., & Essau, C. A. (2024) · Children · doi:10.3390/children11020180 · Cited by 7
“As reported in numerous studies, the onset of most mental disorders is during adolescence [3], with adolescents who have been exposed to stress being at more elevated risk for developing mental health problems [4].”
BackgroundTelehealth Delivery of Trauma-Focused Cognitive-Behavioral Therapy
Stewart, R. W., Orengo‐Aguayo, R., & Shanholtz, C. E. (2024) · Springer eBooks · doi:10.1007/978-3-031-69264-2_4 · Cited by 3
Childhood Maltreatment and Borderline Personality Disorder
Salavati, M., & Selby, E. A. (2024) · Springer eBooks · doi:10.1007/978-3-031-75503-3_4 · Cited by 3
Moed, A., & Razer, A. (2025) · Early Childhood Research Quarterly · doi:10.1016/j.ecresq.2025.02.010 · Cited by 3
Anastasiadou, D. T., Tárrega, S., Fornieles-Deu, A., & Sánchez‐Carracedo, D. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1623411 · Cited by 6
Grant Report on the Effects of Childhood Maltreatment on Neurocircuitry in Adolescent Depression
Gillespie, M. L., & Rao, U. (2020) · Journal of Psychiatry and Brain Science · doi:10.20900/jpbs.20200016 · Cited by 3
Stroud, C. B., Chen, F. R., Dunning, E. E., Cheng, J., Marr, C., & Vrshek‐Schallhorn, S. (2021) · Development and Psychopathology · doi:10.1017/s0954579421001176 · Cited by 3
Jankowski, M. K., Knight, E., & Butcher, R. L. (2021) · Children and Youth Services Review · doi:10.1016/j.childyouth.2021.106326 · Cited by 3
Murray, H., Wild, J., & Ehlers, A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00229-6 · Cited by 3
Krohner, S., Yamin, J. B., Ziadni, M. S., McIntosh, J. N. C., Schubiner, H. H., & Lumley, M. A. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-022-09913-5 · Cited by 3
Lee, J. O., Yoon, Y., Duan, L., Oxford, M. L., & Cederbaum, J. A. (2023) · The Journal of Early Adolescence · doi:10.1177/02724316231151999 · Cited by 3
“The equivalent predictive capacity of child mal-treatment and household dysfunction for externalizing behavior problems in adolescence has also been observed (McLaughlin et al., 2012; Schilling et al., 2008).”
Vieira, A., Sheerin, K. M., Modrowski, C. A., & Kemp, K. A. (2023) · Journal of Community Psychology · doi:10.1002/jcop.23024 · Cited by 3
CHILD IMMIGRANT POST-MIGRATION MENTAL HEALTH: A QUALITATIVE INQUIRY INTO CAREGIVERS’ PERSPECTIVES
Fakhari, N., McIsaac, J. D., & Spencer, R. (2023) · International Journal of Child Youth and Family Studies · doi:10.18357/ijcyfs142202321470 · Cited by 3
“People exposed to ACEs may experience helplessness, depression, anxiety, and affective disorders in adolescence or adulthood (Flouri & Kallis, 2011; McLaughlin et al., 2012); for instance, depression symptoms among caregivers can decrease family warmth and quality of parenting, and may lead to…”
BackgroundYeo, D., Lee, S., Choi, H., Park, M.-H., & Park, B. (2024) · Neurobiology of Stress · doi:10.1016/j.ynstr.2024.100623 · Cited by 5
“Early life adversity induces structural and functional changes in the brain, increasing vulnerability to various mental illnesses (Cassiers et al., 2018; Dannlowski et al., 2012; McLaughlin et al., 2012).”
BackgroundAssociation of 5-HTTLPR With Post-Traumatic Stress Disorder in US Service Members
Hu, X., Ursano, R. J., Benedek, D. M., Li, X., Biomarker Study Group, & Zhang, L. (2024) · Chronic Stress · doi:10.1177/24705470241245497 · Cited by 3
Blevins, E. J., Slopen, N. B., Koenen, K. C., Mikesell, C., & Basu, A. (2024) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000413 · Cited by 4
Looschen, K., Jeffers, A., Chakraborty, S., Salisbury, C., Dodge, A., Hochstetler, M. J., & Mitra, S. (2025) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2025.2469793 · Cited by 3
“While these models primarily focused on ELS (typically between PND 2–15) and its effects in adult-hood, studies on adolescent stress and its impact on opioid-related behaviors in adulthood, especially in females, have been minimal.”
Recognizing and referring at-risk youth
Dopheide, J. A. (2013) · Mental Health Clinician · doi:10.9740/mhc.n145475 · Cited by 3
Nurse fellowships: An advance for population-based mental health care
Delaney, K. R. (2019) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2019.12.003 · Cited by 3
Childhood Trauma and Psychotic Symptomatology in Ethnic Minorities With Schizophrenia
Levit, J. D., Valderrama, J., Georgakopoulos, P., Brooklyn, A.-G., Hansen, S. K., Salisu, M. A., Valderrama, J., Georgakopoulos, P., Fanous, A. H., Bigdeli, T. B., et al. (2020) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgaa068 · Cited by 3
Stability and Change in Psychological Distress and Early Adverse Environments in Japanese Adults
Kawamoto, T. (2021) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-021-09890-3 · Cited by 3
Kagan, J. (2013) · Developmental Review · doi:10.1016/j.dr.2013.07.003 · Cited by 3
McKelvey, L. M., Zhang, D., Whiteside-Mansell, L., & Selig, J. P. (2022) · Adversity and Resilience Science · doi:10.1007/s42844-022-00066-w · Cited by 3
“Another limitation of cumulative risk indices lies in the likelihood that adversities often co-occur (Dong et al., 2004; Green et al., 2010; McLaughlin et al., 2012).”
BackgroundLoidl, V., Hamacher, K., Lang, M., Laub, O., Schwettmann, L., & Grill, E. (2023) · BMC Family Practice · doi:10.1186/s12875-023-02119-0 · Cited by 3
Bailey, S., Newton, N. C., Perry, Y., Grummitt, L. R., Baams, L., & Barrett, E. L. (2023) · Systematic Reviews · doi:10.1186/s13643-023-02365-4 · Cited by 3
“Evidence accumulated over the last few decades has identified one such risk factor, traumatic stress, which is highly prevalent and strongly associated with mental ill-health and substance use in adolescence and early adulthood [20–24].”
BackgroundHammond, C. J. (2016) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2016.05.013 · Cited by 3
Creeden, K. (2018) · Wiley eBooks · doi:10.1002/9781118650868.ch30 · Cited by 3
Schäfer, J., McLaughlin, K. A., Manfro, G. G., Pan, P. M., Rohde, L. A., Miguel, E. C., & Salum, G. A. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.02.09.940858 · Cited by 3
“There is mounting evidence showing that childhood adversity is associated with high levels of general psychopathology, both cross-sectionally and prospectively (Green et al., 2010; Dunn et al., 2017; McLaughlin et al., 2012).”
BackgroundSelf-citationChild Abuse Subtypes and Automatic Emotion Regulation Processes in Children and AdolescentsPreprint
Kim, S. G., Weissman, D. G., Sheridan, M. A., & McLaughlin, K. A. (2021) · doi:10.31234/osf.io/r2yj8 · Cited by 2
Self-citationSmith, B. J., Lussier, A. A., Cerutti, J., Simpkin, A. J., Smith, A. D. A. C., Suderman, M. J., Walton, E., Schaid, D. J., & Dunn, E. C. (2021) · medRxiv · doi:10.1101/2021.06.28.21259426 · Cited by 3
“If the associations between childhood adversities and later depression are causal, childhood adversity could explain up to one-third of all psychiatric disorders (5).”
Xiao, X., Hammond, C. J., Salmeron, B. J., Wang, D., Gu, H., Zhai, T., Murray, L., Quam, A., Hill, J., Nguyen, H., et al. (2024) · medRxiv · doi:10.1101/2024.06.13.24308906 · Cited by 3
“2,7,8 The neurobiological mechanisms through which childhood adversity contributes to risk for psychopathology (and conversely resiliency against this risk) are areas of intense research.”
BackgroundA Novel Diathesis-Stress Model of Comorbid Early Onset Psychiatric DisordersPreprint
Caswell, C. B., Hosseini‐Kamkar, N., Cox, S. M. L., Prada, N. P., Iqbal, M., Nikolic, M., Banaschewski, T., Barker, G. J., Bokde, A. L. W., Brühl, R., et al. (2025) · medRxiv · doi:10.1101/2025.04.08.25325481 · Cited by 4
Kovacs-Balint, Z., Gopakumar, A., Kyle, M., Godfrey, J., Bailey, K., Jonesteller, T., Gray, A., Shabbir, K., Wang, A., Acevedo, J., et al. (2025) · bioRxiv · doi:10.1101/2025.07.30.667163 · Cited by 2
“Early life adversity/stress (ELA/ELS) is a risk factor for physical and mental illness throughout the lifespan (Green et al., 2010; McLaughlin et al., 2012) and has become a critical target of public health initiatives.”
Tomlinson, C. A., McDonald, S. E., Brown, S. M., & Shin, S. H. (2023) · Children and Youth Services Review · doi:10.1016/j.childyouth.2023.107242 · Cited by 2
Kang, Y., Li, Q., Liu, W., Hu, Y., Liu, Z., Xie, S., Ma, C., Zhang, L., Zhang, X., Hu, Z., et al. (2024) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-024-02548-x · Cited by 3
Basic Affective Systems and Sex Differences in the Relationship between Anger and Fear
Manfredi, P. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21101266 · Cited by 2
“Anger and fear have also been studied in cases of traumatic experiences, as follows: the development of fear-based psychopathological forms triggered by trauma exposure also leads to changes in anger, such as excessive trait anger, anger expression and anger control deficits [30,31].”
Background
Metadata
- Authors
- McLaughlin, K. A., Greif Green, J., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C.
- Affiliations
- Boston Children's Hospital (US)
- Boston University (US)
- Corresponding author
- Kessler, Ronald C.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2012-11-01
- Volume
- 69
- Issue
- 11
- Pages
- 1151
- ISSN
- 0003-990X (ISSN-L)
- PMC
- PMC3490224
- OpenAlex
- W2001620133
- Cited by
- 992
- References
- 69
- Citations by year
- 2026: 86 · 2025: 106 · 2024: 102 · 2023: 93 · 2022: 105 · 2021: 90 · 2020: 82 · 2019: 68 · 2018: 65 · 2017: 63 · 2016: 45 · 2015: 39 · 2014: 29 · 2013: 15 · 2012: 2
- FWCI
- 30.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- SRA International
- Kaiser Permanente
- Janssen Scientific Affairs
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- National Institute of Mental Health (R13-MH-066849, R01-MH66627, R01MH066627, R01‐MH070884, R01MH077883, K01MH085710, U01-MH-60220, K01MH092526, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (R01DA016558)
- Fogarty International Center (R03TW006481)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Sociology and Political Science › Child Welfare and Adoption
- Keywords
- childhood adversity, adolescents, subadditivity, parental loss, child abuse, economic adversity, behavior disorders, anxiety disorders, mood disorders, substance use disorders, population attributable risk
- MeSH terms
- Adolescent, Anxiety Disorders, Mental Disorders, Child, Child Behavior Disorders, Cross-Sectional Studies, Female, Health Surveys, Humans, Life Change Events, Male, Personality Assessment, Risk Factors, United States, Comorbidity, Multivariate Analysis, Odds Ratio, Age of Onset, Mood Disorders, Substance-Related Disorders
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