CoChat
Sign Up
Cited by 266Child Abuse and TraumaChild Welfare and AdoptionChild and Adolescent Psychosocial and Emotional Development

Adverse Childhood Experiences and Adult Mental Health Outcomes

Open access
Daníelsdóttir, Hilda Björk, Aspelund, Thor, Shen, Qing, Halldorsdottir, Thorhildur, Jakobsdóttir, Jóhanna, Song, Huan, Lu, Donghao, Kuja-Halkola, Ralf +6 more·2024·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2024.0039PMC PMC10918580
Open this paper in CoChat — free accountOpen PDF

Abstract

Importance: Exposure to adverse childhood experiences (ACEs) has consistently been associated with multiple negative mental health outcomes extending into adulthood. However, given that ACEs and psychiatric disorders cluster within families, it remains to be comprehensively assessed to what extent familial confounding contributes to associations between ACEs and clinically confirmed adult psychiatric disorders. Objective: To investigate whether associations between ACEs and adult mental health outcomes remain after adjusting for familial (genetic and environmental) confounding. Design, Setting, and Participants: This Swedish twin cohort study used a discordant twin pair design based on monozygotic (MZ) and dizygotic (DZ) twins. A total of 25 252 adult twins (aged 18-47 years) from the Swedish Twin Registry born between 1959 and 1998 were followed up from age 19 years until 2016, with a maximum follow-up time of 39 years. Data were analyzed from April 2022 to November 2023. Exposures: A total of 7 ACEs, including family violence, emotional abuse or neglect, physical neglect, physical abuse, sexual abuse, rape, and hate crime, were assessed with items from the Life Stressor Checklist-Revised in a web-based survey. Main Outcomes and Measures: Adult (ages >18 years) clinical diagnosis of psychiatric disorders (ie, depressive, anxiety, alcohol or drug misuse, or stress-related disorders) were obtained from the Swedish National Patient Register. Results: Of 25 252 twins included in the study (15 038 female [59.6%]; mean [SD] age at ACE assessment, 29.9 [8.7] years), 9751 individuals (38.6%) reported exposure to at least 1 ACE. A greater number of ACEs was associated with increased odds of any psychiatric disorder in the full cohort (odds ratio [OR] per additional ACE, 1.52; 95% CI, 1.48-1.57). The association remained but ORs per additional ACE were attenuated in DZ (1.29; 95% CI, 1.14-1.47) and MZ (1.20; 95% CI, 1.02-1.40) twin pairs. Individuals who were exposed to sexual abuse compared with those who were not exposed had increased odds of any clinically confirmed psychiatric disorder in all comparisons: full cohort (OR, 3.09; 95% CI, 2.68-3.56), DZ twin pairs (OR, 2.10; 95% CI, 1.33-3.32), and MZ twin pairs (1.80; 95% CI, 1.04-3.11). Conclusions and relevance: This study found that associations between ACEs and adult mental health outcomes remained after controlling for shared genetic and environmental factors, which was particularly evident after multiple ACEs or sexual abuse. These findings suggest that targeted interventions may be associated with reduced risks of future psychopathology.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2024.0039

Cites

15 of 15 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 43

  1. [1]Stoltenborgh M, Bakermans-Kranenburg MJ, Alink LRA, van Ijzendoorn MH. The prevalence of child maltreatment across the globe: review of a series of meta-analyses. Child Abuse Rev. 2015; 24: 37- 50. doi: 10.1002/car.2353 · DOI · Paper page
  2. [2]Moody G, Cannings-John R, Hood K, Kemp A, Robling M. Establishing the international prevalence of self-reported child maltreatment: a systematic review by maltreatment type and gender. BMC Public Health. 2018; 18(1): 1164. doi: 10.1186/s12889-018-6044-y 30305071 PMC6180456 · DOI
  3. [3]Merrick MT, Ford DC, Ports KA, Guinn AS. Prevalence of adverse childhood experiences from the 2011-2014 Behavioral Risk Factor Surveillance System in 23 states. JAMA Pediatr. 2018; 172(11): 1038- 1044. doi: 10.1001/jamapediatrics.2018.2537 30242348 PMC6248156 · DOI · Paper page
  4. [4]Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009; 373(9657): 68- 81. doi: 10.1016/S0140-6736(08)61706-7 19056114 · DOI · Paper page
  5. [5]Degli Esposti M, Humphreys DK, Jenkins BM,. Long-term trends in child maltreatment in England and Wales, 1858-2016: an observational, time-series analysis. Lancet Public Health. 2019; 4(3): e148- e158. doi: 10.1016/S2468-2667(19)30002-7 30851868 · DOI
  6. [8]Bellis MA, Hughes K, Leckenby N, Hardcastle KA, Perkins C, Lowey H. Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey. J Public Health (Oxf). 2015; 37(3): 445- 454. doi: 10.1093/pubmed/fdu065 25174044 PMC4552010 · DOI · Paper page
  7. [10]Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: a systematic review and meta-analysis. Child Abuse Negl. 2019; 97: 104127. doi: 10.1016/j.chiabu.2019.104127 31454589 · DOI
  8. [12]McLaughlin KA, Koenen KC, Bromet EJ,. Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys. Br J Psychiatry. 2017; 211(5): 280- 288. doi: 10.1192/bjp.bp.116.197640 28935660 PMC5663970 · DOI
  9. [14]Chapman DP, Whitfield CL, Felitti VJ, Dube SR, Edwards VJ, Anda RF. Adverse childhood experiences and the risk of depressive disorders in adulthood. J Affect Disord. 2004; 82(2): 217- 225. doi: 10.1016/j.jad.2003.12.013 15488250 · DOI · Paper page
  10. [15]Mandelli L, Petrelli C, Serretti A. The role of specific early trauma in adult depression: a meta-analysis of published literature: childhood trauma and adult depression. Eur Psychiatry. 2015; 30(6): 665- 680. doi: 10.1016/j.eurpsy.2015.04.007 26078093 · DOI · Paper page
  11. [16]Li M, D’Arcy C, Meng X. Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions. Psychol Med. 2016; 46(4): 717- 730. doi: 10.1017/S0033291715002743 26708271 · DOI · Paper page
  12. [20]Moog NK, Cummings PD, Jackson KL,; ECHO collaborators. Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study. Lancet Public Health. 2023; 8(3): e226- e237. doi: 10.1016/S2468-2667(23)00025-7 36841563 PMC9982823 · DOI
  13. [23]Pezzoli P, Antfolk J, Hatoum AS, Santtila P. Genetic vulnerability to experiencing child maltreatment. Front Genet. 2019; 10: 852. doi: 10.3389/fgene.2019.00852 31608106 PMC6758596 · DOI
  14. [24]Fisher HL, Caspi A, Moffitt TE,. Measuring adolescents’ exposure to victimization: The Environmental Risk (E-Risk) Longitudinal Twin Study. Dev Psychopathol. 2015; 27(4 Pt 2): 1399- 1416. doi: 10.1017/S0954579415000838 26535933 PMC4778729 · DOI · Paper page
  15. [25]Pittner K, Bakermans-Kranenburg MJ, Alink LRA,. Estimating the heritability of experiencing child maltreatment in an extended family design. Child Maltreat. 2020; 25(3): 289- 299. doi: 10.1177/1077559519888587 31773993 PMC7370654 · DOI
  16. [26]Baldwin JR, Sallis HM, Schoeler T,. A genetically informed registered report on adverse childhood experiences and mental health. Nat Hum Behav. 2023; 7(2): 269- 290. doi: 10.1038/s41562-022-01482-9 36482079 PMC7614239 · DOI
  17. [27]Wang D, Jiang Q, Yang Z, Choi JK. The longitudinal influences of adverse childhood experiences and positive childhood experiences at family, school, and neighborhood on adolescent depression and anxiety. J Affect Disord. 2021; 292: 542- 551. doi: 10.1016/j.jad.2021.05.108 34147966 · DOI
  18. [28]Vitaro F, Brendgen M, Arseneault L. The discordant MZ-twin method: one step closer to the holy grail of causality. Int J Behav Dev. 2009; 33(4): 376- 382. doi: 10.1177/0165025409340805 · DOI
  19. [30]Magnusson Å, Lundholm C, Göransson M, Copeland W, Heilig M, Pedersen NL. Familial influence and childhood trauma in female alcoholism. Psychol Med. 2012; 42(2): 381- 389. doi: 10.1017/S0033291711001310 21798111 PMC3648622 · DOI · Paper page
  20. [31]Young-Wolff KC, Kendler KS, Ericson ML, Prescott CA. Accounting for the association between childhood maltreatment and alcohol-use disorders in males: a twin study. Psychol Med. 2011; 41(1): 59- 70. doi: 10.1017/S0033291710000425 20346194 PMC3010204 · DOI
  21. [32]Capusan AJ, Kuja-Halkola R, Bendtsen P,. Childhood maltreatment and attention deficit hyperactivity disorder symptoms in adults: a large twin study. Psychol Med. 2016; 46(12): 2637- 2646. doi: 10.1017/S0033291716001021 27376862 · DOI
  22. [34]Kendler KS, Bulik CM, Silberg J, Hettema JM, Myers J, Prescott CA. Childhood sexual abuse and adult psychiatric and substance use disorders in women: an epidemiological and cotwin control analysis. Arch Gen Psychiatry. 2000; 57(10): 953- 959. doi: 10.1001/archpsyc.57.10.953 11015813 · DOI · Paper page
  23. [35]Nelson EC, Heath AC, Madden PA,. Association between self-reported childhood sexual abuse and adverse psychosocial outcomes: results from a twin study. Arch Gen Psychiatry. 2002; 59(2): 139- 145. doi: 10.1001/archpsyc.59.2.139 11825135 · DOI
  24. [36]Bornovalova MA, Huibregtse BM, Hicks BM, Keyes M, McGue M, Iacono W. Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: a longitudinal discordant twin design. J Abnorm Psychol. 2013; 122(1): 180- 194. doi: 10.1037/a0028328 22686871 PMC3482426 · DOI
  25. [37]Furberg H, Lichtenstein P, Pedersen NL,. The STAGE cohort: a prospective study of tobacco use among Swedish twins. Nicotine Tob Res. 2008; 10(12): 1727- 1735. doi: 10.1080/14622200802443551 18988069 PMC2914543 · DOI
  26. [38]Lichtenstein P, Sullivan PF, Cnattingius S,. The Swedish Twin Registry in the third millennium: an update. Twin Res Hum Genet. 2006; 9(6): 875- 882. doi: 10.1375/twin.9.6.875 17254424 · DOI
  27. [39]Zagai U, Lichtenstein P, Pedersen NL, Magnusson PKE. The Swedish Twin Registry: content and management as a research infrastructure. Twin Res Hum Genet. 2019; 22(6): 672- 680. doi: 10.1017/thg.2019.99 31747977 · DOI
  28. [40]Anckarsäter H, Lundström S, Kollberg L,. The child and adolescent twin study in Sweden (CATSS). Twin Res Hum Genet. 2011; 14(6): 495- 508. doi: 10.1375/twin.14.6.495 22506305 · DOI · Paper page
  29. [41]Wolfe J, Kimerling R. Gender issues in the assessment of posttraumatic stress disorder. In: Wilson JP, Keane TM, eds. Assessing Psychological Trauma and PTSD. The Guilford Press; 1997: 192- 238. Accessed January 31, 2024. https://psycnet.apa.org/record/1997-97162-007
  30. [42]McHugo GJ, Caspi Y, Kammerer N,. The assessment of trauma history in women with co-occurring substance abuse and mental disorders and a history of interpersonal violence. J Behav Health Serv Res. 2005; 32(2): 113- 127. doi: 10.1007/BF02287261 15834262 · DOI
  31. [43]Ludvigsson JF, Andersson E, Ekbom A,. External review and validation of the Swedish National Inpatient Register. BMC Public Health. 2011; 11: 450. doi: 10.1186/1471-2458-11-450 21658213 PMC3142234 · DOI · Paper page
  32. [44]Carpenter JS, Andrykowski MA, Wilson J,. Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale. Issues Ment Health Nurs. 1998; 19(5): 481- 494. doi: 10.1080/016128498248917 9782864 · DOI
  33. [45]Neale MC, Hunter MD, Pritikin JN,. OpenMx 2.0: extended structural equation and statistical modeling. Psychometrika. 2016; 81(2): 535- 549. doi: 10.1007/s11336-014-9435-8 25622929 PMC4516707 · DOI
  34. [46]Zetterqvist J, Sjölander A. Doubly robust estimation with the R package drgee. Epidemiol Methods. 2015; 4(1): 69- 86. doi: 10.1515/em-2014-0021 · DOI
  35. [47]Wettermark B, Hammar N, Fored CM,. The new Swedish Prescribed Drug Register—opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf. 2007; 16(7): 726- 735. doi: 10.1002/pds.1294 16897791 · DOI
  36. [48]Copeland WE, Shanahan L, Hinesley J,. Association of childhood trauma exposure with adult psychiatric disorders and functional outcomes. JAMA Netw Open. 2018; 1(7): e184493. doi: 10.1001/jamanetworkopen.2018.4493 30646356 PMC6324370 · DOI · Paper page
  37. [50]Nelson EC, Heath AC, Lynskey MT,. Childhood sexual abuse and risks for licit and illicit drug-related outcomes: a twin study. Psychol Med. 2006; 36(10): 1473- 1483. doi: 10.1017/S0033291706008397 16854248 · DOI
  38. [51]Dinwiddie S, Heath AC, Dunne MP,. Early sexual abuse and lifetime psychopathology: a co-twin-control study. Psychol Med. 2000; 30(1): 41- 52. doi: 10.1017/S0033291799001373 10722174 · DOI
  39. [52]Dunn EC, Soare TW, Raffeld MR,. What life course theoretical models best explain the relationship between exposure to childhood adversity and psychopathology symptoms: recency, accumulation, or sensitive periods? Psychol Med. 2018; 48(15): 2562- 2572. doi: 10.1017/S0033291718000181 29478418 PMC6109629 · DOI · Paper page
  40. [53]Hardt J, Rutter M. Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry. 2004; 45(2): 260- 273. doi: 10.1111/j.1469-7610.2004.00218.x 14982240 · DOI · Paper page
  41. [54]Reuben A, Moffitt TE, Caspi A,. Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. J Child Psychol Psychiatry. 2016; 57(10): 1103- 1112. doi: 10.1111/jcpp.12621 27647050 PMC5234278 · DOI · Paper page
  42. [57]Durrant JE. Evaluating the success of Sweden’s corporal punishment ban. Child Abuse Negl. 1999; 23(5): 435- 448. doi: 10.1016/S0145-2134(99)00021-6 10348380 · DOI
  43. [58]Pettersson E, Larsson H, D’Onofrio BM, Lichtenstein P. Associations between general and specific psychopathology factors and 10-year clinically relevant outcomes in adult Swedish twins and siblings. JAMA Psychiatry. 2023; 80(7): 728- 737. doi: 10.1001/jamapsychiatry.2023.1162 37163290 PMC10173102 · DOI

Cited by

Sorted by citations

Authors
Daníelsdóttir, H. B., Aspelund, T., Shen, Q., Halldorsdottir, T., Jakobsdóttir, J., Song, H., Lu, D., Kuja-Halkola, R., Larsson, H., Fall, K., Magnusson, P. K. E., Fang, F., Bergstedt, J., & Valdimarsdóttir, U. A.
Affiliations
  • University of Iceland (IS)
  • Tongji University (CN)
  • Reykjavík University (IS)
  • Karolinska Institutet (SE)
  • Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  • Örebro University (SE)
  • Harvard University (US)
Corresponding author
Daníelsdóttir, Hilda Björk
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2024-06-01
Volume
81
Issue
6
Pages
586
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2024.0039
PMC
PMC10918580
OpenAlex
W4392505481
Cited by
266
References
15
Citations by year
2026: 118 · 2025: 110 · 2024: 38
FWCI
133.34
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • Vetenskapsrådet
  • H2020 European Research Council (726413)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
  • Social Sciences › Safety Research › Child Welfare and Adoption
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
adverse childhood experiences, adult psychiatric disorders, familial confounding, monozygotic twins, dizygotic twins, discordant twins, sexual abuse, domestic violence, physical abuse, physical neglect, hate crimes, depression, anxiety, alcohol abuse, drug abuse, stress-related disorders, heritability
MeSH terms
Adverse Childhood Experiences, Adolescent, Adult, Mental Disorders, Female, Humans, Male, Mental Health, Middle Aged, Registries, Sweden, Twins, Dizygotic, Twins, Monozygotic, Cohort Studies, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review