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Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys
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Background: Although significant associations of childhood adversities with adult mental disorders are widely documented, most studies focus on single childhood adversities predicting single disorders. Aims: To examine joint associations of 12 childhood adversities with first onset of 20 DSM–IV disorders in World Mental Health (WMH) Surveys in 21 countries. Method: Nationally or regionally representative surveys of 51 945 adults assessed childhood adversities and lifetime DSM–IV disorders with the WHO Composite International Diagnostic Interview (CIDI). Results: Childhood adversities were highly prevalent and interrelated. Childhood adversities associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect) were the strongest predictors of disorders. Co-occurring childhood adversities associated with maladaptive family functioning had significant subadditive predictive associations and little specificity across disorders. Childhood adversities account for 29.8% of all disorders across countries. Conclusions: Childhood adversities have strong associations with all classes of disorders at all life-course stages in all groups of WMH countries. Long-term associations imply the existence of as-yet undetermined mediators.
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“Thus, work to address a single ACE in children exposed to many might have little effect, 51 with treatment and prevention of many health conditions requiring multiple underlying ACEs to be addressed.”
From The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. (2017) · cites this paper as [51]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“The World Mental Health Surveys across 21 countries found little variation in ACE prevalence between country income groups, with 38-39% of participants reporting at least one ACE and the prevalence of at least four ACEs being 2-3%. 51”
From The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. (2017) · cites this paper as [51]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Exposure to potentially traumatic experiences in childhood is common, with a majority of adolescents having experienced at least one potentially traumatic event [1–3].”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [3]
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“Much research associates CT with adverse physical and mental health outcomes (1,2)”
From Impact of Childhood Trauma on Executive Function in Adolescence—Mediating Functional Brain Networks and Prediction of High-Risk Drinking (2020) · cites this paper as [2]
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“Childhood adversity plays a causal role in most mental health problems in childhood (e.g., conduct disorder, ADHD and oppositional defiant disorder) and in adulthood (e.g., depression, anxiety disorders, eating disorders, sexual dysfunction, personality disorder, dissociative disorder, post-traumatic stress disorder and substance misuse) [1,2] .”
From The traumagenic neurodevelopmental model of psychosis revisited (2014) · cites this paper as [1]
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“although summing of ACEs is a recognised approach, 1,9,51,63 it does not account for potential variations in effects of different combinations of ACEs.”
From The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. (2017) · cites this paper as [51]
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“However, our criteria also meant that studies were excluded because of alternative data analysis methods (eg, analysis of the World Mental Health Surveys 51 ).”
From The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. (2017) · cites this paper as [51]
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In the citing paper
“over a quarter of SUDs in adulthood can be attributed to childhood adversity [3]”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [3]
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“Data from the World Mental Health Surveys indicate that eradication of childhood adversities would lead to a 31% reduction in anxiety disorders 191 .”
From The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management (2021) · cites this paper as [191]
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“It is also important to state that the relationship between childhood adversity or trauma and long-term negative outcomes is not specific to psychosis [1,2] .”
From The traumagenic neurodevelopmental model of psychosis revisited (2014) · cites this paper as [1]
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“and an even higher reduction when considering exclusively adolescence- (32.3%) and childhood-onset (38.2%) cases [28]”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [28]
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In the citing paper
“Childhood adversity is a well-examined risk factor for later psychopathology.”
From Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis (2017) · cites this paper as Kessler et al. 2010
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“The effect of childhood adversity on mental disorder onset persists across the life course, with elevated risk of first onset disorders observed in childhood, adolescence and adulthood (Kessler et al. 2010).”
From Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis (2017) · cites this paper as Kessler et al. 2010
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“People in contact with mental health services who have experienced childhood trauma have longer and more frequent hospital admissions, are prescribed more medication, and are more likely to self- harm and attempt suicide (Kessler et al., 2010 ;”
From A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings (2023) · cites this paper as Kessler et al., 2010
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In the citing paper
“People in contact with mental health services who have experienced childhood trauma have longer and more frequent hospital admissions, are prescribed more medication, and are more likely to self- harm and attempt suicide (Kessler et al., 2010 ;”
From A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings (2023) · cites this paper as Kessler et al., 2010
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“People in contact with mental health services who have experienced childhood trauma have longer and more frequent hospital admissions, are prescribed more medication, and are more likely to self- harm and attempt suicide (Kessler et al., 2010 ;”
From A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings (2023) · cites this paper as Kessler et al., 2010
Experimental — accuracy not yet measuredIn the citing paper
“Childhood adversity accounts for approximately 1/3 of all psychiatric disorders (Kessler et al., 2010) and contributes significantly to chronic physical conditions (Scott et al., 2011).”
From Developmental psychoneuroendocrine and psychoneuroimmune pathways from childhood adversity to disease (2017) · cites this paper as Kessler et al., 2010
In the citing paper
“We know from several large epidemiological studies that childhood adversity predicts lifelong mental and physical illness in a dose-response manner (Caspi et al., 2014; Chapman et al., 2007; Kessler et al., 2010; Vachon, Krueger, Rogosch, & Cicchetti, 2015).”
From Developmental psychoneuroendocrine and psychoneuroimmune pathways from childhood adversity to disease (2017) · cites this paper as Kessler et al., 2010
In the citing paper
“although traumatic experiences during childhood are a well-known risk factor for various psychiatric disorders with convincing evidence from epidemiological studies suggesting a causal relation between childhood trauma and various psychiatric disorders in adulthood 1”
From Resilience in mental health: linking psychological and neurobiological perspectives. (2013) · cites this paper as [1]
In the citing paper
“It is well-established that stressful life events and childhood adversity are substantial risk factors for future psychopathology [21].”
From Positive and Negative Emotion Regulation in Adolescence: Links to Anxiety and Depression (2019) · cites this paper as [21]
In the citing paper
“A large survey conducted by the World Health Organization (WHO) among 51,945 adults in 21 countries reported that eradication of childhood adversities, especially those associated with maladaptive family functioning (e.g. parental mental illness, child abuse, neglect), would lead to a 29.8% reduction of any mental disorder lifetime”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [28]
In the citing paper
“childhood adversities seem to impact negatively on a number of disorders [28]”
From Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care? (2020) · cites this paper as [28]
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 [13]
In the citing paper
“Childhood adversity is a major risk factor for multiple forms of psychopathology”
From Emotion regulation as mediator between childhood adversity and psychopathology: A meta-analysis (2022) · cites this paper as Kessler et al., 2010
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Metadata
- Authors
- Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., Aguilar-Gaxiola, S., Alhamzawi, A. O., Alonso, J., Angermeyer, M., Benjet, C., Bromet, E., Chatterji, S., de Girolamo, G., Demyttenaere, K., Fayyad, J., Florescu, S., Gal, G., Gureje, O., Haro, J. M., Hu, C.-Y., Karam, E. G., Kawakami, N., Lee, S., Lépine, J.-P., Ormel, J., Posada-Villa, J., Sagar, R., Tsang, A., Üstün, T. B., Vassilev, S., Viana, M. C., & Williams, D. R.
- Affiliations
- Harvard University (US)
- Boston University (US)
- Municipal Institute for Medical Research (ES)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- Stony Brook University (US)
- World Health Organization (CH)
- Universitair Ziekenhuis Leuven (BE)
- University of Balamand (LB)
- National School of Public Health, Management and Professional Development (RO)
- Sheba Medical Center (IL)
- University College Hospital, Ibadan (NG)
- Parc Sanitari Sant Joan de Déu (ES)
- The University of Tokyo (JP)
- Chinese University of Hong Kong (HK)
- Inserm (FR)
- University Medical Center Groningen (NL)
- All India Institute of Medical Sciences (IN)
- New Bulgarian University (BG)
- Corresponding author
- Kessler, Ronald C.
- ORCID
- Kessler, Ronald C.
- McLaughlin, Katie A.
- Green, Jennifer Greif
- Gruber, Michael J.
- Sampson, Nancy A.
- Zaslavsky, Alan M.
- Alonso, Jordi
- Benjet, Corina
- Bromet, Evelyn
- Chatterji, Somnath
- Demyttenaere, Koen
- Florescu, Silvia
- Gal, Gilad
- Gureje, Oye
- Haro, Josep Maria
- Karam, Elie G.
- Kawakami, Norito
- Ormel, Johan
- Sagar, Rajesh
- Williams, David R.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2010-11
- Volume
- 197
- Issue
- 5
- Pages
- 378-385
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC2966503
- OpenAlex
- W140219456
- Cited by
- 2,640
- References
- 55
- Citations by year
- 2026: 149 · 2025: 226 · 2024: 235 · 2023: 266 · 2022: 256 · 2021: 252 · 2020: 277 · 2019: 205 · 2018: 185 · 2017: 160 · 2016: 120 · 2015: 104 · 2014: 76 · 2013: 58 · 2012: 43
- FWCI
- 44.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Scientific Electronic Library Online (São Paulo Research Foundation, Latin American and Caribbean Center on Health Sciences Information, Conselho Nacional de Desenvolvimento Científico e Tecnológico) (publishedVersion)
- Lirias (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- GlaxoSmithKline
- Sanofi
- World Health Organization
- Kaiser Permanente
- European Commission (QLG5–1999-01042, SANCO2004123, 2004123)
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Generalitat de Catalunya (01042)
- Shire
- Jawaharlal Institute Of Postgraduate Medical Education and Research
- Regione Piemonte (00/0028)
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
- Pan American Health Organization
- Instituto de Salud Carlos III (CB06/02/0046, CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP, RETICS RD06/0011, RD06/0011, FIS 00/0028, CIBER CB06/02/0046)
- Departament de Salut, Generalitat de Catalunya
- National Institute of Mental Health (R13-MH-066849, R01‐MH070884, R01MH061905, R01MH059575, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (R01DA016558)
- Fogarty International Center (FIRCA R03TW006481, R03TW006481)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- childhood adversity, adult psychopathology, mental illness, child abuse, child neglect, parental mental illness, family functioning, comorbidities, subadditivity, life course, cross-national comparison
- MeSH terms
- Adolescent, Adult, Mental Disorders, Child, Child Abuse, Child, Preschool, Crime, Epidemiologic Methods, Family Health, Family Relations, Humans, Life Change Events, Socioeconomic Factors, World Health Organization, Causality, Child of Impaired Parents, Age of Onset, Adult Survivors of Child Abuse, Young Adult
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