ACEs are not equal: Examining the relative impact of household dysfunction versus childhood maltreatment on mental health in adolescence

Abstract

RationaleAdverse Childhood Experiences (ACEs) have shown substantial effects on health across the lifespan. However, many studies on this topic discount the individual items as well as the distinction between household dysfunction and maltreatment experiences. Objective: The current study examined individual ACEs items as well as the relative contribution of the household dysfunction scale versus the childhood maltreatment scale for predicting mental health outcomes in adolescence. Lastly, we examined the utility of a cut-off score for ACEs in predicting mental health. MethodsData were from Time 4 of a longitudinal study of the effects of maltreatment on adolescent development (n = 352; Mean age = 18). Self reported ACEs were assessed via structured interview and mapped onto the original ACEs questionnaire (Kaiser-CDC). Mental health outcomes were symptoms of depression, anxiety, trauma, and externalizing behavior. ResultsMANCOVA showed few mean differences between those endorsing ‘yes’ versus ‘no’ for the household dysfunction items, with the exception of witnessing parental Intimate Partner Violence (IPV). Those who endorsed witnessign IPV reported more symptoms of depression, anxiety, and trauma. On the other hand, all of the maltreatment items were asscociated with significantly higher scores on at least three of the four outcomes for those endorsing versus not. Sexual abuse and physical abuse were associated with symptoms of depression, trauma, and externalizing behavior. Neglect was associated with depressive, trauma, and anxiety symptoms. Emotional abuse and emotional neglect were both associated with all four mental health outcomes. When household dysfunction and maltreatment sum scores were entered into the model together, maltreatment primarily accounted for mental health symptoms. Finally, our results did not indicate a meaningful cutoff for the number of ACEs needed to predict mental health outcomes. ConclusionsOur findings support the assessment of maltreatment events as more salient than household dysfunction in mental health treatment and caution health providers against only using the total ACEs score in clinical decision-making.