Latent classes of adverse childhood experiences and adult health and behavioural outcomes in Haiti’s Cité Soleil

Abstract

Exposure to adverse childhood experiences (ACEs) is associated with harmful biopsychosocial and behavioral outcomes in adulthood and with reduced community capacity. We investigated the prevalence of ACEs and differential risk of adverse adult outcomes based on latent class assignment in a resource- limited, high violence, and understudied setting of urban Haiti, i.e., Cité Soleil. 100% (N = 673; 41.4% men, 58.6% women, mean age 28.5) reported at minimum one ACE; 70% reported physical and emotional abuse as ACEs, and 47% reported experience of child sexual abuse (CSA). We identified 3 distinct latent classes and evaluated associations between class membership and correlates (e.g., experience of non-partner sexual violence as adults [NPSV], suicidal ideation [SI], substance use to manage stress). Family dysfunction (domestic violence, substance abuse, mental illness, divorce, or incarceration of caregivers) existed across all three classes. Patterns of ACEs reported by members of Class 2 support their identification as a distinct class that is at greatest risk for adverse adult outcomes. Specifically, the increased odds of exposure to CSA distinguished members of Class 2 from Classes 1 and 3. Members of Class 2 also had increased odds of substance use, SI, fear of going outside, NPSV experience, and hypervigilance. Class 2 members further showed reduced odds of education, access to health care, and being men survivors of NPSV. The prevalence of ACEs in this sample is unprecedented. Haiti needs ACE prevention and compassionate trauma-informed care at the population level.