Sex Differences in the Associations of Specific Adverse Childhood Experiences (ACEs) with Comorbid Psychiatric Disorders

Abstract

Using nationally representative data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we examined associations of specific Adverse Childhood Experiences (ACEs) on the comorbid combinations of Depression (DEP), Anxiety (ANX) and Post-Traumatic Stress Disorder (PTSD). The measures of ACEs were derived from the CDC-Kaiser ACE Study. Unlike prior research focusing on the number of ACEs, we hypothesize that there are specific types of ACEs strongly associated with psychiatric comorbidity (i.e., high-risk ACEs) and that these associations differ by sex. The results demonstrated that emotional, physical, and sexual abuse was strongly associated with all combinations of these three disorders. Mental illness in household was also strongly associated with DEP+ANX as well as DEP+PTSD but not DEP+ANX+PTSD. Among females, the odds ratios for the combination of DEP+ANX given 1 or 2 or more high-risk ACEs were 2.07 (95% CI: 1.50-2.85, p<0.0001) and 4.17 (95% CI: 2.90-6.01, p<0.0001); the odds ratios for the combination of DEP+PTSD given 1 or 2 or two or more high-risk ACEs were 2.53 (95% CI: 0.84-7.64, p=0.10) and 16.01 (95% CI: 5.41-47.39, p<0.0001); the odds ratios for the combination of DEP+ANX+PTSD given 1 or 2or more high-risk ACEs were 6.53 (95% CI: 3.22-13.22, p<0.0001) and 18.91 (9.20-38.88, p<0.0001). Similar graded relationships were not found among males. The results reveal that exposure to two or more of the specific high-risk ACEs in females increased their odds of DEP+PTSD by 16 and the odds of DEP+ANX+PTSD by 19 when compared to females with zero high-risk ACE exposure. These findings were not observed in males.