Association Between Adverse Childhood Experiences and Mental Health among Nurses: A Propensity Score Matching Analysis

Background Nursing is a highly stressful profession with elevated risks of mental health issues. Although occupational stress is a well-established driver of poor mental health in nurses, the added impact of adverse childhood experiences (ACEs) on nurses’ mental health remains unclear. This study aims to examine the association between ACEs and mental health by using propensity score matching (PSM). Methods We conducted a cross-sectional analysis of baseline data from the Nurses’ Mental Health Study (NMHS), a nationwide multicenter prospective cohort study covers 67 tertiary hospitals across China’s 31 provincial-level regions. The Childhood Trauma Questionnaire (CTQ) was used to assess ACEs exposure. Outcomes included depressive symptoms (PHQ-9), anxiety (GAD-7), perceived stress (PSS-4), obsessive symptoms (SCL-90) and loneliness. We employed 1:1 nearest-neighbor propensity score matching with a caliper width of 0.02 to reduce selection bias, and regression analysis was applied to strengthen the robustness of the results. Results A total of 121,017 nurses participated, with 93.4% female and 68.2% married. ACEs were reported by 49.5%. After propensity score matching adjustment, nurses with ACEs exhibited substantially higher prevalence of loneliness (27.2% vs 15.7%, p  < 0.001), more severe anxiety symptoms (GAD-7 scores: 11.03 ± 3.89 vs 9.74 ± 3.32, p  < 0.001), depressive symptoms (PHQ-9 scores: 15.03 ± 4.53 vs 13.43 ± 3.92, p  < 0.001), and obsessive symptoms (SCL-90 scores: 8.85 ± 3.57 vs 7.85 ± 3.09, p  < 0.001) compared to counterparts, but paradoxically showing lower levels of perceived stress (PSS-4 scores: 11.44 ± 2.38 vs 11.77 ± 1.78, p  < 0.001). Regression analyses confirmed that ACEs emerged as a strong independent predictor of mental health. Conclusions This study provides robust evidence that ACEs are strongly associated with poorer mental health among Chinese nurses, but the perceived stress is the opposite. The findings highlight the impact of ACEs on nurses’ psychological well-being and contribute to developing targeted interventions to reduce ACE-related psychological risks. Trial registration Registry Chinese Clinical Trail Registry, Registration Number ChiCTR2300072142, Registration date 5th June 2023.