A life-course approach to the relationship between adverse childhood events and later mental health in a longitudinal UK birth cohort

Adverse childhood events (ACEs) have been shown to be negatively correlated with children’s psychological development and various later mental health issues, including depression, anxiety, psychosis and suicidal ideation. However, the life-course trajectory of ACEs on common mental health outcomes in adulthood has not been explored in depth. We analysed longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) in the UK to determine the best-fitting life-course models between any ACEs and mental health outcomes (depression and anxiety) at ages 17 and 24 years, using a Structured Life Course Modelling Approach. Six ACEs representing abuse, violence and neglect were integrated into life-course hypotheses, including: three critical periods (at ages 0-5, 5-11 and 11-17), ACE accumulation, ever-experiencing ACEs and always-experiencing ACEs. Depression and anxiety outcomes met ICD-10 guidelines for diagnoses. Overall, ACEs during adolescence (11-17 years) had the strongest effect on depression and anxiety at age 24, with any ACEs at this time-point approximately doubling the odds of diagnoses. An effect of ACEs in middle childhood (5-11 years) on depression was also observed, although the effect size was much weaker (approx. 25% increase in the odds). Results at age 17 were broadly similar for depression, but differed for anxiety, with either the accumulation of ACEs, or sensitive periods in both in middle childhood and adolescence, having the strongest associations. Life-course trajectories for analyses of the individual ACEs were more inconsistent, potentially due to the relative rarity of these events and their correlation over time, resulting in a lack of statistical power. In sum, ACEs during adolescence may have the strongest effect on subsequent mental health at age 24, potentially followed by ACE effect during middle childhood. While these conclusions apply to the impact of any ACEs, the relationship between individual ACEs and later mental health is less clear. These results may help inform prevention strategies for improving mental health in late adolescence and young adulthood.