Adverse Childhood Experiences: Prevalence and Association With Adolescent Health in Malawi

Abstract

Introduction: Childhood adversity is robustly associated with poor health across the life course. However, very few studies have examined the prevalence and implications of adverse childhood experiences (ACEs) in low-and middle-income countries. The objective of this study is to measure ACEs among adolescents in Malawi and examine the association with mental and physical health outcomes. Methods:From 2017 to 2018, baseline data were collected among adolescents aged 10-16 years (N=2,089). Respondents were interviewed in their local language at their homes. Respondents completed questions on childhood adversity (ACE-International Questionnaire), self-rated health, mortality expectations, and mental health (Beck Depression Inventory and Post-traumatic Stress Disorder Scale). Stunting, obesity, and grip strength were measured. Analyses were conducted in 2018. Frequencies described the prevalence of ACEs and adjusted multivariate models examined whether cumulative adversity predicts current health.Results: Adolescents reported a high burden of adversity (i.e., five lifetime ACEs on average). Adolescents who scored in the top ACEs quintile were more likely to report depression (OR=3.11, 95% CI=2.10, 4.60), post-traumatic stress disorder (OR=4.19, 95% CI=2.43, 7.23), worse selfrated health (OR=3.72, 95% CI=2.03, 6.81), and a higher expected likelihood of dying in the next 5 years (RR=5.02, 95% CI=2.15, 7.88) compared with those in the bottom quintile. However, ACEs did not demonstrate a graded relationship with obesity, stunting, or grip strength.

Adverse childhood experiences, adult depression, and suicidal ideation in rural Uganda: A cross-sectional, population-based study

“…Significant associations were present for all 9 types of ACEs and depression, and between 2 of the ACEs and suicidal ideation. While previous research from sub-Saharan Africa has shown associations between ACEs and depression among adolescents and young adults [30][31][32][33][34][35][36][37], our findings demonstrate that the associations are consistent across all age ranges within a general population of adults. Moreover, our study extends prior work by assessing major depressive disorder and suicidal ideation in addition to using a standardized depression screening instrument.…”

“…Two studies of children and adolescents in Uganda found that depression was associated with loss of a parent and alcohol consumption [34] and domestic violence [35]. These and other studies have indicated a high prevalence of ACEs and associations with depression and suicidality among children, adolescents, and young adults in sub-Saharan Africa [31,32,36,37]. To address the gap in the literature on ACEs and mental health among adults, we aimed to estimate the associations between ACEs and depression symptom severity, major depressive disorder, and suicidal ideation in a population-based sample of adults in rural Uganda.…”

“…While research studies from sub-Saharan Africa indicate a high prevalence of childhood adversity [29][30][31][32], research on the associations between ACEs and adult depression and suicidal ideation in these settings is limited. A study from South Africa found that emotional neglect and sexual abuse before age 18 were both associated with suicidality, problematic substance use, and depression 2 years after initial measurement among adolescents and young adults aged 15 to 26 [30].…”

The association between adverse childhood experiences and childhood obesity: A systematic review

“…After removal of duplicates, 6,966 studies were screened in Rayyan with 6,801 excluded at the title/abstract level and 143 excluded at the full‐text level due to not examining the association between ACEs and obesity ( n = 102), sample population not children ( n = 36), or not being peer reviewed ( n = 5). Twenty‐four studies remained for inclusion, including 12 cross sectional 45–55 and 12 longitudinal 20,22,56–65 …”

“…Regarding selection of the cohort, most studies 15,16,20,22,45–48,51,52,56,58–60,62–66 included individuals who were representative or somewhat representative of the population of interest (defined as youth who are at risk for or have experienced ACEs). Fewer studies 22,49–51,54,57,59,64,65 used verifiable records or structured interviews to assess ACE exposure, with most relying on retrospective youth or parent report via survey 15,16,20,45–48,52,53,56,58,60–63,66 . Most longitudinal studies assessed the outcome (obesity) at baseline 22,57–65 .…”