Confirmatory factor analysis of adverse childhood experiences (ACEs) among a community-based sample of parents and adolescents

Abstract

Background: Despite increased understanding of Adverse Childhood Experiences (ACEs), very little advancement has been made in how ACEs are defined and conceptualized. The current objectives were to determine: 1) how well a theoretically-derived ACEs model fit the data, and 2) the association of all ACEs and the ACEs factors with poor self-rated mental and physical health. Methods: Data were obtained from the Well-Being and Experiences Study, survey data of adolescents aged 14 to 17 years (n = 1002) and their parents (n = 1000) in Manitoba, Canada collected from 2017 to 2018. Statistical methods included confirmatory factor analysis (CFA) and logistic regression models. Results: The study findings indicated a two-factor solution for both the adolescent and parent sample as follows: a) child maltreatment and peer victimization and b) household challenges factors, provided the best fit to the data. All original and expanded ACEs loaded on one of these two factors and all individual ACEs were associated with either poor self-rated mental health, physical health or both in unadjusted models and with the majority of findings remaining statistically significant in adjusted models (Adjusted Odds Ratios ranged from 1.16-3.25 among parents and 1.12-8.02 among adolescents). Additionally, both factors were associated with poor mental and physical health. Conclusions: Findings confirm a two-factor structure (i.e., 1) child maltreatment and peer victimization and 2) household challenges) and indicate that the ACEs list should include original ACEs (i.e., physical abuse, sexual abuse, emotional abuse, emotional neglect, physical neglect, exposure to intimate partner violence (IPV), household substance use, household mental health problems, parental separation or divorce, parental problems with police) and expanded ACEs (i.e., spanking, peer victimization, household gambling problems, foster care placement or child protective organization (CPO) contact, poverty, and neighborhood safety).

Secondary analysis of retrospective and prospective reports of adverse childhood experiences and mental health in young adulthood: Filtered through recent stressors

“…Table 4 shows the distribution of mental health outcomes for ACEs reported prospectively and retrospectively, categorized as ‘less than four’ or ‘four or more’. Given patterns in the literature associating adversity in childhood with poor mental health [ 12 , 13 ], it is expected that a greater proportion of respondents who report four or more ACEs will present with psychological distress. Using prospective reports of ACEs there appears to be little significance between reported ACEs and psychological distress (somatization, p = 0·465; anxiety, p = 0·263; social dysfunction, p = 0·522; depression, p = 0·050; GHQ total, p = 0·273).…”

“…For example, one study linked a cluster of ACEs related to abuse and neglect to higher severity bipolar disorder and schizophrenia, compared to a cluster of social support-related ACEs [12] . In another study on the clustering of individual ACEs, a child maltreatment and peer victimization group was associated with double the odds of self-rated poor physical health and three times the odds of self-rated poor mental health, compared to a household challenges grouping which was linked to an almost 3-fold chance of reporting poor physical health and six-times odds of reporting poor mental health [13] .…”

Protective Factors for Decreasing Nicotine, Alcohol, and Cannabis Use Among Adolescents with a History of Adverse Childhood Experiences (ACEs)

“…Adverse Childhood Experiences (ACEs) ACEs included adolescent experiences of emotional neglect, emotional abuse, exposure to verbal intimate partner violence (IPV), spanking, peer victimization, parental separation or divorce, parental trouble with police, parental gambling, foster care or child protective organization (CPO) contact, household substance use, household mental illness, household poverty, and living in an unsafe neighbourhood. ACEs were selected based on work from a previous study (Afifi, Salmon, et al, 2020a). We could not assess other important ACEs, including physical abuse, sexual abuse, or physical neglect (Felitti et al, 1998), due to requirements of the Health Research Ethics Board related to the Manitoba child welfare mandatory reporting laws.…”

Can the adverse childhood experiences (ACEs) checklist be utilized to predict emergency department visits among children and adolescents?

“…Hence, child and adolescent mental health programs should consider collecting more information about childhood exposure to adversities. A recent Canadian study has suggested that in addition to the ACE items, expanded ACEs such as household gambling problems, spanking, peer victimization, and neighborhood safety factor well with child maltreatment and household dysfunction and are associated with poor physical and mental health [ 56 ]. Collecting data on these emerging adversities through the health system and using them to predict health outcomes could also be the future direction.…”