Advertisement

Patterns of exposure to adverse childhood experiences and their associations with mental health: a survey of 1346 university students in East Asia

  • Grace W. K. HoEmail author
  • D. Bressington
  • T. Karatzias
  • W. T. Chien
  • S. Inoue
  • P. J. Yang
  • A. C. Y. Chan
  • P. Hyland
Original Paper

Abstract

Introduction

Adverse childhood experiences (ACEs) constitute a significant global mental health burden. Prior studies typically investigated the impact of ACEs on mental health using a cumulative risk approach; most ACEs studies were also conducted in Western settings.

Purpose

This study aimed to examine ACEs using a pattern-based approach and assess their associations with mental health outcomes by early adulthood in East Asia.

Methods

The present study included measures of exposure to 13 categories of ACEs, depression, anxiety, maladjustment, and posttraumatic stress in a sample of 1346 university students from Hong Kong, China, Taiwan, and Japan.

Results

Latent class analysis indicated three distinct patterns of ACE exposure: Class 1: Low ACEs (76.0%); Class 2: Household Violence (20.6%); and Class 3: Household Dysfunction (3.4%). Those representing Class 3 had significantly more ACEs compared with those in Classes 1 or 2. Controlling for age and sex, those in Class 2 reported significantly higher depression and maladjustment symptoms compared with those in Class 1; both Classes 2 and 3 had significantly higher anxiety symptoms and odds for meeting diagnostic criteria for posttraumatic stress disorders compared with those in Class 1.

Conclusions

Study findings suggest that young adults’ mental health, at least under certain contexts, is more closely linked with the nature and pattern of ACE co-occurrence, rather than the number of ACEs.

Keywords

Adverse childhood experiences East Asia Latent class analysis Mental health Young adults 

Notes

Acknowledgements

This study was supported by The Hong Kong Polytechnic University Internal Start-Up Fund.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 14(4):245–258CrossRefGoogle Scholar
  2. 2.
    Green JG, McLaughlin KA, Berglund PA, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC (2010) Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 67(2):113–123.  https://doi.org/10.1001/archgenpsychiatry.2009.186 CrossRefGoogle Scholar
  3. 3.
    Turner HA, Finkelhor D, Ormrod R (2006) The effect of lifetime victimization on the mental health of children and adolescents. Soc Sci Med 62(1):13–27.  https://doi.org/10.1016/j.socscimed.2005.05.030 CrossRefGoogle Scholar
  4. 4.
    Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Aguilar-Gaxiola S, Alhamzawi AO, Alonso J, Angermeyer M, Benjet C, Bromet E, Chatterji S, de Girolamo G, Demyttenaere K, Fayyad J, Florescu S, Gal G, Gureje O, Haro JM, Hu CY, Karam EG, Kawakami N, Lee S, Lepine JP, Ormel J, Posada-Villa J, Sagar R, Tsang A, Ustun TB, Vassilev S, Viana MC, Williams DR (2010) Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br J Psychiatry 197(5):378–385.  https://doi.org/10.1192/bjp.bp.110.080499 CrossRefGoogle Scholar
  5. 5.
    Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public health 2(8):e356–e366.  https://doi.org/10.1016/s2468-2667(17)30118-4 CrossRefGoogle Scholar
  6. 6.
    Cavanaugh CE, Petras H, Martins SS (2015) Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States. Soc Psychiatry Psychiatr Epidemiol 50(8):1257–1266.  https://doi.org/10.1007/s00127-015-1024-3 CrossRefGoogle Scholar
  7. 7.
    Shin SH, McDonald SE, Conley D (2018) Patterns of adverse childhood experiences and substance use among young adults: a latent class analysis. Addict Behav 78:187–192.  https://doi.org/10.1016/j.addbeh.2017.11.020 CrossRefGoogle Scholar
  8. 8.
    Roos LE, Afifi TO, Martin CG, Pietrzak RH, Tsai J, Sareen J (2016) Linking typologies of childhood adversity to adult incarceration: findings from a nationally representative sample. Am J Orthopsychiatry 86(5):584–593.  https://doi.org/10.1037/ort0000144 CrossRefGoogle Scholar
  9. 9.
    Ho GWK, Chan ACY, Chien W-T, Bressington DT, Karatzias T (2019) Examining patterns of adversity in Chinese young adults using the Adverse Childhood Experiences—International Questionnaire (ACE-IQ). Child Abuse Negl 88:179–188.  https://doi.org/10.1016/j.chiabu.2018.11.009 CrossRefGoogle Scholar
  10. 10.
    Bellis MA, Hughes K, Leckenby N, Jones L, Baban A, Kachaeva M, Povilaitis R, Pudule I, Qirjako G, Ulukol B, Raleva M, Terzic N (2014) Adverse childhood experiences and associations with health-harming behaviours in young adults: surveys in eight eastern European countries. Bull World Health Organ 92(9):641–655.  https://doi.org/10.2471/blt.13.129247 CrossRefGoogle Scholar
  11. 11.
    Marginson S (2011) Higher education in East Asia and Singapore: rise of the Confucian model. High Educ 61(5):587–611.  https://doi.org/10.1007/s10734-010-9384-9 CrossRefGoogle Scholar
  12. 12.
    Fujiwara T, Kawakami N (2011) Association of childhood adversities with the first onset of mental disorders in Japan: results from the World Mental Health Japan, 2002–2004. J Psychiatr Res 45(4):481–487.  https://doi.org/10.1016/j.jpsychires.2010.08.002 CrossRefGoogle Scholar
  13. 13.
    Kim YH (2017) Associations of adverse childhood experiences with depression and alcohol abuse among Korean college students. Child Abuse Negl 67:338–348.  https://doi.org/10.1016/j.chiabu.2017.03.009 CrossRefGoogle Scholar
  14. 14.
    Tran QA, Dunne MP, Vo TV, Luu NH (2015) Adverse childhood experiences and the health of university students in eight provinces of Vietnam. Asia Pac J Public Health 27(8 Suppl):26S–32S.  https://doi.org/10.1177/1010539515589812 CrossRefGoogle Scholar
  15. 15.
    Wei W (2013) Adverse childhood experience as a risk factor for adolescent pregnancy in China. Int J Child Adolesc Health 6(3):323Google Scholar
  16. 16.
    Li Y, Cao F, Cao D, Liu J (2015) Nursing students’ post-traumatic growth, emotional intelligence and psychological resilience. J Psychiatr Ment Health Nurs 22(5):326–332CrossRefGoogle Scholar
  17. 17.
    Chang X, Jiang X, Mkandarwire T, Shen M (2019) Associations between adverse childhood experiences and health outcomes in adults aged 18–59 years. PLoS one 14(2):e0211850.  https://doi.org/10.1371/journal.pone.0211850 CrossRefGoogle Scholar
  18. 18.
    Shwalb DW, Nakazawa J, Yamamoto T, Hyun J-H (2004) Fathering in Japanese, Chinese, and Korean cultures: a review of the research literature. In: Wiley John, Inc Sons (eds) The role of the father in child development, 4th edn. Hoboken, New York, pp 146–181Google Scholar
  19. 19.
    Douglas EM (2006) Familial violence socialization in childhood and later life approval of corporal punishment: a cross–cultural perspective. Am J Orthopsychiatry 76(1):23–30CrossRefGoogle Scholar
  20. 20.
    Ozaki R, Otis MD (2016) Gender equality, patriarchal cultural norms, and perpetration of intimate partner violence: comparison of male university students in Asian and European cultural contexts. Violence Against Women 23(9):1076–1099.  https://doi.org/10.1177/1077801216654575 CrossRefGoogle Scholar
  21. 21.
    Coleman DL, Dodge KA, Campbell SK (2010) Where and how to draw the line between reasonable corporal punishment and abuse. Law Contemp Probl 73(2):107–166Google Scholar
  22. 22.
    Ho GWK, Gross DA (2015) Differentiating physical discipline from abuse: Q findings from Chinese American mothers and pediatric nurses. Child Abuse Negl 43:83–94.  https://doi.org/10.1016/j.chiabu.2015.03.012 CrossRefGoogle Scholar
  23. 23.
    Barboza GE (2018) Latent classes and cumulative impacts of adverse childhood experiences. Child Maltreatment 23(2):111–125.  https://doi.org/10.1177/1077559517736628 CrossRefGoogle Scholar
  24. 24.
    McLafferty M, Armour C, McKenna A, O’Neill S, Murphy S, Bunting B (2015) Childhood adversity profiles and adult psychopathology in a representative Northern Ireland study. J Anxiety Disord 35:42–48.  https://doi.org/10.1016/j.janxdis.2015.07.004 CrossRefGoogle Scholar
  25. 25.
    Merians AN, Baker MR, Frazier P, Lust K (2019) Outcomes related to adverse childhood experiences in college students: comparing latent class analysis and cumulative risk. Child Abuse Negl 87:51–64.  https://doi.org/10.1016/j.chiabu.2018.07.020 CrossRefGoogle Scholar
  26. 26.
    Charak R, Koot HM (2015) Severity of maltreatment and personality pathology in adolescents of Jammu, India: a latent class approach. Child Abuse Negl 50:56–66.  https://doi.org/10.1016/j.chiabu.2015.05.010 CrossRefGoogle Scholar
  27. 27.
    Chng GS, Li D, Chu CM, Ong T, Lim F (2018) Family profiles of maltreated children in Singapore: a latent class analysis. Child Abuse Negl 79:465–475.  https://doi.org/10.1016/j.chiabu.2018.02.029 CrossRefGoogle Scholar
  28. 28.
    Yang FAN, Lou VWQ (2015) Childhood adversities, urbanisation and depressive symptoms among middle-aged and older adults: evidence from a national survey in China. Ageing Soc 36(5):1031–1051.  https://doi.org/10.1017/S0144686X15000239 CrossRefGoogle Scholar
  29. 29.
    World Health Organization (2016) Adverse childhood experiences international questionnaire (ACE-IQ). www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences
  30. 30.
    Choo W-Y, Dunne MP, Marret MJ, Fleming M, Wong Y-L (2011) Victimization experiences of adolescents in Malaysia. J Adolesc Health 49(6):627–634.  https://doi.org/10.1016/j.jadohealth.2011.04.020 CrossRefGoogle Scholar
  31. 31.
    Stoltenborgh M, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Alink LRA (2013) Cultural–geographical differences in the occurrence of child physical abuse? A meta-analysis of global prevalence. Int J Psychol 48(2):81–94.  https://doi.org/10.1080/00207594.2012.697165 CrossRefGoogle Scholar
  32. 32.
    Herringa RJ, Birn RM, Ruttle PL, Burghy CA, Stodola DE, Davidson RJ, Essex MJ (2013) Childhood maltreatment is associated with altered fear circuitry and increased internalizing symptoms by late adolescence. Proc Natl Acad Sci 110(47):19119–19124.  https://doi.org/10.1073/pnas.1310766110 CrossRefGoogle Scholar
  33. 33.
    Schilling EA, Aseltine RH Jr, Gore S (2007) Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC Public Health 7:30.  https://doi.org/10.1186/1471-2458-7-30 CrossRefGoogle Scholar
  34. 34.
    Schilling EA, Aseltine RH, Gore S (2008) The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations. Soc Sci Med 66(5):1140–1151.  https://doi.org/10.1016/j.socscimed.2007.11.023 CrossRefGoogle Scholar
  35. 35.
    Berzenski SR, Yates TM (2011) Classes and consequences of multiple maltreatment: a person-centered analysis. Child Maltreatment 16(4):250–261.  https://doi.org/10.1177/1077559511428353 CrossRefGoogle Scholar
  36. 36.
    Miller-Graff LE, Howell KH, Martinez-Torteya C, Hunter EC (2015) Typologies of childhood exposure to violence: associations with college student mental health. J Am Coll Health 63(8):539–549.  https://doi.org/10.1080/07448481.2015.1057145 CrossRefGoogle Scholar
  37. 37.
    Han M, Choi Y, Jung S (2015) Exploring the relationship between exposure to interparental violence and child physical abuse in childhood and the impacts on mental health problems in later young adulthood among South Korean college students. Int Soc Work 59(6):821–835.  https://doi.org/10.1177/0020872814562481 CrossRefGoogle Scholar
  38. 38.
    Shen AC-T (2009) Long-term effects of interparental violence and child physical maltreatment experiences on PTSD and behavior problems: a national survey of Taiwanese college students. Child Abuse Negl 33(3):148–160.  https://doi.org/10.1016/j.chiabu.2008.07.006 CrossRefGoogle Scholar
  39. 39.
    The Hong Kong Polytechnic University (2016) mySurvey (Version 1.1) [Software]. https://www.polyu.edu.hk/mysurvey/
  40. 40.
    Saunders JA, Morrow-Howell N, Spitznagel E, Doré P, Proctor EK, Pescarino R (2006) Imputing missing data: a comparison of methods for social work researchers. Soc Work Res 30(1):19–31CrossRefGoogle Scholar
  41. 41.
    World Health Organization (2017) Process of translation and adaptation of instruments. http://www.who.int/substance_abuse/research_tools/translation/en/
  42. 42.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370CrossRefGoogle Scholar
  43. 43.
    Chan YF, Leung DY, Fong DY, Leung CM, Lee AM (2010) Psychometric evaluation of the hospital anxiety and depression scale in a large community sample of adolescents in Hong Kong. Qual Life Res 19(6):865–873.  https://doi.org/10.1007/s11136-010-9645-1 CrossRefGoogle Scholar
  44. 44.
    Matsudaira T, Igarashi H, Kikuchi H, Kano R, Mitoma H, Ohuchi K, Kitamura T (2009) Factor structure of the Hospital Anxiety and Depression Scale in Japanese psychiatric outpatient and student populations. Health Qual Life Outcomes 7(1):42.  https://doi.org/10.1186/1477-7525-7-42 CrossRefGoogle Scholar
  45. 45.
    Glaesmer H, Romppel M, Brahler E, Hinz A, Maercker A (2015) Adjustment disorder as proposed for ICD-11: dimensionality and symptom differentiation. Psychiatry Res 229(3):940–948.  https://doi.org/10.1016/j.psychres.2015.07.010 CrossRefGoogle Scholar
  46. 46.
    Cloitre M, Shevlin M, Brewin CR, Bisson JI, Roberts NP, Maercker A, Karatzias T, Hyland P (2018) The International trauma questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatr Scand 138(6):536–546.  https://doi.org/10.1111/acps.12956 CrossRefGoogle Scholar
  47. 47.
    Ho GWK, Karatzias T, Cloitre M, Chan ACY, Bressington D, Chien WT, Hyland P, Shevlin M (2019) Translation and validation of the Chinese ICD-11 international trauma questionnaire (ITQ) for the assessment of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Eur J Psychotraumatol 10(1):1608718.  https://doi.org/10.1080/20008198.2019.1608718 CrossRefGoogle Scholar
  48. 48.
    StataCorp (2015) Stata statistical software: release 14. StataCorp LP, College StationGoogle Scholar
  49. 49.
    The Methodology Center (2015) LCA stata plugin (Version 1.2) [Software]. Penn State, University ParkGoogle Scholar
  50. 50.
    Akaike H (1987) Factor analysis and AIC. Psychometrika 52(3):317–332.  https://doi.org/10.1007/bf02294359 CrossRefGoogle Scholar
  51. 51.
    Schwarz G (1978) Estimating the dimension of a model. Ann Stat 6(2):461–464CrossRefGoogle Scholar
  52. 52.
    Sclove SL (1987) Application of model-selection criteria to some problems in multivariate analysis. Psychometrika 52(3):333–343.  https://doi.org/10.1007/bf02294360 CrossRefGoogle Scholar
  53. 53.
    Magidson J, Vermunt J (2002) Latent class models for clustering: a comparison with K-means. Can J Market Res 20(1):36–43Google Scholar
  54. 54.
    Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model 14(4):535–569CrossRefGoogle Scholar
  55. 55.
    Clark SL, Muthén B (2009) Relating latent class analysis results to variables not included in the analysis. Retrieved from https://www.statmodel.com/download/relatinglca.pdf
  56. 56.
    Chan KL (2011) Children exposed to child maltreatment and intimate partner violence: a study of co-occurrence among Hong Kong Chinese families. Child Abuse Negl 35(7):532–542.  https://doi.org/10.1016/j.chiabu.2011.03.008 CrossRefGoogle Scholar
  57. 57.
    Fulu E, Miedema S, Roselli T, McCook S, Chan KL, Haardörfer R, Jewkes R, Fulu E, Jewkes R, Warner X, Miedema S, Roselli T, Lang J, Naved RT, Huque H, Farah S, Shuvra MMR, Erken A, Xiangxian W, Gang F, Hongtao L, Mudrovcic Z, Hua W, Hoekman A, Nikulainen E, Coquelin B, Khan M, Kusuma W, Manero CM, Larsen F, Fulu E, Warner X, Moussavi S, de Mel N, Peiris P, Gomez S, Team SI, Jinadasa K, Jewkes R, Sikweyiya Y, Shai N, Drapuluvik-Tinabar F, Magoola P, Agyenta A, Shanahan T, Vienings T, Jewkes R, Garcia-Moreno C, Naved RT, Jinadasa K, Vienings T, Kusuma W, Jewkes R, Connell R, Barker G, Greig A, Roy R, Verma R, Sen KM, Johnson S (2017) Pathways between childhood trauma, intimate partner violence, and harsh parenting: findings from the UN Multi-country Study on Men and Violence in Asia and the Pacific. Lancet Glob Health 5(5):e512–e522.  https://doi.org/10.1016/S2214-109X(17)30103-1 CrossRefGoogle Scholar
  58. 58.
    Ji K, Finkelhor D (2015) A meta-analysis of child physical abuse prevalence in China. Child Abuse Negl 43:61–72.  https://doi.org/10.1016/j.chiabu.2014.11.011 CrossRefGoogle Scholar
  59. 59.
    Hovens JGFM, Wiersma JE, Giltay EJ, Van Oppen P, Spinhoven P, Penninx BWJH, Zitman FG (2010) Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Acta Psychiatr Scand 122(1):66–74.  https://doi.org/10.1111/j.1600-0447.2009.01491.x CrossRefGoogle Scholar
  60. 60.
    Spilsbury JC, Belliston L, Drotar D, Drinkard A, Kretschmar J, Creeden R, Flannery DJ, Friedman S (2007) Clinically significant trauma symptoms and behavioral problems in a community-based sample of children exposed to domestic violence. J Family Violence 22(6):487–499.  https://doi.org/10.1007/s10896-007-9113-z CrossRefGoogle Scholar
  61. 61.
    Grych JH, Jouriles EN, Swank PR, McDonald R, Norwood WD (2000) Patterns of adjustment among children of battered women. J Consult Clin Psychol 68(1):84CrossRefGoogle Scholar
  62. 62.
    Pynoos RS, Steinberg AM, Piacentini JC (1999) A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biol Psychiatry 46(11):1542–1554.  https://doi.org/10.1016/S0006-3223(99)00262-0 CrossRefGoogle Scholar
  63. 63.
    Naicker SN, Norris SA, Mabaso M, Richter LM (2017) An analysis of retrospective and repeat prospective reports of adverse childhood experiences from the South African Birth to Twenty Plus cohort. PLoS One 12(7):e0181522.  https://doi.org/10.1371/journal.pone.0181522 CrossRefGoogle Scholar
  64. 64.
    Reuben A, Moffitt TE, Caspi A, Belsky DW, Harrington H, Schroeder F, Hogan S, Ramrakha S, Poulton R, Danese A (2016) Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. J Child Psychol Psychiatry 57(10):1103–1112.  https://doi.org/10.1111/jcpp.12621 CrossRefGoogle Scholar
  65. 65.
    Purewal SK, Bucci M, Gutiérrez Wang L, Koita K, Silvério Marques S, Oh D, Burke Harris N (2016) Screening for adverse childhood experiences (ACEs) in an integrated pediatric care model. Zero Three 37(1):10–17Google Scholar
  66. 66.
    Finkelhor D (2018) Screening for adverse childhood experiences (ACEs): cautions and suggestions. Child Abuse Negl 85:174–179.  https://doi.org/10.1016/j.chiabu.2017.07.016 CrossRefGoogle Scholar
  67. 67.
    Lieberman AF, Chu A, Van Horn P, Harris WW (2011) Trauma in early childhood: empirical evidence and clinical implications. Dev Psychopathol 23(2):397–410.  https://doi.org/10.1017/s0954579411000137 CrossRefGoogle Scholar
  68. 68.
    Oshri A, Lucier-Greer M, O’Neal CW, Arnold AL, Mancini JA, Ford JL (2015) Adverse childhood experiences, family functioning, and resilience in military families: a pattern-based approach. Fam Relat 64(1):44–63.  https://doi.org/10.1111/fare.12108 CrossRefGoogle Scholar
  69. 69.
    Kim UE, Triandis HC, Kâğitçibaşi ÇE, Choi S-CE, Yoon GE (1994) Individualism and collectivism: theory, method, and applications. Sage Publications Inc, Thousand OaksGoogle Scholar
  70. 70.
    Leggett A (2017) Online civic engagement and the anti-domestic violence movement in china: shifting norms and influencing law. VOLUNTAS Int J Volunt Nonprofit Org 28(5):2251–2277.  https://doi.org/10.1007/s11266-016-9680-9 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of NursingThe Hong Kong Polytechnic UniversityHung HomHong Kong
  2. 2.School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
  3. 3.NHS Lothian, Rivers Centre for Traumatic StressEdinburghUK
  4. 4.The Nethersole School of NursingThe Chinese University of Hong KongSha TinHong Kong
  5. 5.Department of Nursing ScienceOkayama Prefectural UniversityOkayamaJapan
  6. 6.Graduate Institute of Social WorkNational Chengchi UniversityTaipei CityTaiwan
  7. 7.Department of PsychologyMaynooth UniversityMaynoothIreland

Personalised recommendations