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



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.


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.


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.


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.


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.


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



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.


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© 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

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