The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses

Abstract

Adverse childhood experiences (ACEs) are related to increased risk of common mental disorders. This umbrella review of systematic reviews and meta-analyses aimed to identify the key ACEs that are consistently associated with increased risk of mental disorders and suicidality. We searched PsycINFO, PubMed, and Google Scholar for systematic reviews and meta-analyses on the association between ACEs and common mental disorders or suicidality published from January 1, 2009 until July 11, 2019. The methodological quality of included reviews was evaluated using the AMSTAR2 checklist. The effect sizes reported in each meta-analysis were combined using a random-effects model. Meta-regressions were conducted to investigate whether associations vary by gender or age of exposure to ACEs. This review is registered with PROSPERO (CRD42019146431). We included 68 reviews with moderate (55%), low (28%) or critically low (17%) methodological quality. The median number of included studies in these reviews was 14 (2–277). Across identified reviews, 24 ACEs were associated with increased risk of common mental disorders or suicidality. ACEs were associated with a two-fold higher odds of anxiety disorders (pooled odds ratios (ORs): 1.94; 95% CI 1.82, 2.22), internalizing disorders (OR 1.76; 1.59, 1.87), depression (OR 2.01; 1.86, 2.32) and suicidality (OR 2.33; 2.11, 2.56). These associations did not significantly (P > 0.05) vary by gender or the age of exposure. ACEs are consistently associated with increased risk of common mental disorders and suicidality. Well-designed cohort studies to track the impact of ACEs, and trials of interventions to prevent them or reduce their impact should be global research priorities.

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The authors declare that the data supporting the findings of this study are available within the article and its supplementary information files.

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Acknowledgements

This study is funded by The National Health and Medical Research Council (NHMRC) and Beyond Blue co-funded Centre of Research Excellence in Childhood Adversity and Mental Health (#1153419). The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.

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NHMRC and Beyond Blue co-funded Centre of Research Excellence in Childhood Adversity and Mental Health (#1153419).

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BWS, NJR, WL, AJM, MBHY, AR, AJF contributed to the design of the review. BWS and WL did the search, screening, data extraction and quality assessment. BWS did the analyses and wrote the draft report. NJR, WL, AJM, MBHY, AR, AJF contributed to critically revising the consecutive drafts. All authors reviewed the study findings and approved the final version before submission.

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Correspondence to Berhe W. Sahle.

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Sahle, B.W., Reavley, N.J., Li, W. et al. The association between adverse childhood experiences and common mental disorders and suicidality: an umbrella review of systematic reviews and meta-analyses. Eur Child Adolesc Psychiatry (2021). https://doi.org/10.1007/s00787-021-01745-2

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Keywords

  • Adverse childhood experiences
  • Mental health
  • Suicide
  • Evidence synthesis
  • Umbrella review