Abstract
While there is evidence that histories of adverse childhood experiences (ACEs) are common in university students and are associated with an increased risk of mental health difficulties, current research has limited geographic and cross-cultural representation. Comparing ACEs across diverse contexts using a standardized measure can illuminate geographic and sociocultural similarities or differences in exposure. The present study aimed to assess ACE exposure and its relationship with mental health symptoms in university students from seven countries. We sampled 5945 university students from the United States, Canada, England, South Africa, Spain, Argentina, and Uruguay. Participants completed the Adverse Childhood Experiences International Questionnaire (ACE-IQ) and the Inventory of Depression and Anxiety Symptoms (IDAS). Most participants (94.8%) reported exposure to at least one type of ACE and 61% reported exposure to four or more types. Repeated exposure to at least one ACE was reported by 70.2% and repeated exposure to at least four ACEs was reported by 21.2%. Spanish students had significantly lower ACE exposure than other students. Cumulative ACE exposure was significantly higher among students in lower income countries, but when repeated exposure was considered these differences fell away. For the total sample, cumulative ACE exposure was significantly associated with severity of depression symptoms, anxiety symptoms, and suicidality. Findings indicate that universities globally should be guided by a trauma-informed approach that recognizes students as a psychologically vulnerable group carrying a long-standing burden of childhood adversity.
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Data and analytic outputs are available at DOI https://doi.org/10.17605/OSF.IO/UX8RK
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References
Alhowaymel, F. K., Kalamakis, K., & Jacelon, C. (2021). Developing the concept of adverse childhood experiences: A global perspective. Journal of Pediatric Nursing, 56, 18–23. https://doi.org/10.1016/j.pedn.2020.10.004
Auerbach, R. P., Mortier, P., Bruffaerts, R., Alonso, J., Benjet, C., Cuijpers, P., Demyttenaere, K., Ebert, D. D., Green, J. G., Hasking, P., Murray, E., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Stein, D. J., Vilagut, G., Zaslavsky, A. M., Kessler, R. C.; WHO WMH-ICS Collaborators. (2018). WHO world mental health surveys international college student project: Prevalence and distribution of mental disorders. Journal of Abnormal Psychology, 127(7), 623–638. https://doi.org/10.1037/abn0000362.
Bravo, A. J., Prince, M. A., Pilatti, A., Mezquita, L., Keough, M. T., Hogarth, L., & Cross-Cultural Addictions Study Team. (2021). Young adult concurrent use and simultaneous use of alcohol and marijuana: A cross-national examination among college students in seven countries. Addictive Behaviors Reports, 14, 100373. https://doi.org/10.1016/j.abrep.2021.100373
Bravo, A. J., Villarosa-Hurlocker, M. C., Pearson, M. R., & Protective Strategies Study Team. (2018). College student mental health: An evaluation of the DSM–5 self-rated level 1 cross-cutting symptom measure. Psychological Assessment, 30(10), 1382–1389. https://doi.org/10.1037/pas0000628
Bringiotti, M. I., & Raffo, P. E. (2010). Abuso sexual infanto-juvenil. Prevalencia y caracteristicas de estudiantes Universitarios de la Ciudad de Buenos Aires. Revista de Derecho de Familia, 46, 293–305.
Brown, T. A. (2015). Confirmatory factor analysis for applied research (2nd ed.). Guilford Press.
Burlaka, V., Hong, J. S., Churakova, I., Surdiak, O., Proskura, V., & Shvets, D. (2020). The role of adverse childhood experiences and corporal punishment in early adulthood depression and substance use among Ukrainian college students. Journal of Family Violence, 35, 285–295. https://doi.org/10.1007/s10896-019-00110-x
Bywaters P., Bunting, L., Davidson, G., Hanratty, J., Mason, W., McCartan, C., & Steils, N. et al. (2015). The relationship between poverty, child abuse and neglect: An evidence review. : Joseph Rowntree Foundation. https://www.jrf.org.uk/report/relationship-between-poverty-child-abuse-and-neglect-evidence-review23EffectivePublic.
Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233–255. https://doi.org/10.1207/S15328007SEM0902_5
Crouch, E., Radcliff, E., Brown, M., & Hung, P. (2019). Exploring the association between parenting stress and a child’s exposure to adverse childhood experiences (ACEs). Child and Youth Services Review, 102, 186–192. https://doi.org/10.1016/j.childyouth.2019.05.019
Danese, A., & McEwen, B. S. (2012). Adverse childhood experiences, allostasis, allostatic load and age-related disease. Physiology & Behavior, 106, 29–39. https://doi.org/10.1016/j.physbeh.2011.08.019
Efron, B., & Tibshirani, R. J. (1993). An introduction to the bootstrap (Vol. 57). Chapman & Hall/CRC.
Erceg-Hurn, D. M., & Mirosevich, V. M. (2008). Modern robust statistical methods: An easy way to maximize the accuracy and power of your research. American Psychologist, 63(7), 591–601. https://doi.org/10.1037/0003-066X.63.7.591
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of child abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
Finkelhor, D., Ji, K., Mikton, C., & Dunne, M. (2013). Explaining lower rates of sexual abuse in China. Child Abuse and Neglect, 37(10), 852–860. https://doi.org/10.1016/j.chiabu.2013.07.006
Fontes, L. A., & Plummer, C. (2010). Cultural issues in disclosures of child sexual abuse. Journal of Child Sexual Abuse, 19(5), 491–518. https://doi.org/10.1080/10538712.2010.512520
Forster, M., Grigsby, T. J., Rogers, C. J., & Benjamin, S. M. (2018). The relationship between family-based adverse childhood experiences and substance use behaviors among a diverse sample of college students. Addictive Behaviors, 76, 298–304. https://doi.org/10.1016/j.addbeh.2017.08.037
Gomis-Pomares, A., & Villanueva, L. (2020). The effect of adverse childhood experiences on deviant and altruistic behavior during emerging adulthood. Psicothema, 32(1), 33–39. https://doi.org/10.7334/psicothema2019.142
Graham, J. W., Taylor, B. J., Olchowski, A. E., & Cumsille, P. E. (2006). Planned missing data designs in psychological research. Psychological Methods, 11(4), 323–343. https://doi.org/10.1037/1082-989X.11.4.323
Grassi-Oliveira, R., Ashy, M., & Stein, L. M. (2008). Psychobiology of childhood maltreatment: Effects of allostatic load. Brazilian Journal of Psychiatry, 30(1), 60–68. https://doi.org/10.1590/S1516-44462008000100012
Hamby, S., Elm, J. H. L., Howell, K. H., & Merrick, M. T. (2021). Recognizing the cumulative burden of childhood adversities transforms science and practice for trauma and resilience. American Psychologist, 76(2), 230–242. https://doi.org/10.1037/amp0000763
Hardt, J., & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. Journal of Child Psychology and Psychiatry, 45(2), 260–273. https://doi.org/10.1111/j.1469-7610.2004.00218.x
Ho, G. W. K., Chan, A. C. Y., Chien, W.-T., Bressington, D. T., & Karatzias, T. (2019). Examining patterns of adversity in Chinese young adults using the adverse childhood experiences—International questionnaire (ACE-IQ). Child Abuse & Neglect, 88, 179–188. https://doi.org/10.1016/j.chiabu.2018.11.009
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Ji, S., & Wang, H. (2018). A study of the relationship between adverse childhood experiences, life events, and executive function among college students in China. Psychology: Research & Review, 31, 28. https://doi.org/10.1186/s41155-018-0107-y
Kalmakis, K. A., & Chandler, G. E. (2014). Adverse childhood experiences: Towards a clear conceptual meaning. Journal of Advanced Nursing, 70(7), 1489–1501. https://doi.org/10.1111/jan.12329
Karatekin, C. (2018). Adverse childhood experiences (ACEs), stress and mental health in college students. Stress and Health, 34(1), 36–45. https://doi.org/10.1007/s00213-010-2009-2
Kelifa, M. O., Yang, Y., Carly, H., Bo, W., & Wang, P. (2021). How adverse childhood experiences relate to subjective wellbeing in college students: The role of resilience and depression. Journal of Happiness Studies, 22, 2103–2123. https://doi.org/10.1007/s10902-020-00308-7
Kessler, R., et al. (2010). Childhood adversities and adult psychopathology in the WHO world mental health surveys. The British Journal of Psychiatry, 197(5), 378–385. https://doi.org/10.1192/bjp.bp.110.080499
Khrapatina, I., & Berman, P. S. (2017). The impact of adverse childhood experiences on health in college students. Journal of Child and Adolescent Trauma, 10(3), 275–287. https://doi.org/10.1007/s40653-016-0093-0
Kidman, R., Smith, D., Piccolo, L. R., & Kohler, H. P. (2019). Psychometric evaluation of the adverse childhood experience international questionnaire (ACE-IQ) in Malawian adolescents. Child Abuse & Neglect, 92, 139–145. https://doi.org/10.1016/j.chiabu.2019.03.015
Kim, P., Evans, G. W., Angstadt, M., Shaun Ho, S., Sripada, C. S., Swain, J. E., Liberzon, I., & Luan Phan, K. (2013). Childhood poverty, chronic stress, and adult brain. Proceedings of the National Academy of Sciences Nov 2013, 110(46), 18442–18447. https://doi.org/10.1073/pnas.1308240110
Kim, Y. H. (2017). Associations of adverse childhood experiences with depression and alcohol abuse among Korean college students. Child Abuse & Neglect, 67, 338–348. https://doi.org/10.1016/j.chiabu.2017.03.009
Lacey, R., Howe, L., Kelly-Irving, M., Bartley, M., & Kelly, Y. (2020). The clustering of adverse childhood experiences in the Avon longitudinal study of parents and children: Are gender and poverty important? Journal of Interpersonal Violence, 37, 2218–2241. https://doi.org/10.1177/0886260520935096
Lacey, R. E., & Minnis, H. (2020). Practitioner review: Twenty years of research with adverse childhood experience scores - advantages, disadvantages and applications to practice. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 61(2), 116–130. https://doi.org/10.1111/jcpp.13135
Mall, S., Mortier, P., Taljaard, L., Roos, J., Stein, D. J., & Lochner, C. (2018). The relationship between childhood adversity, recent stressors, and depression in college students attending a south African university. BMC Psychiatry, 18, 63. https://doi.org/10.1186/s12888-017-1583-9
Martin-Denham, S. L., & Donaghue, J. J. (2020). The impact and measure of adverse childhood experiences: Reflections of undergraduates and graduates in England. Journal of Public Health, 30, 1023–1032. https://doi.org/10.1007/s10389-020-01359-z
Massetti, G. M., Hughes, K., Bellis, M. A., & Mercy, J. (2020). Global perspective on ACEs. In G. J. G. Asmundson & T. O. Afifi (Eds.), Adverse childhood experiences: Using evidence to advance research, practice, policy, and prevention (pp. 209–231). Elsevier Academic Press. https://doi.org/10.1016/B978-0-12-816065-7.00011-2
McGavock, L., & Spratt, T. (2014). Prevalence of adverse childhood experiences in a university population: Associations with use of social services. The British Journal of Social Work, 44(3), 657–674. https://doi.org/10.1093/bjsw/bcs127
Merians, A. N., Baker, M. R., Frazier, P., & Lust, K. (2019). Outcomes related to adverse childhood experiences in college students: Comparing latent class analysis and cumulative risk. Child Abuse & Neglect, 87, 51–64. https://doi.org/10.1016/j.chiabu.2018.07.020
Ministerio de Justicia y Derechos Humanos-UNICEF (2021). Un análisis de los datos del programa Las Víctimas contra las Violencias 2020-2021 (No. 9. Serie Violencia contra niñas, niños y adolescentes). https://www.unicef.org/argentina/informes/serie-violencia-contra-ninas-ninos-y-adolescentes
Muthén, L.K., Muthén, B.O., (1998–2020). Mplus User’s Guide. Seventh Edition. Los Angeles, CA: Muthén & Muthén.
Naicker, S. N., Norris, S. A., Mabaso, M., & Richter, L. M. (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
Overstreet, S., & Chafouleas, S. M. (2016). Trauma-informed schools: Introduction to the special issue. School Mental Health, 8(1), 1–6. https://doi.org/10.1007/s12310-016-9184-1
Parra, Á., Sánchez-Queija, I., García-Mendoza, M., Coimbra, S., Egídio Oliveira, J., & Díez, M. (2019). Perceived parenting styles and adjustment during emerging adulthood: A cross-national perspective. International Journal of Environmental Research and Public Health, 16(15), 2757. https://doi.org/10.3390/ijerph16152757
Pechtel, P., & Pizzagalli, D. A. (2011). Effects of early life stress on cognitive and affective function: An integrated review of human literature. Psychopharmacology, 214(1), 55–70. https://doi.org/10.1007/s00213-010-2009-2
Perales, J., Olaya, B., Fernandez, A., Alonso, J., Vilagut, G., Forero, C. G., et al. (2013). Association of childhood adversities with the first onset of mental disorders in Spain: Results from the ESEMeD project. Social Psychiatry and Psychiatric Epidemiology, 48(3), 371–384. https://doi.org/10.1007/s00127-012-0550-5
Prokopez, C. R., Vallejos, M., Farinola, R., Alberio, G., Caporusso, G. B., Cozzarin, L. G., Chiapella, L. C., Fuentes, P., & Daray, F. M. (2020). The history of multiple adverse childhood experiences in patients with schizophrenia is associated with more severe symptomatology and suicidal behavior with gender-specific characteristics. Psychiatry Research, 293, 113411. https://doi.org/10.1016/j.psychres.2020.113411
Raman, S., & Hodes, D. (2012). Cultural issues in child maltreatment. Journal of Paediatric Child Health, 48(1), 30–37. https://doi.org/10.1111/j.1440-1754.2011.02184.x
Roman, N. V., Makwakwa, T., & Marlies Lacante, M. (2016). Perceptions of parenting styles in South Africa: The effects of gender and ethnicity. Cogent Psychology, 3(1), 1153231. https://doi.org/10.1080/23311908.2016.1153231
Roubinov, D. S., & Boyce, W. T. (2017). Parenting and SES: Relative values or enduring principles? Current Opinion in Psychology, 15, 162–167. https://doi.org/10.1016/j.copsyc.2017.03.001
Sander, P., & de la Fuente, J. (2020). Undergraduate student gender, personality and academic confidence. International Journal of Environmental Research and Public Health, 17(15), 5567. https://doi.org/10.3390/ijerph17155567
Schafer, J. L. (1997). Analysis of incomplete multivariate data. Chapman Hall.
Solberg, M. A., & Peters, R. M. (2020). Adverse childhood experiences in non-westernized nations: Implications for immigrant and refugee health. Journal of Immigrant and Minority Health, 22(1), 145–155. https://doi.org/10.1007/s10903-019-00953-y
Stasik-O’Brien, S. M., Brock, R. L., Chmielewski, M., Naragon-Gainey, K., Koffel, E., McDade-Montez, E., O'Hara, M. W., & Watson, D. (2019). Clinical utility of the inventory of depression and anxiety symptoms (IDAS). Assessment, 26(5), 944–960. https://doi.org/10.1177/1073191118790036
Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., & van IJzendoorn, M. H. (2012). The universality of childhood emotional abuse: A meta-analysis of worldwide prevalence. Journal of Aggression, Maltreatment & Trauma, 21(8), 870–890. https://doi.org/10.1080/10926771.2012.708014
Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., & van IJzendoorn, M. H. (2015). The prevalence of child maltreatment across the globe: Review of a series of meta-analyses. Child Abuse Review, 24, 37–50. https://doi.org/10.1002/car.2353
Stoltenborgh, M., Bakermans-Kranenburg, M. J., van Ijzendoorn, M. H., & Alink, L. R. (2013). Cultural-geographical differences in the occurrence of child physical abuse? A meta-analysis of global prevalence. International Journal of Psychology, 48(2), 81–94. https://doi.org/10.1080/00207594.2012.697165
Substance Abuse and Mental Health Services Administration (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach. https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4884.pdf
Turner, J. C., Leno, E. V., & Keller, A. (2013). Causes of mortality among American college students: A pilot study. Journal of College Student Psychotherapy, 27(1), 31–42. https://doi.org/10.1080/87568225.2013.739022
Unidad Fiscal Especializada en Violencia contra las Mujeres (2019). Relevamiento de fuentes secundarias de datos sobre violencia sexual a nivel país y en la Ciudad Autónoma de Buenos Aires. Ministerio Público Fiscal. https://www.mpf.gob.ar/ufem/files/2019/10/Informe_UFEM.pdf
Walsh, D., McCartney, G., Smith, M., & Armour, G. (2019). Relationship between childhood socioeconomic position and adverse childhood experiences (ACEs): A systematic review. Journal of Epidemiology & Community Health, 73, 1087–1093. https://doi.org/10.1136/jech-2019-212738
Wang, Y.-R., Sun, J., Lin, P.-Z., Zhang, H.-H., Mu, G.-X., & Cao, F.-L. (2019). Suicidality among young adults: Unique and cumulative roles of 14 different adverse childhood experiences. Child Abuse & Neglect, 98, 104183. https://doi.org/10.1016/j.chiabu.2019.104183
Watson, D., O'Hara, M. W., Simms, L. J., Kotov, R., Chmielewski, M., McDade-Montez, E. A., Gamez, W., & Stuart, S. (2007). Development and validation of the inventory of depression and anxiety symptoms (IDAS). Psychological Assessment, 19(3), 253–268. https://doi.org/10.1037/1040-3590.19.3.253
Watt, T., Ceballos, N., Kim, S., Pan, X., & Sharma, S. (2020). The unique nature of depression and anxiety among college students with adverse childhood experiences. Journal of Child and Adolescent Trauma, 13(2), 163–172. https://doi.org/10.1007/s40653-019-00270-4
Wiehn, J., Hornberg, C., & Fischer, F. (2018). How adverse childhood experiences relate to single and multiple health risk behaviours in German public university students: A cross-sectional analysis. BMC Public Health, 18, 1005. https://doi.org/10.1186/s12889-018-5926-3
Windle, M., Haardörfer, R., Getachew, B., Shah, J., Payne, J., Pillai, D., & Berg, C. J. (2018). A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students. Journal of American College Health, 66(4), 246–251. https://doi.org/10.1080/07448481.2018.1431892
World Health Organization (2020). Adverse Childhood Experiences International Questionnaire (ACE-IQ). https://www.who.int/publications/m/item/adverse-childhood-experiences-international-questionnaire-(ace-iq)
Zhang, J., Tang, B. W., Liu, M. W., Yuan, S., Yu, H. J., Zhang, R., Huang, X. C., Nzala, S. H., Chikoya, M., Wang, P. G., & He, Q. Q. (2020). Association of adverse childhood experiences with health risk behaviors among college students in Zambia. International Journal of Behavioral Medicine, 27(4), 400–405. https://doi.org/10.1007/s12529-020-09863-y
Acknowledgements
This project was completed by the Cross-cultural Addictions Study Team (CAST), which includes the following investigators (in alphabetical order): Adrian J. Bravo, William & Mary (Coordinating PI); Christopher C. Conway, Fordham University; James M. Henson, Old Dominion University; Lee Hogarth, University of Exeter; Manuel I. Ibáñez, Universitat Jaume I de Castelló; Debra Kaminer, University of Cape Town; Matthew Keough, York University; Laura Mezquita, Universitat Jaume I de Castelló; Generós Ortet, Universitat Jaume I de Castelló; Matthew R. Pearson, University of New Mexico; Angelina Pilatti, National University of Cordoba; Mark A. Prince, Colorado State University; Jennifer P. Read, University of Buffalo; Hendrik G. Roozen, University of New Mexico; Paul Ruiz, Universidad de la República.
Funding
Dr. Bravo was supported by a training grant (j) from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in the United States during the duration of data collection for this project. Data collection was supported, in part, by grant T32-AA018108. NIAAA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Data collection in Spain was also supported by grant UJI-A2019–08 from the Universitat Jaume and RTI2018–099800-B-I00 from the Spanish Ministry of Science, Innovation and Universities (MCIU). Data collection in Argentina was also supported by grants from the National Secretary of Science and Technology (FONCYT, grant number PICT 2018-3170) and by grants from the Secretary of Science and Technology- National University of Córdoba (SECyT-UNC).
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All authors contributed to the study conception and design. Data analysis was performed by Adrian Bravo. The first draft of the manuscript was written by Debra Kaminer and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Kaminer, D., Bravo, A.J., Mezquita, L. et al. Adverse childhood experiences and adulthood mental health: a cross-cultural examination among university students in seven countries. Curr Psychol 42, 18370–18381 (2023). https://doi.org/10.1007/s12144-022-02978-3
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DOI: https://doi.org/10.1007/s12144-022-02978-3