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. Ho, D. Bressington, T. Karatzias, W. T. Chien, S. Inoue, P. J. Yang, P. Hyland, A.C.Y. Chan

Research output: Journal article publicationJournal articleAcademic researchpeer-review

20 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)339-349
Number of pages11
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number3
Publication statusPublished - 1 Mar 2020


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

ASJC Scopus subject areas

  • Epidemiology
  • Health(social science)
  • Social Psychology
  • Psychiatry and Mental health

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