Adverse childhood experiences and their differential relationships with transdiagnostic mental health outcomes in young adults

Adverse childhood experiences (ACEs) are associated with poor mental health outcomes, which are increasingly conceptualized from a transdiagnostic perspective. We examined the impact of ACEs on transdiagnostic mental health outcomes in young adulthood and explored potential effect modification. We included participants from the Avon Longitudinal Study of Parents and Children with prospectively measured data on ACEs from infancy till age 16 as well as mental health outcomes at ages 18 and 24. Exposures included emotional neglect, bullying, and physical, sexual or emotional abuse. The outcome was a pooled transdiagnostic Stage of 1b (subthreshold but clinically significant symptoms) or greater level (Stage 1b+) of depression, anxiety, or psychosis - a clinical stage typically associated with first need for mental health care. We conducted multivariable logistic regressions, with multiple imputation for missing data. We explored effect modification by sex at birth, first-degree family history of mental disorder, childhood neurocognition, and adolescent personality traits. Stage 1b + outcome was associated with any ACE (OR = 2.66, 95% CI = 1.68-4.22), any abuse (OR = 2.08, 95% CI = 1.38-3.14), bullying (OR = 2.15, 95% CI = 1.43-3.24), and emotional neglect (OR = 1.68, 95% CI = 1.06-2.67). Emotional neglect had a weaker association with the outcome among females (OR = 1.14, 95% CI = 0.61-2.14) than males (OR = 3.49, 95% CI = 1.64-7.42) and among those with higher extraversion (OR = 0.91, 95% CI = 0.85-0.97), in unweighted ( n = 2,126) and weighted analyses ( n = 7,815), with an openness-neglect interaction observed in the unweighted sample. Sex at birth, openness, and extraversion could modify the effects of adverse experiences, particularly emotional neglect, on the development of poorer transdiagnostic mental health outcomes.