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Prospective Longitudinal Associations Between Adverse Childhood Experiences and Adult Mental Health Outcomes: Systematic Review and Meta-Analysis.

Christina Thurston·Aja Louise Murray·Hannabeth Franchino-Olsen·Mpho Silima·Chad Lance Hemady·Franziska Meinck
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Abstract

Research suggests a strong, dose-response relationship between adverse childhood experiences (ACEs) and poor adult mental health outcomes. This systematic review and meta-analysis aimed to systematically investigate the existence and strength of prospective associations between ACEs and adult mental health outcomes: anxiety, depression, psychotic-like experiences, post-traumatic stress disorder (PTSD), self-harm, and suicidality. We searched 12 electronic databases for publications after 1990. A narrative synthesis of included studies and random-effects meta-analyses with moderation were completed for all outcomes, excluding self-harm. In total, 62 studies from 15 countries were included. Most studies were from the United States; 95% of publications (N = 59) came from high-income countries (HICs) and 5% (N = 3) from upper-middle-income countries. Pooled associations between ACEs and adult mental illness were strongest for PTSD (OR = 2.26; 95% CI [1.75, 2.77]), followed by anxiety (OR = 1.78; 95% CI [1.45, 2.11]), depression (OR = 1.61; 95% CI [1.45, 1.76]), psychotic-like experiences (OR = 1.34; 95% CI [1.13, 1.54]), and suicidality (OR = 1.28; 95% CI [1.13, 1.43]). Moderation analyses suggested ACEs with a violence or maltreatment component were significant risk factors for adult depression compared to household ACEs, and that study location was a significant moderator in the depression, anxiety, and PTSD models. Further moderation effects will be discussed. Findings confirm ACEs are a significant risk factor for mental ill-health in adulthood. Our review highlights the urgent need for research exploring associations between ACEs measured in childhood and adult mental illness outside of HIC settings.

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HumansAdverse Childhood ExperiencesAdultMental DisordersStress Disorders, Post-TraumaticFemaleChildMental HealthProspective StudiesAdult Survivors of Child AbuseMaleAnxietybullyingchild abusemental health and violenceneglectviolence exposureJournal ArticleSystematic ReviewMeta-AnalysisReview

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Christina Thurston, Aja Louise Murray, Hannabeth Franchino-Olsen, Mpho Silima, Chad Lance Hemady, Franziska Meinck. 2025-08-17. Prospective Longitudinal Associations Between Adverse Childhood Experiences and Adult Mental Health Outcomes: Systematic Review and Meta-Analysis.. https://doi.org/10.1177/15248380251358223

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Adult subjectAnxiety subjectBullying subjectChild subjectFemale subjectHumans subjectJournal Article subjectJournal Article; Systematic Review; Meta-Analysis; Review resourceMale subjectMental Health subjectMeta-Analysis subjectSystematic reviews study

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