Background Mental health conditions are increasing worldwide and can have substantial consequences on all aspects of life. Exposure to adverse childhood experiences (ACEs) at a young age increases the risk of mental health problems later in life. ACEs are characterized as stressful psychosocial conditions, outside of the child’s control, which can occur during sensitive periods of development and impact health throughout the life-course. In addition, obesity across the life-course is related to exposure to ACEs and associated with an increased risk in mental illness. A long-term association between ACEs and mental health requires further investigation of intermediate variables and their effect such as, obesity. Hence, the aim of this study is to examine the association between prospectively measured ACEs and an outcome of mental health in adulthood and to examine the role of obesity as an intermediate variable.
Methods The study used data from the 1958 National Child Development Study, an observational prospective birth cohort study conducted in Great Britain (N = 18, 558). ACEs were measured prospectively (7, 11 and 16 years) using reports of (1) Child in care; (2) Physical neglect; (3) Contact with probation; (4) Parental separation; (5) Family mental illness and (6) Alcohol abuse. Exposures were counted and combined into a categorical ACEs variable (No ACEs, one ACEs and ≥ 2 ACEs). Depression and anxiety related symptoms were assessed at age 44/45 using an abbreviated version of the Clinical Interview Schedule-Revised. Obesity at 16y was determined as the upper BMI sex-specific quartile. Sequential nested logistic regression modelling was performed adjusting for early life covariates: individual’s characteristics, mother characteristics, parental socioeconomic background. In view of imputing data, analyses were conducted on complete cases.
Results In our study sample of 5 509 participants, we found a robust graded association between ACEs and CIS-R after accounting for covariates. The odds of having depression-anxiety symptoms at 44/45 was 2 times larger in participants who experienced two or more ACEs versus those with no ACEs, after adjusting for confounders (OR [95%CI]: 2.31[1.72–3.09], p<0.001). Further adjustment for obesity at 16y had no effect on the observed association (OR [95%CI]: 2.30[1.71–3.08], p<0.001).
Conclusion This study consolidates findings on the long-term cumulative effects of ACEs with late life psychopathology, independent of covariates and obesity status at 16y. In future analyses, testing the potential effects of intermediate variables during different time periods will be considered. Interventions that target early life stressors are recommended for primary prevention of adult psychopathology.
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