Adverse childhood experiences and trajectories of psychological distress in adulthood: an analysis of the 1958 British birth cohort

Abstract

Background The evidence on the association between adverse childhood experiences (ACEs) and psychological distress in adulthood tends to rely on cross-sectional studies. In this 50-year long longitudinal study, we examined the association between both prospectively and retrospectively reported ACEs and adulthood trajectories of psychological distress between age 23 and 50. We also studied potential effect modifiers of these associations, spanning social and developmental domains of child development. Methods The sample comprised 8,055 participants of the 1958 National Child Development Study. Psychological distress was measured by the Malaise Inventory at ages 23-50. We used growth curve analysis and multinomial regression. Results After accounting for covariates, those with more ACEs experienced persistently higher psychological distress between age 23 and 50, with a graded relationship observed. The associations were relatively consistent across prospectively and retrospectively reported ACEs. Those with prospective or retrospective ACE score of 1 compared with 0, had on average between 0.27 and 0.39 higher distress throughout adulthood. In relative terms, the prospective ACE score of 2+ (vs 0) was associated with 3.31 and the retrospective ACE score of 4+ (vs 0) with 5.76 (95% CI 4.24 to 7.82) times higher risk of being in the 'high symptoms' compared with the 'low symptoms' trajectory of distress. None of the potential effect modifiers altered the association between ACEs and trajectories of distress. Conclusion If the associations between ACEs and trajectories of distress are causal, this emphasises the need to act early to prevent psychopathology across the adult life course.