Overall and Gender-specific Associations between Dimensions of Adverse Childhood Experiences and Mental Health Outcomes among Homeless Adults: Associations Générales et Sexospécifiques Entre les Dimensions des Expériences Défavorables de L’enfance et les Résultats de Santé Mentale Chez les Adultes Sans Abri

Abstract

Objective: The associations between adverse childhood experiences (ACEs) and psychopathology have been well-established in the general population. Research on ACEs in the homeless population has been limited. This study examined whether ACE exposure is associated with specific mental health outcomes among a national sample of homeless adults with mental illness and whether this association varies according to ACE dimension and gender. Methods: This cross-sectional study utilized data from a national sample of 2,235 homeless adults with mental illness in Canada to evaluate their sociodemographic characteristics, exposure to ACEs, and mental health outcomes. Exploratory and confirmatory factor analyses were conducted to identify and confirm ACE dimensions (maltreatment, sexual abuse, neglect, divorce, and household dysfunction) from individual ACE items. Multivariable logistic regression was used to examine the associations between total ACE score and ACE dimensions with mental illness diagnoses and psychopathology severity. Results: The mean total ACE score among all study participants was 4.44 (standard deviation [ SD]: 2.99). Total ACE score was positively associated with several mental illness diagnoses and psychopathology severity. Unique associations were found between specific ACE dimensions and poor mental health outcomes. The prevalence of almost all ACEs was significantly higher among women. Yet, associations between several ACE dimensions and poor mental health outcomes existed uniquely among men. Conclusions: There are unique and gender-specific associations between specific ACE dimensions and mental health outcomes among homeless adults. Better understanding of the mechanisms underlying these associations is needed to inform screening, prevention, and treatment efforts, particularly given the very high prevalence of ACEs among this vulnerable and marginalized population.

Adverse childhood experiences and related outcomes among adults experiencing homelessness: a systematic review and meta-analysis

“…60 One possible explanation is that both criminal justice involvement and ACEs are risk factors for homelessness, thereby modifying the associations that are observed among the homeless population. 61 Blankertz et al (1993) 53 Bymaster et al (2017) 43 Dawson-Rose et al (2020) 34 Edalati et al (2016) 41 Ferguson et al (2009) 54 Larkin et al (2012) 48 Lee et al (2017) 44 Liu et al (2021) 57 Middleton et al (2018) 49 Mounier et al (2003) 45 Munoz et al (2019) 37 Narayan et al (2017) 35 Narendorf et al (2020) 39 Pluck et al (2011 Edalati et al (2016) 41 Ferguson et al ( 2009) 54 Forde et al (2012) 55 Greeson et al (2019) 52 Koegel et al (1995) 30 Larkin et al (2012) 48 Lee et al (2017) 44 Liu et al (2021) 57 Middleton et al (2018) 49 Mounier et al ( 2003) 45 Munoz et al (2019) 37 Narayan et al (2017) 35 Narendorf et al (2020) 39 Pluck et al (2011) 33 Putnam-Hornstein et al (2017) 50 Another important finding is that most ACE studies among homeless adults were done in Canada or the USA. The disproportionate representation of ACE studies from North America was also reported in another review of homeless adults.…”

“…A narrative summary of associations is reported in table 4, broken down by definition of ACE exposure, significance of associations, and direction of associations. Of outcomes that were assessed by two or more studies, ACE exposure was consistently associated with high suicidality, 31,57 past suicide attempt, 39,44,47 major depressive disorder, 44,57 substance misuse, 29,39 and adult victimisation in all studies that evaluated ACE exposure and these outcomes. 36,41 Many studies reported no association between ACE exposure and involvement in the criminal justice system as an adult among homeless adults.…”

Adverse Childhood Experiences and Psychological Well-Being in Chinese College Students: Moderated Mediation by Gender and Resilience

“…Several studies have examined gender differences in ACEs. Some have found the effects of ACEs, particularly household challenges, on certain mental health outcomes to be stronger for male than female participants ( 25 ), while others suggested ACEs to be more harmful to females ( 50 ). Still, others have found no gender differences in psychological outcomes ( 62 ).…”

“…The moderation effect of gender on the relationships among ACEs, resilience, and psychological well-being may manifest in several perspectives. First, the prevalence of ACEs could vary across different gender groups ( 25 , 48 ). For instance, a national survey of 17-year-olds in the U.S. estimated that over one quarter (26.6%) of the female participants had a lifetime history of child sexual abuse, compared to 5.1% of the male counterparts ( 48 ).…”

“…For instance, a national survey of 17-year-olds in the U.S. estimated that over one quarter (26.6%) of the female participants had a lifetime history of child sexual abuse, compared to 5.1% of the male counterparts ( 48 ). Analyzing 2,235 homeless adults in Canada, Liu et al ( 25 ) found that female participants were likely to report a higher prevalence of 7 out of 10 ACEs items, excluding parental separation/divorce, substance abuse in the household, and incarcerated household members. In another study, Cavanaugh et al ( 49 ) investigated the gender-specific profiles of ACEs among 34,652 U.S adults and demonstrated that female adults had 2–3 times higher probabilities of being in the class of child sexual abuse.…”