The Impact of Adverse Childhood Experiences on Mental Health and Suicidal Behaviors: A Study from Portuguese Language Countries

Abstract

Background: Research on adverse childhood experiences (ACEs) demonstrates that they can be associated with physical and mental health problems throughout the lifecourse. However, few studies have examined this topic in the Community of Portuguese Language Countries (CPLC). Objective: This study aims to assess the impact of ACEs on mental health and suicidal behaviors in a sample of participants from the CPLC. Participants and Setting: The sample consists of 1006 participants aged between 18 and 80 years (mean = 41.76; SD = 14.19). Methods: This study used an online survey that included a sociodemographic questionnaire, the Brief Symptom Inventory-18 (BSI-18) to assess somatization, depression, and anxiety symptoms, and overall mental functioning, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) to assess suicidal behaviors, and the Family Adverse Childhood Experiences Questionnaire to assess ACEs. Results: Emotional abuse was the most reported ACE (32.7%). Participants from Brazil had higher levels of somatization, depression, anxiety, and suicide ideation and attempt, while participants from Portugal had a higher probability of suicide in the future. ACEs were strong and significant predictors of psychological symptoms and the likelihood of suicide in the future, with emotional abuse and emotional neglect being the domains with the greatest contribution, respectively. Conclusions: ACEs are a prevalent and general phenomenon across several countries. It is urgent to alert policymakers and mental health professionals of the need to intervene with children and families to ensure their harmonious and adjusted development, thus promoting quality of life and well-being of populations.

The Mediating Effect of Post-Traumatic Growth on the Relationship between Adverse Childhood Experiences and Psychological Distress in Adults

“…The results show a high prevalence of ACEs ranging from 10.8% (physical neglect) to 59.7% (emotional abuse), with emotional abuse being the most reported category of ACEs. These results are like those found by other studies (Silva and Maia 2008;Silveira and Pereira 2023;Riedl et al 2020), which suggest that ACEs represent an alarming phenomenon with a significant impact in various cultural contexts. These findings can be associated with the relationship between ACEs and some risk factors that may influence parenting practices, including high parental stress related especially to lower-income situations (Crouch et al 2019), the lack of parenting skills such as little knowledge about child development (Stith et al 2009), and the repetition of dysfunctional family patterns, where parents who experienced ACEs in their childhood may be more likely to expose their children to the same experiences (Schickedanz et al 2021).…”

“…It is important to mention the need for greater investment in research in the future. Significant, positive correlations were found between the different categories of ACEs (e.g., positive strong correlations between physical and emotional abuse, as well as a positive strong correlation between domestic violence in the household and substance abuse in the household) (Silveira and Pereira 2023), suggesting that they are multidimensional and influence each other, not occurring in an isolated way (Karatekin 2017;Soares et al 2016;Riedl et al 2020), which is expected. Also, emotional abuse has a stronger correlation with depression (compared to anxiety), as evidenced in the recent literature (Elmore and Crouch 2020), showing that exposure to emotional abuse is positively associated with psychopathology in adults, especially with mood disorders (Martins et al 2014) A significant, positive, and strong correlation was found between depression and anxiety (Lou et al 2012).…”

“…ACEs can be a contributing factor to the occurrence of risk behaviors, such as exposure to risky sexual behaviors-early sex life (Novais et al 2021), multiple sexual partners, sexually transmitted diseases (Felitti et al 1998;Novais et al 2021) and unwanted pregnancy (Ramiro et al 2010)-, smoking (Felitti et al 1998;Hughes et al 2017;Novais et al 2021;Ramiro et al 2010), alcohol use (Felitti et al 1998;Hughes et al 2017;Merrick et al 2017;Ramiro et al 2010), drug use (Felitti et al 1998;Merrick et al 2017), self-harm behaviors (Novais et al 2021) and suicide attempts (Felitti et al 1998;Lu et al 2008;Merrick et al 2017;Silveira and Pereira 2023;Thompson et al 2019).…”

“…Psychological distress is the result of physical and psychological symptoms experienced by the individual (Varela et al 2017) that are based on emotional suffering such as depression (Agbaje et al 2021;Belay et al 2021, Serviço Nacional de Saúde 2018Varela et al 2017), anxiety (Agbaje et al 2021;Belay et al 2021;Serviço Nacional de Saúde 2018;Varela et al 2017), stress (Agbaje et al 2021), and somatic symptoms (Serviço Nacional de Saúde 2018). Research suggests that ACEs are related to depression and anxiety (Watt et al 2019;Qu et al 2022;Riedl et al 2020;Silveira and Pereira 2023). However, a study by Elmore and Crouch (2020) found that ACEs have a greater impact on depression, with emotional abuse (Chapman et al 2004;Qu et al 2022;Silveira and Pereira 2023;Qu et al 2022) and a family history of mental illness (Giano et al 2021;Pinto et al 2015) being significant risk factors when it comes to the occurrence of this mood disorder.…”

“…Research suggests that ACEs are related to depression and anxiety (Watt et al 2019;Qu et al 2022;Riedl et al 2020;Silveira and Pereira 2023). However, a study by Elmore and Crouch (2020) found that ACEs have a greater impact on depression, with emotional abuse (Chapman et al 2004;Qu et al 2022;Silveira and Pereira 2023;Qu et al 2022) and a family history of mental illness (Giano et al 2021;Pinto et al 2015) being significant risk factors when it comes to the occurrence of this mood disorder. At the same time, PD is linked to sadness and low self-esteem (Agbaje et al 2021;Varela et al 2017), aggression (Agbaje et al 2021), unhappiness, loss of interest and excessive tiredness (Belay et al 2021), hopelessness (Belay et al 2021;Varela et al 2017), and tension and agitation (Belay et al 2021;Varela et al 2017).…”