Psychometric evaluation of the Adverse Childhood Experience International Questionnaire (ACE-IQ) in Malawian adolescents.

Background: Adverse childhood experiences (ACEs) can have lifelong adverse impacts on health and behavior. While this relationship has been extensively documented in high-income countries, evidence from lower-income contexts is largely missing. In order to stimulate greater research on the prevalence and consequences of ACEs in low-income countries, the World Health Organization (WHO) developed the ACE-International Questionnaire (ACE-IQ).

Objective: In this paper, we explore the factor structure, validity and reliability of the original ACE-IQ, and evaluate whether potential adaptations improve its predictive validity.

Participants And Setting: Four hundred and ten adolescents (age 10-16 years old) from Malawi.

Methods: The adolescents answered an adapted version of ACE-IQ and Beck Depression Inventory (BDI).

Results: Taken together, our results suggest that (a) the ACE-IQ is structured in three dimensions: household disruption, abuse, and neglect; (b) there is support for the validity of the scale evidenced by the correlation between subdimensions (average across 13 correlations, phi = .20, p < 0,01; across subdomains (phi = .10, p < 0,01); partial agreement among children with the same caregiver (ICC = .43, p < .001) and correlation between ACE and depression (predictive validity; r = .35, p < .001); (c) information on the timing of the adversities ("last year" in addition to "ever") modestly improved the predictive value of the ACE-IQ in models of depression (from R = .12 to .15, p < .001); and (d) additional HIV-related questions showed low endorsement and a modest correlation with BDI (r = .25, p < 0,01).

Conclusion: Our findings suggest that the ACE-IQ is appropriate for use among adolescents from a low-income context.