Adverse childhood experiences and mental health disorder in China: A nationwide study from CHARLS.

Objectives: Mental health disorder is highly prevalent worldwide, and factors attributable to its development have not been fully understood. We aimed to explore the association of adverse childhood experiences (ACEs) with mental health disorder using data from the China Health and Retirement Longitudinal Study (CHARLS).

Methods: CHARLS is an ongoing nationwide survey enrolling 17,708 residents aged ≥45 years in China. Total 20 ACE indicators were extracted. Unmeasured confounding and potential mediation were assessed, and effect-size estimates are expressed as odds ratio (OR) with 95 % confidence interval (CI).

Results: Of 10,961 assessable participants with complete information, 3652 were reported to have mental health disorder. The risk for mental health disorder was increased by 20.7 % for participants with one to less than four events of ACEs (OR: 1.207, 95 % CI: 0.711 to 2.049), and this number reached 102.7 % for participants with four or more events (OR: 2.027, 95 % CI: 1.196 to 3.436) relative to those with no ACE. In subgroup analyses, between-group risk estimates differed significantly for residence, marital status, personal asset, life satisfaction, and living standard. The E-value of 2.35 for ACEs of 4 or more events indicated the low likelihood of unmeasured confounders. In mediation analyses, the proportion eliminated was 5.1 % for continuous ACEs and 6.1 % for categorical ACEs (both P < 0.001).

Discussion: Our findings indicate that ACEs, especially with four or more events, can predict the significant risk of mental health disorder, underscoring the necessity of screening mental illness based on ACEs to reduce the resultant morbidity and mortality in China.