The Relationship Between Adverse Childhood Experiences, Mental Health, and Risky Alcohol Behaviors – Does Race/Ethnicity and Sex Moderate Outcomes?

Introduction:Adverse childhood experiences (ACEs) have been found to be associated with increased risk of poor mental health and substance use in adulthood. This study assessed whether experiences of maltreatment and family dysfunction in childhood were associated with poor mental health and substance abuse and whether race/ethnicity and sex moderate these associations. 

Methods:The study used data from the 2010 Behavioral Risk Factor Surveillance System, specifically the 10 states and the District of Columbia that included the ACE module in their state survey.  The ACE items were categorized into two domains: 1) maltreatment (childhood physical, verbal, and sexual abuse) and 2) family dysfunction (childhood exposure to household mental illness, alcoholism, drug use, and incarceration; parental intimate partner violence and parental separation/divorce). The outcomes of interest were ever diagnosed with an anxiety or depressive disorder; heavy drinking, binge drinking, and alcohol impaired driving in the previous 30 days. Logistic regression models examined the relationship between the ACE domains and outcomes of interest as well as whether sex and race moderated those relationships. 

Results:Both ACE domains were significantly associated with mental health problems and risky alcohol behaviors (p<0.05). Childhood maltreatment and exposure to family dysfunction were associated with an increased risk of an anxiety (OR=2.4 (95% CI=1.9, 2.9) and 1.8 (95% CI=1.5, 2.3), respectively) and a depressive disorder (OR=2.4 (95% CI=2.0, 2.9) and 1.8 (95% CI=1.5, 2.2), respectively); binge drinking (OR=1.3 (95% CI=1.1, 1.4) and 1.4 (95% CI=1.2, 1.6), respectively); heavy drinking (OR=1.4 (95% CI=1.2, 1.7) and 1.6 (95% CI=1.3, 1.9), respectively); and alcohol impaired drinking (OR=1.5 (95% CI=1.1, 2.0) and 1.4 (95% CI=1.1, 1.9), respectively). Sex did not moderate the relationship between these exposures and any outcomes. Though race did not moderate the relationship between either type of exposure and risky alcohol behavior or anxiety, the race by dysfunction interaction was significant for depression.

Conclusions: Both types of ACEs appear to increase risk of mental health problems and risky alcohol behaviors. The effect of maltreatment and dysfunction did not differ across sexes. With the exception of results related to dysfunction and depression, race did not moderate the relationship between ACEs and other outcomes. Next steps include analyses to test the relative influence of the ACE domains. Implications for prevention and intervention will be discussed.