Association of Adverse Childhood Experiences with Lifetime Mental and Substance Use Disorders Among Individuals Aged 50+ Years

Background/Purpose: Substantial evidence points to the powerful long-term influence of adverse childhood experiences (ACEs [i.e., childhood maltreatment and family dysfunction]) on physical/mental health and health risk behaviors in adulthood. Despite increasing rates of mental and substance use disorders (MSUDs) among the rapidly growing older adult population, ACE studies have not focused on this group. Using nationally representative, epidemiologic data, this study examined the association of ten types of ACEs and the total number of ACEs with six lifetime MSUDs among the 50+ age group.

Methods: Data (N=14,738 for the 50+ age group) came from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), which used the National Institute on Alcohol Abuse and Alcoholism’s Alcohol Use Disorder and Associated Disabilities Interview Schedule to identify DSM-5 diagnoses of MSUDs. We used multivariable binary logistic regression analyses, reporting odds ratios (OR) and 95% confidence intervals (CI), to examine the associations of ten ACEs and the total number of ACEs with lifetime major depressive disorder (MDD), anxiety disorder, post-traumatic stress disorder (PTSD), alcohol use disorder (AUD), drug use disorder, and nicotine use disorder (NUD). Gender differences were examined using tests of interaction effects between ACEs and gender, with follow-up gender-separate logistic regression analyses.

Results: Of the sample, 53.2% of women and 50.0% of men reported having at least one ACE before they were 18 years old. For both genders, parent/other adults’ (OA) substance use problems were the most prevalent (23.8% in women, 21.3% in men), followed by physical abuse (17.5% in women, 19.6% in men) and emotional neglect (17.6% in women, 15.9% in men). Sexual abuse was more than twice as prevalent in women (15.7%) than in men (6.4%). Psychological, physical, and sexual abuse, emotional and physical neglect, and parent/OA substance use problems had small but consistently significant effects on each MSUD (e.g., OR=1.28, 95% CI=1.12-1.46 for parental/OA substance misuse on MDD; OR=2.21, 95% CI=1.75-2.78 for sexual abuse on PTSD; and OR=1.83, 95% CI=1.60-2.10 for parental/OA substance misuse on AUD). Witnessing domestic violence and household member incarceration were also associated with lifetime PTSD. The total number of ACEs had gender-neutral, cumulative, and consistent effects on each MSUD with ORs ranging from 1.19 (95% CI=1.26-1.23) for NUD to 1.45 (95% CI=1.39-1.51) for PTSD. Including PTSD as a covariate in the model did not affect the ORs for the other five MSUDs. However, results also showed that the effects of physical abuse, sexual abuse, and emotional neglect, as well as parental separation/divorce, were stronger for men than women.

Conclusions and Implications: This study underscores ACEs’ long-lasting negative impacts on MSUDs in adulthood. Prevention and early detection of childhood maltreatment and family dysfunction and appropriate interventions for these events through formal and informal channels of support are key in preventing/reducing these negative impacts throughout the life span. More research is also needed to investigate why ACEs seem to have greater effects on older men and to discern sources of gender differences in ACEs’ effects so social workers and others can better assist those in need.