Patterns of Adverse Childhood Experiences and Mental Health: Evidence from College Students in Korea

Background and Purpose: Adverse childhood experiences (ACEs) are concerning exposures that may have detrimental effects on mental health. Much of the previous evidence on ACEs comes from the U.S and western developed countries. In light of the limited knowledge of ACEs in other social contexts and the interconnection among adversities, this study aims to identify distinct patterns of co-occurring ACEs and examines the associations between those adversities and mental health of young adults in South Korea.

Methods: This study conducted an online survey with a national sample of college students in Korea in 2019. We recruited college students through non-probability quota sampling to invite socioeconomically diverse young adults (N=1037). The sample was balanced in terms of gender (female and male) and geographic locations (the capital city Seoul and the other cities) to reflect the current sex ratio and population density. The dependent variables were assessed using three measures of mental health assessed by the Brief Symptom Inventory (BSI): depressive, anxiety, and somatization symptoms. The independent variable was the type of ACEs, using 14 indicators of childhood adversity. They included exposure to emotional neglect, emotional abuse, physical abuse, sexual abuse, parental separation/divorce, intimate partner violence (IPV), loss of a family member, a household member(s) with substance abuse, a household member(s) with mental illness, economic hardship in food/housing, public assistance use, and three experiences of bullying victimization (teasing, property theft, and hitting). We conducted a Latent Class Analysis (LCA) with a distal outcome, using the Bolck, Croons, and Hagenaars (BCH) method. We first identified the types of ACEs and then examined the associations between the identified types of ACEs and mental health symptoms, controlling for sociodemographic characteristics.

Results: The analysis found four patterns of ACEs: extreme adversity (8%), family violence (20.3%), economic adversity (10.4%), and low adversity (61.3%). The extreme adversity class exhibited multiple exposures, including interpersonal violence in home environments, economic hardship, and bullying victimization by peers. The family violence class was notably exposed to maltreatment and violence within their family. The economic hardship class had high probabilities of public assistance use and food/housing hardship. The results presented that the extreme adversity and family violence classes showed significantly worse mental health symptoms (depressive, anxiety, and somatization symptoms) than the economic adversity and low adversity classes. Also, the extreme adversity class reported significantly higher levels of depressive symptoms (b = 2.12, p < .01) and somatization symptoms (b= 1.6, p< .05) than the family violence class.

Discussion and Implications: This study is one of the few studies examining ACEs' patterns and the link to mental health specific to college students in Korea. We examined expanded ranges of ACEs from family to peer environments, informed by the emerging discussion and current social contexts. Researchers and practitioners should recognize the co-occurrence of ACEs rather than overestimating sole adversity experience. This study supports comprehensive assessments of expanded ACEs and timely interventions to mitigate the negative consequences on mental health.