Adverse Childhood Experiences and Mental Health: The Moderating Role of Adulthood Lifestyle Trajectories in a United Kingdom Cohort

Background and Purpose

A healthy lifestyle is a protective factor that may mitigate the negative effects of adverse childhood experiences (ACEs) on mental health. However, most studies have evaluated individual lifestyle behaviors at a single time point, overlooking their potential synergy and fluctuations over time. Moreover, how ACEs intersect with combined lifestyle trajectories to influence mental health outcomes over the life course remains underexplored.

Methods

This study utilized data from the UK Biobank baseline survey (2006-2010), two follow-up assessments (2012-2013 and 2014-2015), and the online mental health survey (2016). Group-based trajectory modeling and linear regression analyses were applied to examine the interaction between ACEs and lifestyle trajectories on mental health outcomes.

Results

A total of 39,437 participants aged 40-71 years (mean [SD] age = 64.66 [7.52] years, 53.03% female, 97.69% White) were included. Dose-response relationships were observed between cumulative ACEs, individual ACE types, and mental health outcomes. Five distinct lifestyle trajectories were identified: "persistent unhealthy," "increasing healthy," "moderate healthy," "decreasing healthy," and "persistent healthy." Lifestyle trajectories significantly moderated the association between ACEs and mental health, with stronger effects in younger adults compared to older adults.

Conclusions and Implications

These findings provide insight into why ACEs lead to mental health problems for some individuals but not others. The study underscores the enduring impact of childhood adversity while highlighting the potential for even small but sustained improvements in lifestyle to offer significant mental health benefits. These results suggest actionable targets for clinical and public health interventions aimed at enhancing resilience and reducing mental health disparities.