Bartolomé-Valenzuela, M., Pereda, N., & Guilera, G. (2024). Patterns of adverse childhood experiences and associations with lower mental well-being among university students. Child Abuse & Neglect, 152, 106770. https://doi.org/10.1016/j.chiabu.2024.106770
Key Points:
- The study identified four distinct classes of adverse childhood experiences (ACEs) among university students in Spain: Low ACEs, Dysfunctional Household, Household and Peer Abuse, and High ACEs.
- Students in the Dysfunctional Household, Household and Peer Abuse, and High ACEs classes reported significantly lower levels of mental well-being compared to those in the Low ACEs class.
- Having a mental illness was the strongest predictor of lower levels of well-being, followed by belonging to the High ACEs or Household and Peer Abuse classes.
- The research, while enlightening, has certain limitations such as the cross-sectional design and the overrepresentation of females in the sample.
- Understanding the impact of ACEs on mental health is crucial for designing effective prevention and intervention strategies.
Rationale
Previous studies have consistently shown that university students report high levels of ACEs (Aizpurua et al., 2021; Ho et al., 2019; Khrapatina & Berman, 2017), which can lead to severe mental health problems (Merians et al., 2019; Tran et al., 2015; Windle et al., 2018).
However, research on the impact of ACEs on mental well-being in this population is limited, especially in the cultural context of south-western Europe (Gomis-Pomares & Villanueva, 2020; Kaminer et al., 2022).
Moreover, few studies have explored the co-occurrence of different types of ACEs and their relationship with mental health outcomes (Hughes et al., 2017).
This study aims to address these gaps by employing latent class analysis (LCA) to identify patterns of ACEs among Spanish university students and examine their association with lower mental well-being, while also considering the role of mental illness in this relationship.
Method
The study employed a cross-sectional design and used self-report questionnaires to assess ACEs, mental well-being, and mental illness among university students in Spain.
The sample comprised 1,023 Spanish university students (71.6% female) aged between 18 and 64 years (M = 20.10, SD = 3.93).
Participants completed a structured self-report questionnaire that gathered demographic information and assessed their ACEs, mental well-being, and psychiatric diagnoses.
Measures
- Adverse Childhood Experiences International Questionnaire (ACE-IQ): Assesses the presence of 13 categories of ACEs.
- Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS): Measures mental well-being by asking respondents about their experiences of positive mental states over the past two weeks.
- Demographic and health variables: A structured self-report questionnaire gathered information on age, gender, sexual orientation, religious affiliation, and psychiatric diagnoses.
Statistical measures
Latent class analysis (LCA) was used to identify patterns of ACEs. Multiple linear hierarchical regression was conducted to examine the relationship between ACE classes, mental well-being, and other covariates.
Results
- At least three classes of ACEs were expected. The LCA identified four classes: Low ACEs, Dysfunctional Household, Household and Peer Abuse, and High ACEs.
- Individuals who experienced a higher number of ACEs were expected to report lower levels of mental well-being. The results partially confirmed this, as the Dysfunctional Household, Household and Peer Abuse, and High ACEs classes reported significantly lower levels of mental well-being compared to the Low ACEs class.
- Individuals with a psychiatric diagnosis were expected to report lower levels of mental well-being. This hypothesis was confirmed, as having a mental illness was the strongest predictor of lower levels of well-being.
Insight
The study used latent class analysis (LCA) to investigate patterns of adverse childhood experiences (ACEs) among university students in Spain. Four distinct classes were identified, each with varying prevalence and types of ACEs. Significant differences in mental health outcomes were also found across the classes.
Students in the High ACEs class were more likely to have a mental illness diagnosis and reported lower well-being compared to those in other classes. Interestingly, the Household and Peer Abuse class and the High ACEs class had similar predicted levels of well-being, despite the Household and Peer Abuse class experiencing fewer adversities than the Dysfunctional Household class.
This suggests that when examining moderate levels of ACEs, it is crucial to consider the specific types of co-occurring ACEs rather than just the total number experienced, as the combination of ACEs may have a more substantial impact on self-reported well-being than the overall number. Understanding the specific types and combinations of ACEs is valuable for comprehending changes in mental health.
Having a mental illness was the strongest predictor of lower well-being among all analyzed variables. This may be due to the symptomatic challenges that not only affect the well-being of individuals with mental illnesses but also hinder various aspects of their lives, such as employment opportunities and social connections. Additionally, the stigma surrounding mental illnesses is a critical factor that often contributes to discrimination.
However, ACEs still played a role in mental well-being, indicating that mental illness alone does not determine this relationship. Experiencing childhood adversity was nearly as relevant as mental illness in understanding lower well-being.
Therefore, when working with university students, professionals should adopt a comprehensive approach that addresses both mental health issues and the impact of childhood adversity.
These findings highlight the association between childhood adversity, mental illness, and lower well-being outcomes, providing a foundation for future research in this area.
Strengths
- Use of LCA to identify patterns of ACEs
- Examination of the relationship between ACEs, mental well-being, and mental illness
- Relatively large sample size.
Limitations
- Cross-sectional design, which precludes the inference of causal relationships
- Overrepresentation of females in the sample
- The study did not consider the frequency or duration of ACEs, which are potentially important factors in understanding the severity of the experience and might affect the identification of patterns in ACEs.
- Self-report measures, due to the potential impact of the individual’s mental state during assessment. For example, being in a depressive state at the time of the interview can influence not only their well-being self-report scores but also render them more inclined to report negative experiences from their past.
Implications
The results underscore the importance of screening for ACEs and mental health problems among university students and developing targeted interventions to promote mental well-being.
The findings also highlight the need for a comprehensive approach that addresses both mental health issues and the impact of childhood adversity when working with this population.
References
Primary reference
Bartolomé-Valenzuela, M., Pereda, N., & Guilera, G. (2024). Patterns of adverse childhood experiences and associations with lower mental well-being among university students. Child Abuse & Neglect, 152, 106770. https://doi.org/10.1016/j.chiabu.2024.106770
Other references
Aizpurua, E., Caravaca-Sanchez, F., & Stephenson, A. (2021). Victimization status of female and male college students in Spain: Prevalence and relation to mental distress. Journal of Interpersonal Violence, 36(11-12), 4988–5010. https://doi.org/10.1177/0886260518802842
Gomis-Pomares, A., & Villanueva, L. (2020). The effect of adverse childhood experiences on deviant and altruistic behavior during emerging adulthood. Psicothema, 32(1), 33–39. https://doi.org/10.7334/psicothema2019.142
Ho, G. W., Chan, A. C., Chien, W. T., Bressington, D. T., & Karatzias, T. (2019). Examining patterns of adversity in Chinese young adults using the Adverse Childhood Experiences—International Questionnaire (ACE-IQ). Child Abuse & Neglect, 88, 179–188. https://doi.org/10.1016/j.chiabu.2018.11.009
Hughes, K., Bellis, M. A., Hardcastle, K. A., Sethi, D., Butchart, A., Mikton, C., Jones, L., & Dunne, M. P. (2017). The effect of multiple adverse childhood experiences on health: A systematic review and meta-analysis. The Lancet Public Health, 2(8), e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
Kaminer, D., Bravo, A. J., Mezquita, L., & Pilatti, A. (2022). Adverse childhood experiences and adulthood mental health: A cross-cultural examination among university students in seven countries. Current Psychology. https://doi.org/10.1007/s12144-022-02978-3
Khrapatina, I., & Berman, P. (2017). The impact of adverse childhood experiences on health in college students. Journal of Child & Adolescent Trauma, 10, 275–287. https://doi.org/10.1007/s40653-016-0093-0
Merians, A. N., Baker, M. R., Frazier, P., & Lust, K. (2019). Outcomes related to adverse childhood experiences in college students: Comparing latent class analysis and cumulative risk. Child Abuse & Neglect, 87, 51–64. https://doi.org/10.1016/j.chiabu.2018.07.020
Tran, Q. A., Dunne, M. P., Vo, T. V., & Luu, N. H. (2015). Adverse childhood experiences and the health of university students in eight provinces of Vietnam. Asia Pacific Journal of Public Health, 27(8), 26S–32S. https://doi.org/10.1177/1010539515589812
Windle, M., Haardorfer, R., Getachew, B., Shah, J., Payne, J., Pillai, D., & Berg, C. J. (2018). A multivariate analysis of adverse childhood experiences and health behaviors and outcomes among college students. Journal of American College Health, 66(4), 246–251. https://doi.org/10.1080/07448481.2018.1431892
Keep Learning
- How might the identification of the Household and Peer Abuse class inform the development of targeted prevention and intervention strategies for university students?
- Given the strong association between mental illness and lower well-being, what steps can universities take to better support students with mental health problems and promote their overall well-being?
- How can future research build upon the findings of this study to further our understanding of the long-term impact of ACEs on mental health and well-being across the lifespan?
- Considering the limitations of this study, what methodological improvements can be made in future research to strengthen the generalizability and robustness of the findings?
