adverse childhood experiences; perceived health; depression; mediation; sociological factors; child abuse; domestic violence; health behavior; psychological stress


Community Health and Preventive Medicine | Developmental Psychology | Health Psychology


Background: Adverse Childhood Experiences (ACEs) have been shown to contribute to a litany of mental and physical health problems, including several chronic diseases and death, via a model known as the ACE pyramid. Many of the results of ACEs in the ACE pyramid are known contributors to poor perceived health, which has significant health implications. Despite these results, a possible link between ACEs and perceived health has not been examined to date. Based on the temporal order of the ACE pyramid, we believe any relationship between ACEs and perceived health will be mediated by other components of the model.

Methods: We conducted an analysis of the 2010 Behavioral Risk Factor Surveillance System (BRFSS) data for 4 states (Hawaii, Nevada, Vermont and Wisconsin).The Adverse Childhood Experiences Scale (11 questions) and Physical Health Days (days out of the last 30 where physical health was not good) were the primary predictor and outcome variables, respectively. The PHQ-8, a depression measure, served as a first-level mediator, while body mass index, Sleep Days (days out of the last 30 that sleep was poor) and average monthly alcohol consumption served as second-level mediators. We conducted a multiply-mediated regression using PROCESS (Hayes, 2018).

Results: The analysis included 6,060 respondents. ACEs were associated with an increase of 0.28 additional days of poor perceived health days per ACE through increases in depression and poor sleep.

Conclusions: Adverse childhood experiences may influence perceived health through multiple intermediary factors, including depression and poor sleep quality. We discuss several theoretical and clinical implications, and future directions are proposed that take advantage of the multiply-mediated model.