Adverse childhood experiences and child mental health: an electronic birth cohort study

Emily Lowthian* (Corresponding Author), Rebecca Anthony, Annette Evans, Rhian Daniel, Sara Long, Amrita Bandyopadhyay, Ann John, Mark A. Bellis, Shantini Paranjothy

*Corresponding author for this work

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Adverse Childhood Experiences (ACEs) are negatively associated with a range of child health outcomes. In this study, we explored associations between five individual ACEs and child mental health diagnoses or symptoms. ACEs included living with someone who had an alcohol related problem, common mental health disorder or serious mental illness, or experienced victimisation or death of a household member.


We analysed data from a population-level electronic cohort of children in Wales, UK, (N= 191,035) between the years of 1998 - 2012. We used Cox regression with discrete time-varying exposure variables to model time to child mental health diagnosis during the first 15 years of life. Child mental health diagnoses include four categories: (i) externalising symptoms (anti-social behaviour), (ii) internalising symptoms (stress, anxiety, depression), (iii) developmental delay (e.g., learning disability), and (iv) other (e.g., eating disorder, personality disorders). Our analyses were adjusted for social deprivation and perinatal risk factors.


There were strong univariable associations between the five individual ACEs, sociodemographic and perinatal factors (e.g., gestational weight at birth), and an increased risk of child mental health diagnoses. After adjusting for sociodemographic and perinatal aspects, there was a remaining conditional increased risk of any child mental health diagnosis, associated with victimisation (conditional hazard ratio (cHR) 1.90, CI 95% 1.34 – 2.69), and living with an adult with a common mental health diagnosis (cHR 1.63, CI 95% 1.52 – 1.75). Coefficients of product terms between ACEs and deprivation were not statistically significant.


The increased risk of child mental health diagnosis associated with victimisation, or exposure to common mental health diagnoses and alcohol problems in the household supports the need for policy measures and intervention strategies for children and their families.
Original languageEnglish
Article number172
Pages (from-to)1-13
Number of pages13
JournalBMC medicine
Early online date6 Aug 2021
Publication statusPublished - 6 Aug 2021

Bibliographical note

We thank the SAIL databank for assisting in the statistical disclosure process.
Declarations and Funding Data is collected routinely and access to this was granted via the SAIL databank. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication. The data sets generated and analysed during the current study are available in the SAIL databank repository, This work was supported by funds from the Economic and Social Research Council, the Medical Research Council, and Alcohol Research UK to the ELAStiC Project (ESL015471/1) and Public Health Wales. The views expressed are those of the authors and should not be assumed to be of the funding body. The research was also supported by The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, a UK Clinical Research Collaboration Public Health Research Centre of Excellence. This work was supported by Health Data Research UK, which receives its funding from HDR UK Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust. The funders had no role in designing the study, data collection, analysis, or interpretation, or in writing the report; MAB’s role in the design, analysis, and writing was independent of the funding from Public Health Wales. SP, SL and MAB had the original idea for this study. SP, AE, RA, EL and RD designed the study and developed the analysis plan. AJ provided advice on the mental health codes used in this analysis. AB extracted the data and prepared data sets for analysis. EM, AE and RA analysed the data. EM and RA wrote the first draft of the paper. All authors were involved in interpreting the findings, revising drafts and agreeing the final version.


  • Adverse Childhood Experiences
  • Mental Health
  • Cohort
  • Wales
  • Survival Analysis
  • Administrative Data


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