The Association of Adverse Childhood Experiences With Anxiety and Depression for Children and Youth, 8 to 17 Years of Age

  • Amanda L. Elmore
    Address correspondence to Amanda L. Elmore, MPH, Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC 29208
    Department of Epidemiology and Biostatistics (AL Elmore), Arnold School of Public Health, University of South Carolina, Columbia, SC
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  • Elizabeth Crouch
    Rural and Minority Health Research Center (E Crouch), Arnold School of Public Health, University of South Carolina, Columbia, SC
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Published:February 21, 2020DOI:



      To determine the prevalence of anxiety and depression and examine their association with adverse childhood experiences (ACEs) among children and adolescents ages 8 to 17 years old.


      Using data from the 2016-2017 National Survey of Children's Health, we conducted a cross-sectional study design with a total sample of 39,929. Our exposure and outcome variables included caregiver report of 9 ACE exposures and current anxiety or current depression. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results.


      Our study found that 9% of children had current anxiety while 4% had current depression. Multivariate analysis concluded that all ACE measures were associated with significantly higher odds of both anxiety and depression. Children exposed to 4 or more ACEs had higher odds of anxiety (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI], 1.4–2.1) and depression (aOR = 2.2; 95% CI, 1.7–2.9) than children with exposure to fewer than four ACEs. Assessment of the outcomes of anxiety and depression separately showed differential impacts of ACE exposures as associations were stronger with depression for almost all ACE categories.


      Our study demonstrates a differential association between ACEs and anxiety and depression. This highlights the importance of assessing the impact of ACEs on internalizing behaviors separately. These findings are significant for pediatric providers as diagnosis and treatment for mental health disorders are vital components of pediatric care and further support the American Academy of Pediatrics' recommendation to screen for ACEs.


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