Association of childhood adversities with psychosocial difficulties among Chinese children and adolescents

Yuchen Li, Yanan Shang, Yao Yang, Can Hou, Huazhen Yang, Yao Hu, Jian Zhang, Huan Song, Wei Zhang

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Adverse childhood experiences (ACEs) have been well recognized as risk factors for various adverse outcomes. However, the impacts of ACEs on psychological wellbeing among Chinese children and adolescents are unknown. METHODS: In total, 27 414 participants (6592 Grade 4-6 and 20 822 Grade 7-12 students) were included and information on ACEs and various psychosocial outcomes was collected. We identified subgroups with distinct psychosocial statuses using cluster analysis and logistic regression was applied to measure the associations of ACEs [individual, cumulative numbers by categories or co-occurring patterns identified by using multiple correspondence analysis (MCA)] with item- and cluster-specific psychosocial difficulties. RESULTS: Three and four cluster-based psychosocial statuses were identified for Grade 4-6 and Grade 7-12 students, respectively, indicating that psychosocial difficulties among younger students were mainly presented as changes in relationships/behaviours, whereas older students were more likely featured by deviations in multiple domains including psychiatric symptoms and suicidality. Strongest associations were found for threat-related ACEs (e.g. bullying experiences) with item- or cluster-based psychosocial difficulties (e.g. for cluster-based difficulties, the highest odds ratios = 1.72-2.08 for verbal bullying in Grade 4-6 students and 6.30-12.81 for cyberbullying in Grade 7-12 students). Analyses on cumulative numbers of ACEs and MCA-based ACE patterns revealed similar risk patterns. Additionally, exposure patterns predominated by poor external environment showed significant associations with psychosocial difficulties among Grade 7-12 students but not Grade 4-6 students. CONCLUSIONS: Chinese adolescents faced different psychosocial difficulties that varied by age, all of which were associated with ACEs, particularly threat-related ACEs. Such findings prompt the development of early interventions for those key ACEs to prevent psychosocial adversities among children and adolescents.

Original languageEnglish
Pages (from-to)1887-1897
Number of pages11
JournalInternational Journal of Epidemiology
Issue number6
Publication statusPublished - 25 Dec 2023
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the International Epidemiological Association.

Other keywords

  • adolescents
  • Adverse childhood experiences
  • Chinese
  • cluster analysis
  • psychosocial status


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