The childhood roots of adult psychological distress: Interdisciplinary perspectives toward a better understanding of exposure to cumulative childhood adversity.

ABSTRACT

BACKGROUND: Although most children experience at least one adversity, it is the experience of multiple adversities that produces a context of disadvantage that increases the risk of various negative outcomes in adulthood. Previous measures of cumulative childhood adversity consider a limited number of adversities, overlook potential differences across experiences of adversity, and fail to measure the effects of multiple co-occurring childhood adversities. These limitations have led to inconsistent and incomplete conclusions regarding the impact of multiple adverse childhood experiences on adult mental health. OBJECTIVE: This study assesses how the operationalization and modeling of exposure to cumulative childhood adversity (CCA) influences estimates of the association between CCA and adult psychological distress and develops an improved measure of CCA. METHODS: We use data from the Panel Study of Income Dynamics, a nationally representative sample of households in the United States, and its supplement, the Childhood Retrospective Circumstances Study (N = 4219). We compare four measures of CCA that consider various distinct aspects of adverse experiences (additive, severity, type, and patterns of experience using latent class analysis). RESULTS: All measures of CCA were associated with increases in adult psychological distress, but effects depend on the measurement of CCA. Results suggest the sum score overestimates the overall impact of CCA. Latent class analysis captures the co-occurrence of adversities across severity and type, providing an improved measure of CCA. CONCLUSIONS: The heterogeneity across adversities impacts estimates of adult psychological distress. Measuring CCA as patterns of co-occurring adverse experiences is a promising approach.