Patterns of contextually sensitive adverse childhood experiences and associations with adult mental health outcomes in a longitudinal South African community sample: a latent class analysis

BACKGROUND: Adverse Childhood Experiences (ACEs) are associated with poor adult mental health, particularly in low-and middle-income countries where ACE exposure is high. AIMS: This study used latent class analysis (LCA) to characterise patterns of ACEs in a longitudinal sample of South African adolescents and explored associations between ACE classes and adult mental health, including anxiety, depression, post-traumatic stress disorder, psychosis, and suicidality. METHODS: Fourteen ACEs were assessed in 1648 adolescents (54.92% girls) from Mpumalanga using data collected across three waves (2010/2011, 2011/2012, and 2022/2023). Each ACE was dichotomised (exposed vs. not exposed), with exposure defined as meeting threshold criteria at either childhood wave. RESULTS: A four-class solution was identified: Low ACEs, High Parental AIDS-Affectedness and High Parental Sickness, High Parental AIDS-Affectedness and High Parental Death, and High multi-type ACEs. Compared to the low ACEs class, other classes had significantly higher poverty levels with further differences in gender, age and location. Adults in the highest multi-ACEs class reported significantly worse symptoms across all five mental health outcomes. Contextually sensitive ACEs (such as parental AIDS-affectedness) played an important role in differentiating ACE classes. Adults who experience multiple ACEs may be particularly at risk for poor mental health. In the two classes with, on average, the worst mental health outcomes, classes were primarily characterised by expanded ACEs, suggesting these broader adversities may confer unique risks in low-resource settings. CONCLUSIONS: Findings highlight the value of person-centred approaches like LCA to understand the complexity and multiplicative effects of ACEs and their long-term mental health impacts.