Associations between adverse childhood experiences and progression to incident psychiatric disorders in older adults: A 22-year cohort study

The long-term impact of adverse childhood experiences (ACEs) on the development of psychiatric disorders in older adults remains unclear. This study examined associations between ACEs and incident psychiatric disorders in older adults. Data from the 2000-2022 wave of Health and Retirement Study in the USA were analyzed. Time-varying Cox regression and multistate Markov models were applied to explore the impact of ACEs on transitions across five health states: healthy, physical conditions (PC), mental health symptoms (MS), comorbid PC & MS, and psychiatric disorders. Models were adjusted for demographic, behavioral, and disease-related factors. A total of 8628 participants were included, with a mean age of 64.75 years (SD = 8.01). During a mean follow-up duration of 16.8 years, 1429 developed psychiatric disorders (incidence: 9.85 per 1000 person-years). ACEs were significantly associated with higher risk of incident psychiatric disorders in a dose-response relationship. Participants with ACEs had higher transition percentages and intensities from healthy to less healthy states, notably from PC & MS to psychiatric disorders (percentages: 3.7 vs. 3.2%) and from the healthy state to MS (intensities: 0.130 vs. 0.104). They also spent less time in the healthy state and more time in comorbid states, with a 33% higher 22-year cumulative probability of psychiatric disorders (25.3 vs. 19.0%). ACEs appear to have enduring adverse impacts on mental health in later life by accelerating the progression to comorbidity and the development of psychiatric disorders. Early clinical screening and physical-mental health interventions are essential for prevention.