Assessing adverse childhood experiences and mental health status in diverse and underrepresented young people: advancing Inclusive research

Abstract Background Young people impacted by adverse childhood experiences (ACEs) are often underrepresented in mental health research. Aims This paper aims to advance inclusive research on ACEs by 1) describing co-designed recruitment and engagement methods in a national project on ACEs (Attune), 2) characterising a highly marginalised cohort of young people using identity descriptors co­designed with participants, and 3) reporting associations between ACEs, identity characteristics and mental health outcomes. Methods A trauma-aware approach to engage under-represented young people was co­developed with a national youth advisory group, lived experience researchers, and trusted community partners. Our co-created purposive sampling strategy recruited 74 young people, aged 10-24 years, across England, seeking representation by age, sex, gender identity, sexual orientation, ethnicity, neurodivergence, and geographic location. Participants completed validated self-report measures of ACEs, life events, and mental health. Descriptive, correlational and regression analyses examined cohort characteristics and associations between ACEs, identity characteristics, and mental health measures. Results The final cohort included participants identifying as non-White British (39.5%), non- binary/other gender (25%), and neurodivergent (30%). Half of participants reported exposure to at least one ACE. Analyses identified patterns consistent with prior literature. In addition, ACEs and barriers related to being neurodivergent were associated with increased depression and anxiety symptom severity. Non-binary gender identity was associated with anxiety. We did not observe associations of ACEs or mental health measures, with sex or ethnicity. Conclusions Under-represented groups can be reached via co-created engagement methods informed by lived experience. We identified important associations between ACEs, identities, and mental health outcomes.