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 (PDOA) over 22 years. Data from the 2000–2022 Health and Retirement Study (HRS) 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 symptoms (MS), comorbid PC & MS, and PDOA. Models were adjusted for demographic, behavioral, and disease-related factors. Among 8,628 participants during average 16.8-year follow-up, 1,429 developed psychiatric disorders (incidence: 9.85 per 1,000 person-years). ACEs, particularly trauma/ violence (aHR = 1.279) and family dysfunction (aHR = 1.358), were significantly associated with higher risk. A dose-response relationship was found. Participants with ACEs had higher transition percentages and intensities from healthy to less healthy states, notably from PC & MS to PDOA (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 PDOA (25.3% vs. 19.0%). Risk was further elevated by younger age, female sex, higher educational level, low physical activity, insomnia, lung diseases, and arthritis. 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 screening and physical-mental health interventions are essential for prevention.