Associations of Adverse Childhood Experiences with Past-Year DSM-5 Psychiatric and Substance Use Disorders in Older Adults

Taeho Greg Rhee, Lisa C Barry, George A Kuchel, David C Steffens, Samuel T Wilkinson

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


OBJECTIVES: To examine the prevalence of adverse childhood experiences (ACEs) and the associations of ACEs with psychiatric and substance use disorders among older adults in the United States. DESIGN: Cross-sectional analysis of the 2012-2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC-III). SETTING: Nationally representative drug-related health interview survey in the United States. PARTICIPANTS: Survey respondents aged 65 or older (n = 5806 unweighted). MEASUREMENTS: ACEs, the key independent variable, were assessed using validated measures. Outcome variables consisted of past-year psychiatric disorders (eg, major depressive disorder and generalized anxiety disorder) and substance use disorders (eg, alcohol use disorder) using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We estimated the national prevalence of ACEs in older adults and used multivariable-adjusted logistic regression analyses to assess the association between ACEs and the outcomes after adjusting for sociodemographics and clinical comorbidities. RESULTS: Overall, 35.9% of older adults, representative of 14.8 million older adults nationwide, reported some form of ACEs. The most common types were parental psychopathology (20.3%), other traumatic events (14.0%), and physical/psychological abuse (8.4%). Having experienced any ACEs was associated with higher odds of having a past-year psychiatric disorder (adjusted odds ratio = 2.11; 95% confidence interval = 1.74-2.56). Similar results were found for substance use disorders (P <.01). CONCLUSION: ACEs are linked to an increased risk for past-year psychiatric and substance use disorders in older adults. ACEs may have long-term effects on older adults’ mental well-being. Although further research is needed, preventing ACEs may lead to large improvements in public mental health that persist well into older age. J Am Geriatr Soc 67:2085–2093, 2019.

Original languageEnglish (US)
Pages (from-to)2085-2093
Number of pages9
JournalJournal of the American Geriatrics Society
Issue number10
Early online dateJun 17 2019
StatePublished - Oct 1 2019

Bibliographical note

Funding Information:
Financial Disclosure: In the past 3 years, Taeho Greg Rhee was supported in part by the National Institute on Aging (#T32AG019134). Samuel T. Wilkinson was supported in part by the Agency for Healthcare Research and Quality (no. K12HS023000), American Foundation for Suicide Prevention, Brain and Behavior Research Foundation (formerly NARSAD), the Patient-Centered Outcomes Research Institute, and the Robert E. Leet and Clara Guthrie Patterson Foundation. Conflict of Interest: Each author completed and submitted the International Committee of Medical Journal Editors Form for Disclosure of Potential Conflicts of Interest. David C. Steffens has received consulting fees from Janssen Research & Development, LLC. Samuel T. Wilkinson has received funding administered through Yale University from Janssen Research & Development, LLC and Sage Therapeutics. Author Contributions: Study concept and design: Rhee. Data acquisition and statistical analyses: Rhee. Interpretation of data: All authors. Drafting of manuscript: Rhee. Critical revision of manuscript for important intellectual content: All authors. Sponsor's Role: The funding agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.

Publisher Copyright:
© 2019 The American Geriatrics Society


  • adverse childhood experiences
  • mental health
  • older adults
  • psychiatric disorder
  • substance use disorder

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural


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