Keyword: confounding; meta-analysis

Schuster, Filip; Quotes from: Associations of the ten original Adverse Childhood Experiences (ACEs) with mental health impairments after controlling for the other ACEs (meta-analysis)
The ten original ACEs (including emotional, physical, and "sexual abuse") are associated with mental impairment among the people affected in countless studies. The corresponding bivariate associations are to a considerable extent confounding bias. The extent of the causal relationships is unresolved.
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Results: The magnitude of the bivariate associations between the ten original ACEs and mental health impairments is typically medium across
studies (median r=0.22), typically very small (r=0.07) after controlling for the nine other original ACEs, and even smaller (r=0.05) after controlling for additional ACEs. The ACEs incarceration of a household member (r=-0.01) and witnessing violence against the mother/parents (r=0.01) are not associated with mental health impairments after controlling for more than each of the nine other original ACEs. These associations are also very low for the ACEs "sexual abuse", divorce/separation of parents, and alcohol/drug problem of a household member (r=0.04 each).
Conclusions: The causal relationships between the ten original ACEs and mental health impairments are smaller than widely suspected. In the case of several original ACEs, long-term important negative health consequences
are not to be assumed. The ACEs concept should be fundamentally reconsidered.
Limitations: Also, because of the many ncontrolled confounding variables (including genes and other ACEs), the ssociations identified by the metaanalysis are not precise causal effect sizes.