Capturing Risk Associated with Childhood Adversity: Independent, Cumulative, and Multiplicative Effects of Physical Abuse, Sexual Abuse, and Family Violence on Mental Disorders and Suicidality.

Adverse childhood experiences (ACEs) are often operationalized as a cumulative score, treating all forms of adversity as equivalent despite fundamental differences in the type of exposure. To explore the suitability of this approach, we examined the independent, cumulative, and multiplicative effects of physical abuse, sexual abuse, and/or family violence on the occurrence of mental disorders in adults. Data from the 2012 Canadian Community Health Survey-Mental Health were used to derive a series of logistic regression models. A set of interaction terms was included to model the multiplicative effects of ACEs on mental disorders and suicidality. The independent effects of physical abuse and sexual abuse were stronger than the effects of family violence. The cumulative effects represent nearly a 2-fold increase in disorder for each additional form of adversity. The multiplicative effects suggested that the clustering of physical abuse and sexual abuse had the greatest effect on mental disorders and suicidality. These findings highlight the need to examine the nuanced effects of clustering of adversity in an individual, rather than relying on a single cumulative score. Future work should examine a comprehensive set of ACEs to identify which ACE combinations contribute to greater mental health burden, thereby informing the development of specific interventions.