Skip to main content

Association of adverse childhood experiences with lifetime mental and substance use disorders among men and women aged 50+ years

  • Namkee G. Choi (a1), Diana M. DiNitto (a1), C. Nathan Marti (a1) and Bryan Y. Choi (a2)

Given growing numbers of older adults with mental and substance use disorders (MSUDs), this study examined the association between ten types of adverse childhood experiences (ACEs) and lifetime MSUDs among those aged 50+.


Data (N = 14,738 for the 50+ age group) came from the 2012 to 2013 National Epidemiologic Survey on Alcohol and Related Conditions. Using multivariable binary logistic regression analyses, we examined relationships between ten ACEs and six lifetime MSUDs (major depressive disorder (MDD) and anxiety, post-traumatic stress, alcohol use, drug use, and nicotine use disorders). Gender differences were examined using tests of interaction effects and gender-separate logistic regression models.


Of the sample, 53.2% of women and 50.0% of men reported at least one ACE. For both genders, parental/other adult's substance abuse was the most prevalent (22.6%), followed by physical abuse, and emotional neglect. Child abuse and neglect and parental/other adult's mental illness and substance abuse had small but consistently significant associations with MSUDs (e.g., odds ratio = 1.28, 95% CI = 1.12–1.46 for parental/other adult's substance misuse and MDD). Although the relationship between total number of ACEs and MSUDs was cumulative for both men and women, the associations of physical abuse, sexual abuse, emotional neglect, and parental separation/divorce with MSUDs were stronger among men.


This study underscores the significant yet modest association between ACEs and lifetime MSUDs in late life. More research is needed to investigate why ACEs seem to have greater effects on older men and to discern the sources of gender differences in ACEs’ effects.

Corresponding author
Correspondence should be addressed to: Namkee G. Choi, The University of Texas at Austin School of Social Work, 1925 San Jacinto Blvd, Austin, Texas 78759, USA. Email:
Hide All
Allison, P. (2015). Statistical Horizons. When Can You Safely Ignore Multicollinearity?. Available at:
Anda, R. F. et al. (2002). Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatric Services, 53, 10011009.
Anda, R. F. et al. (2006). The enduring effects of abuse and related adverse experiences in childhood. A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174186.
Bellis, M. A., Lowey, H., Leckenby, N., Hughes, K. and Harrison, D. (2014). Adverse childhood experiences: retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36, 8191. doi: 10.1093/pubmed/fdt038
Bernstein, D. P., Fink, L., Handelsman, L. and Foote, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. American Journal of Psychiatry, 151, 11321136.
Brady, K. T. and Back, S. E. (2012). Childhood trauma, posttraumatic stress disorder, and alcohol dependence. Alcohol Research: Current Reviews, 34, 408413.
Briere, J. and Elliott, D. (2003). Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse & Neglect, 27, 12051222. doi: 10.1016/j.chiabu.2003.09.008
Cavanaugh, C. E., Petras, H. and Martins, S. S. (2015). Gender-specific profiles of adverse childhood experiences, past year mental and substance use disorders, and their associations among a national sample of adults in the United States. Social Psychiatry and Psychiatric Epidemiology, 50, 12571266. doi: 10.1007/s00127-015-1024-3
Centers for Disease Control and Prevention. (2010, December 17). Adverse childhood experiences reported by adults – five states, 2009. Morbidity and Mortality Weekly Report (MMWR) , 59, 16091613. Available at:
Centers for Disease Control and Prevention. (2016). About Behavioral Risk Factor Surveillance System ACE Data. Available at:
Chapman, D. P., Whitfield, C. L ., Felitti, V. J., Dube, S. R., Edwards, V. J. and Anda, R. F. (2004). Adverse childhood experiences and the risk of depressive disorders in adulthood. Journal of Affective Disorders, 82, 217225.
Choi, N. G., DiNitto, D. M. and Marti, C. N. (2015). Alcohol and other substance use, mental health treatment use, and perceived unmet treatment need: comparison between baby boomers and older adults. American Journal on Addictions, 24, 299307.
Cross, D., Crow, T., Powers, A. and Bradley, B. (2015). Childhood trauma, PTSD, and problematic alcohol and substance use in low-income, African-American men and women. Child Abuse & Neglect, 44, 2635. doi: 10.1016/j.chiabu.2015.01.007
Douglas, K. R. et al. (2010). Adverse childhood events as risk factors for substance dependence: partial mediation by mood and anxiety disorders. Addictive Behaviors, 35, 713. doi: 10.1016/j.addbeh.2009.07.004
Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H. and Anda, R. F. (2003). The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Preventive Medicine, 37, 268277.
Edwards, V. J., Holden, G. W., Felitti, V. J. and Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. American Journal of Psychiatry, 160, 14531460.
Ehlert, U. (2013). Enduring psychobiological effects of childhood adversity. Psychoneoroendocrinology, 38, 18501857. doi: 10.1016/j.psyneuen.2013.06.007
Felitti, V. J. et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245258.
Fink, L. A., Bernstein, D., Handelsman, L., Foote, J. and Lovejoy, M. (1995). Initial reliability and validity of the childhood Trauma interview: a new multidimensional measure of childhood interpersonal trauma. American Journal of Psychiatry, 152, 13291335.
Grant, B. F. et al. (2015). National Institute on Alcohol Abuse and Alcoholism National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC- III) Source and Accuracy Statement. Available at:
Kalmakis, K. A. and Chandler, G. E. (2015). Health consequences of adverse childhood experiences: a systematic review. Journal of the American Association of Nurse Practitioners, 27, 457465. doi: 10.1002/2327-6924.12215
Kamiya, Y., Doyle, M., Henretta, J. C. and Timonen, V. (2013). Depressive symptoms among older adults: the impact of early and later life circumstances and marital status. Aging & Mental Health, 17, 349357. doi: 10.1080/13607863.2012.747078.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593602.
Keyes, K. M. et al. (2012). Childhood maltreatment and the structure of common psychiatric disorders. The British Journal of Psychiatry, 200, 107115. doi: 10.1192/bjp.bp.111.093062.
Lev-Ran, S., Le Strat, Y., Imtiaz, S., Rehm, J. and Le Foll, B. (2013). Gender differences in prevalence of substance use disorders among individuals with lifetime exposure to substances: results from a large representative sample. American Journal on Addictions, 22, 713. doi: 10.1111/j.1521-0391.2013.00321.x.
McCrory, E. J. and Mayes, L. (2015). Understanding addiction as a developmental disorder: an argument for a developmentally informed multilevel approach. Current Addiction Report, 2, 326330.
Straus, M. A. (1979). Measuring intrafamily conflict and violence: the conflict tactics (CT) scales. Journal of Marriage and Family, 41, 7588. doi: 10.2307/351733
Tamayo, T., Christian, H. and Rathmann, W. (2010). Impact of early psychosocial factors (childhood socioeconomic factors and adversities) on future risk of type 2 diabetes, metabolic disturbances and obesity: a systematic review. BMC Public Health, 10, 525. doi: 10.1186/1471-2458-10-525.
Tamres, L. K., Janicki, D. and Helgeson, V. S. (2002). Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Personality and Social Psychology Review, 6, 230.
Whitesell, N. R. et al. (2009). Childhood exposure to adversity and risk of substance-use disorder in two American Indian populations: the meditational role of early substance-use initiation. Journal of Studies on Alcohol and Drugs, 70, 971981.
Wyatt, G. E. (1985). The sexual abuse of Afro-American and white-American women in childhood. Child Abuse & Neglect, 9, 507519.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed