Background:
Adverse childhood experiences (ACEs) are well-established risk factors for self-harm and depression.
However, despite their high comorbidity, there has been little focus on the impact of developmental
timing and the duration of exposure to ACEs on co-occurring self-harm and depression.
Methods:
Data were utilised ...
Background:
Adverse childhood experiences (ACEs) are well-established risk factors for self-harm and depression.
However, despite their high comorbidity, there has been little focus on the impact of developmental
timing and the duration of exposure to ACEs on co-occurring self-harm and depression.
Methods:
Data were utilised from over 22,000 children and adolescents participating in three UK cohorts,
followed up longitudinally for 14 to 18 years: the Avon Longitudinal Study of Parents and Children
(ALSPAC), the Millennium Cohort Study (MCS), and the Environmental Risk (E-Risk) Longitudinal Twin
Study. Multinomial logistic regression models estimated associations between each ACE type and a
four-category outcome: no self-harm or depression, self-harm alone, depression alone, and selfharm with co-occurring depression. A Structured Life Course Modelling Approach was used to
examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of
ACEs) had the strongest effects on self-harm and depression in adolescence.
Results:
The majority of ACEs were associated with co-occurring self-harm and depression, with consistent
findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and
across cohorts. For parental mental health problems, longer duration of exposure was strongly
associated with co-occurring self-harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI:
1.10-1.25) and MCS (1.18, 1.11-1.26) cohorts. For other ACEs in ALSPAC, exposure in middle
childhood was most strongly associated with co-occurring self-harm and depression, and ACE
occurrence in early childhood and adolescence were more important in the MCS.
Conclusion:
Efforts to mitigate the impact of ACEs should start in early life with continued support throughout
childhood, to prevent long-term exposure to ACEs contributing to risk of self-harm and depression in
adolescence.
