Adverse Childhood Experiences Linked to Poor Mental Health in US Adolescents

Strategic Insights -

A recent study from Boston Children's Hospital has found a significant association between adverse childhood experiences (ACEs) and poor mental health in US adolescents. The research, published in the Journal of Adolescent Health, analyzed data from the 2019 and 2021 National Health Interview Survey and found that millions of adolescents were exposed to ACEs, leading to a range of negative outcomes, including anxiety and depression, delayed or forgone mental health care, and unmet health care needs due to cost.

Key Takeaways:

  • The study found that 77.7% of adolescents were exposed to 0 ACEs, 13.2% were exposed to 1 ACE, and 9.2% were exposed to 2+ ACEs.
  • Exposure to 1 or 2+ ACEs was positively associated with anxiety and depression symptom frequency, urgent care and emergency department use, trouble paying medical bills, delayed and forgone mental health care due to cost, and delayed and forgone care due to the COVID-19 pandemic.
  • Adolescents exposed to ACEs experienced mutually reinforcing disadvantages, including a worse mental health symptom burden and greater barriers to accessing needed medical and mental health care.
  • The researchers concluded that ACEs must be reconceptualized as markers of structural rather than individual adversity and addressed through structural and policy interventions.
  • The study highlights the need for policymakers and healthcare providers to prioritize addressing ACEs and their consequences in order to improve mental health outcomes for US adolescents.

Statistics:

  • 77.7% (N = 15,758,023) of adolescents were exposed to 0 ACEs.
  • 13.2% (N = 2,671,342) of adolescents were exposed to 1 ACE.
  • 9.2% (N = 1,864,704) of adolescents were exposed to 2+ ACEs.
  • 7.8% (N = 1,407,670) of adolescents were exposed to parental incarceration.
  • 6.9% (N = 1,567,483) of adolescents were exposed to neighborhood violence.
  • 10.3% (N = 2,088,957) of adolescents were exposed to a guardian with serious mental illness.
  • 11.4% (N = 2,304,953) of adolescents were exposed to a guardian with alcohol or drug problems.
  • 15,758,023 adolescents did not experience any ACEs.
  • 2,671,342 adolescents experienced one ACE.
  • 1,864,704 adolescents experienced two or more ACEs.

Sources:

  • "Adverse Childhood Experiences and Unmet Health Care Needs Due to Cost and the COVID-19 Pandemic: A Nationally Representative Analysis of U.S. Adolescents." Journal of Adolescent Health, vol. 77, no. 3, 2025, pp. 514-523.
  • Boston Children's Hospital. Reports from Boston Children's Hospital Describe Recent Advances in COVID-19 (Adverse Childhood Experiences and Unmet Health Care Needs Due to Cost and the COVID-19 Pandemic: A Nationally Representative Analysis of U.S. Adolescents). Mental Health Weekly Digest. September 15, 2025; p 292.