Mental Health

Adverse childhood experiences and mental health symptoms among aviation shift workers in China: A national cohort study.

TL;DR

Adverse childhood experiences showed a dose-response association with mental health risks among aviation shift workers in China, with family dysfunction showing the strongest associations with depression (AOR 5.22), anxiety (AOR 3.94), and suicidal ideation (AOR 4.46).

Key Findings

Latent class analysis identified three distinct ACE patterns among aviation personnel: low ACE, abuse, and family dysfunction.

  • The study analyzed 19,137 aviation personnel aged 18-60 from the Civil Aviation Health Cohort of China (data collected November to December 2023)
  • 61.7% of participants were male with a mean age of 31.7 years
  • Low ACE class comprised 96.5% of participants, abuse class comprised 2.8%, and family dysfunction class comprised 0.7%
  • 11 ACE types were reported and categorized both by count and latent class analysis

ACE prevalence showed that 22.6% of aviation personnel reported at least one ACE and 1.2% reported four or more ACEs.

  • 22.6% of the sample reported ≥1 ACE
  • Only 1.2% reported ≥4 ACEs
  • A dose-response association was observed between ACE count and mental health risks
  • ACEs were assessed using 11 types via retrospective self-report

Family dysfunction showed the strongest association with depression symptoms among aviation shift workers.

  • Adjusted odds ratio (AOR) for depression in the family dysfunction class was 5.22 (95% CI 3.80–7.17)
  • Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) and a single-item screener
  • Family dysfunction class represented only 0.7% of the sample yet showed the strongest effect sizes across all mental health outcomes
  • This association was stronger than that observed for the abuse class

Family dysfunction showed the strongest association with anxiety symptoms among aviation shift workers.

  • AOR for anxiety in the family dysfunction class was 3.94 (95% CI 2.82–5.50)
  • Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7) and a single-item screener
  • The abuse class also showed elevated anxiety risk, but to a lesser degree than the family dysfunction class

Family dysfunction showed the strongest association with suicidal ideation among aviation shift workers.

  • AOR for suicidal ideation in the family dysfunction class was 4.46 (95% CI 2.55–7.82)
  • Suicidal ideation was assessed using a single-item screener
  • This association was notably strong given the small proportion (0.7%) of participants in the family dysfunction class

A dose-response relationship was observed between ACE count and mental health symptom risks in this aviation worker sample.

  • Higher numbers of ACEs were associated with progressively greater risks of depression, anxiety, and suicidal ideation
  • This dose-response pattern was observed across mental health outcomes assessed by both standardized scales (PHQ-9, GAD-7) and single-item screeners
  • The cross-sectional design precludes causal inference about this association

What This Means

This research suggests that difficult childhood experiences — such as abuse or growing up in a dysfunctional family environment — are strongly linked to mental health problems like depression, anxiety, and suicidal thoughts in adults who work shifts in the aviation industry in China. The study surveyed over 19,000 aviation workers and found that about 1 in 4 had experienced at least one adverse childhood experience (ACE). Using a statistical technique called latent class analysis, the researchers grouped workers into three categories based on their childhood experiences: those with few or no ACEs (the vast majority), those with a history of abuse, and those from dysfunctional family backgrounds. Workers who grew up in dysfunctional families had the most elevated mental health risks — more than five times the odds of depression, nearly four times the odds of anxiety, and more than four times the odds of suicidal ideation compared to those with low ACE exposure. The findings also show a 'dose-response' pattern, meaning the more types of adverse childhood experiences a person reported, the greater their risk of mental health symptoms as an adult. This pattern held even though the vast majority of workers had low ACE exposure, with only about 1 in 100 reporting four or more types of childhood adversity. Aviation shift workers — who already face high stress, irregular schedules, and demanding safety responsibilities — may be especially vulnerable to these effects. This research suggests that workplaces in high-stress industries like aviation should consider screening for and addressing the mental health needs of employees who may have experienced childhood adversity. Because the study was conducted at a single point in time and relied on workers recalling childhood events, it cannot prove that ACEs directly caused these mental health outcomes, and the authors note that recall bias and other limitations apply. Nevertheless, the findings highlight a potentially important and underrecognized factor in occupational mental health for shift workers.

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Citation

Li R, Su Y, Zhang L, Chen M, Zhang E, Zhang J, et al.. (2026). Adverse childhood experiences and mental health symptoms among aviation shift workers in China: A national cohort study.. Journal of affective disorders. https://doi.org/10.1016/j.jad.2026.121979