What This Means
This research followed 1,648 young people in Mpumalanga, South Africa over roughly a decade, measuring difficult childhood experiences (called Adverse Childhood Experiences or ACEs) when they were adolescents and then assessing their mental health as adults. Using a statistical method called latent class analysis, the researchers identified four distinct groups based on the patterns of ACEs people experienced: a low-ACE group, a group marked by having a parent affected by AIDS and parental illness, a group marked by parental AIDS-affectedness and parental death, and a group with many different types of ACEs. Importantly, the two classes with the worst adult mental health outcomes were largely defined by experiences specific to the South African context—particularly having a parent affected by HIV/AIDS—suggesting that assessments of childhood adversity need to account for local conditions rather than relying solely on measures developed in high-income Western countries.
Adults who had experienced the highest number and variety of ACEs as children showed significantly worse outcomes across all five mental health conditions measured: anxiety, depression, post-traumatic stress disorder, psychosis, and suicidality. Across all non-low ACE groups, poverty was notably higher, and differences in gender, age, and location were also found between the groups. This suggests that childhood adversity does not affect all children in the same way and that patterns of ACEs matter, not just how many a person experienced.
This research suggests that efforts to identify and support children at risk of poor mental health in South Africa and similar settings should consider a broader set of adversities than those traditionally included in ACE frameworks, including parental HIV/AIDS affectedness and death. The findings also support using approaches that look at which combinations of ACEs co-occur in specific individuals, rather than simply adding up how many adversities a child experienced, as this can reveal distinct risk profiles and help target support more effectively.