Mental Health

Positive and Adverse Childhood Experiences and Adult Health and Economic Outcomes.

TL;DR

Positive childhood experiences (PCEs) were strongly associated with better adult health and well-being, even in the presence of adversity, and maximizing PCEs at the population level could theoretically prevent up to 36.5% of depression and 30.7% of poor mental health in adulthood.

Key Findings

Higher PCEs were associated with significantly improved adult outcomes including reduced depression, better mental health, and increased income and education, regardless of ACEs levels.

  • Data were drawn from the Behavioral Risk Factor Surveillance Survey from 4 states (2015-2020)
  • Sample included 18,773 adults
  • PCEs and ACEs were categorized and evaluated against 20 adult health and life opportunity outcomes
  • Propensity score matching and survey-weighted generalized linear models were used to estimate adjusted prevalence ratios
  • Associations with improved outcomes held regardless of ACEs exposure

Among adults reporting ACEs, those with high PCEs reported lower tobacco use, lower rates of chronic diseases (including asthma, diabetes, and heart disease), and better general health.

  • This finding specifically applied to the subgroup reporting ACEs
  • Chronic diseases examined included asthma, diabetes, and heart disease
  • ACEs moderated some but not all associations between PCEs and adult outcomes
  • Results highlight the independent protective associations of PCEs even in the presence of adversity

Maximizing PCEs at the population level could theoretically prevent up to 36.5% of depression and 30.7% of poor mental health in adulthood, based on prevented fraction estimates.

  • Population attributable fractions (PAFs) and prevented fractions for the population (PFPs) were calculated
  • PFP for depression was up to 36.5%
  • PFP for poor mental health was up to 30.7%
  • These figures represent the theoretical maximum preventable burden if PCEs were maximized across the population

Reports of PCEs and ACEs were inversely related, meaning individuals reporting more PCEs tended to report fewer ACEs.

  • This inverse relationship was observed in the sample of 18,773 adults
  • Data spanned 2015-2020 across 4 states using the Behavioral Risk Factor Surveillance Survey
  • This pattern suggests PCEs and ACEs may co-occur in complementary rather than independent distributions in the population

ACEs moderated some but not all associations between PCEs and adult health outcomes, indicating PCEs have both independent and adversity-buffering protective effects.

  • 20 adult health and life opportunity outcomes were evaluated
  • Some outcomes showed ACE moderation of the PCE-health relationship while others did not
  • The independent protective associations of PCEs were highlighted as a distinct finding from the moderation effect
  • Authors describe these findings as supporting 'the potential value of PCEs as a public health strategy to improve long-term outcomes and reduce societal costs'

What This Means

This research suggests that positive childhood experiences (PCEs) — such as having supportive relationships, feeling safe, and having opportunities to learn — are strongly linked to better health and economic outcomes in adulthood, including lower rates of depression, less chronic disease, higher income, and more education. The study analyzed survey data from nearly 19,000 adults across four U.S. states collected between 2015 and 2020, comparing people with different levels of both positive and adverse childhood experiences across 20 different health and life outcomes. One of the most notable findings is that the benefits of PCEs appeared even among people who had also experienced childhood adversity (ACEs), such as abuse, neglect, or household dysfunction. Adults who experienced both adversity and high levels of positive experiences had better health than those who experienced adversity alone, suggesting that PCEs may help buffer some of the harmful effects of ACEs. The study estimated that if PCEs were maximized across the entire population, up to 36.5% of adult depression and 30.7% of poor mental health cases could theoretically be prevented. This research suggests that public health efforts focused not only on reducing childhood adversity but also on actively promoting positive childhood experiences could have significant long-term benefits for population health and economic well-being. Policies and programs that support nurturing relationships, safe environments, and enriching opportunities for children may serve as an important complement to existing efforts that focus on preventing or addressing childhood trauma.

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Citation

Aslam M, Burstein D, Hannan K, Holditch Niolon P, Swedo E, Besera G, et al.. (2026). Positive and Adverse Childhood Experiences and Adult Health and Economic Outcomes.. Pediatrics. https://doi.org/10.1542/peds.2025-074543