Adverse Childhood Experiences and Mental Health Outcomes Among Black Men and Women: A Latent Class Analysis

Abstract

Objective: Adverse childhood experiences (ACEs) often co-occur and may cluster in patterns that influence mental health outcomes across the life course. Prior studies have primarily focused on conventional ACEs, with fewer incorporating expanded ACEs (i.e., community/neighborhood adversities) or examining these patterns specifically among Black adults. This study aimed to identify latent patterns of conventional and expanded ACEs among Black females and males and examine their associations with depression and post-traumatic stress disorder (PTSD).

Methods: Data were collected from 487 Black adults recruited through the Prolific online panel. Using the Philadelphia ACEs questionnaire, latent class analysis (LCA) was conducted to identify subgroups with similar ACE exposure patterns in the full sample and stratified by sex. OLS regression models examined associations between class membership (in the full sample and stratified by sex) and depression and PTSD, adjusting for age, marital status, educational attainment, income, employment status, and social support.

Results: A two-class solution was selected: (1) Class 1: High Conventional and Expanded ACEs and (2) Class 2: Low ACEs with High Emotional Neglect and Adverse Neighborhood Experiences. Individuals in Class 1 reported significantly higher depressive (B=5.51, p<0.001) and PTSD (B=13.41, p<0.001) symptoms when compared to those in Class 2. Age, income between $60,001-$100,000 and ≥100,001 (versus ≤$20,000), and social support were found to reduce depressive and PTSD symptoms, respectively, while being married/living with someone as if married (versus single/never married) increased risk for both depression and PTSD within the sample.

Sex-stratified analyses yielded four groups: (1) Class 1 Females: High Conventional and Expanded ACEs; (2) Class 1 Males: High Conventional and Expanded ACEs; (3) Class 2 Females: Low ACEs with High Emotional Neglect and Adverse Neighborhood Experiences; and (4) Class 2

Males: Low ACEs with High Emotional Neglect, Being Bullied, and Adverse Neighborhood Experiences.

Black females (B=3.83, p=0.001) and males (B=3.62, p=0.002) in the high conventional and expanded ACEs class reported higher depression scores when compared to those in the lower female ACE exposure group (Class 2 Females). Additionally, Class 2 males reported significantly lower depressive symptoms (B=-3.28, p=0.006) than Class 2 females.

Higher rates of PTSD were also found for females (B=11.58, p<0.001) and males (B=10.97, p<0.001) in the high conventional and expanded ACEs groups when compared to those in the lower female ACE exposure group (Class 2 females). Class 2 male membership was not found to be significantly associated with PTSD symptoms.

Age and social support were found to significantly reduce depressive and PTSD symptoms in the sex stratified model. However, income between $60,001-$100,000 and ≥100,001 (versus ≤$20,000), and social support were also found to reduce PTSD symptoms, while being married/living with someone as if married (versus single/never married) increased risk for PTSD.

Conclusion: Findings highlight the importance of examining clustered patterns of both conventional and community-level ACEs when assessing mental health risk among Black adults. The identification of distinct ACE profiles highlights the need for contextually and culturally grounded assessment and intervention approaches that extend beyond individual and family-level adversities to address broader structural and community-level factors that shape risk. Further, observed sex differences in ACE patterns and mental health outcomes highlight the importance of tailoring prevention and intervention strategies to gendered experiences, while strengthening social support and addressing socioeconomic disparities as key protective factors to mitigate long-term mental health consequences among Black adults.