DOI: 10.6084/m9.figshare.27754137.v1
title: Supplementary Material for: Adverse Childhood Experiences are associated with Mental Health Problems later in life: An Umbrella Review of Systematic Review and Meta-analysis

description: Abstract
Introduction: Evidence suggested a link between early adversity and mental health problems. 
However, it is unclear how much adverse childhood experiences (ACEs) contribute to mental health problems because researchers have produced inconsistent findings. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the effect of ACEs on the development of mental health problems later in life in the global context. 
Methods: PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar which reported the effect of ACEs on the development of mental health problems were searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed. 
Results: Forty-three SRM with 14707614 study participants were included. The pooled effect of ACEs on the development of mental health problems later in life in the global context is found to be (AOR=1.66 (1.46, 1.87)). Subgroup analysis based on country revealed (AOR=1.67(1.23, 2.11)) in UK, (AOR=0.61(0.41, 0.81)) in Canada, (AOR=1.55(1.40, 1.69)) in Brazil, (AOR=5.65(4.12, 7.18)) in Ethiopia, (AOR=1.92(1.45, 2.38)) in USA, (AOR=2.30(1.89, 2.72)) in Australia and (AOR=1.66(1.46, 1.87)) in irland. While subgroup analysis based on types of adverse childhood adverse experience: domestic violence ((AOR=4.13(1.96, 6.30)), maltreatment (AOR=1.5(0.79, 2.21)), physical abuse(AOR=1.56(1.43,1.63), sexual abuse (AOR=2.07(1.63, 2.51)), child abuse (AOR=5.66(4.12,7.18)), parental mental health problem (AOR=1.73(1.39,2.08)), bullying (AOR=1.99(1.69, 2.29), neglect(AOR=2.11(1.53,2.69)), and parental divorce (AOR=1.66(1.46,1.87)). Based on the type of mental health problem the pooled effect size is 1.87(1.45, 2.30) for depression and 1.67(1.22, 2.13) for anxiety. 
Conclusion: This umbrella review revealed that adverse childhood experience is significantly associated (with 66% increased risk) with anxiety and depression later in life in a global context. This association is most noticeable when one is subjected to domestic violence, maltreatment, physical abuse, sexual abuse, child abuse, parental mental health problems, bullying, neglect, and parental divorce. Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures. Preventing childhood maltreatment and addressing psychiatric risk factors can prevent psychopathology. Longitudinal studies are needed to optimize healthcare responses to ACEs. Increased awareness and public health interventions are needed to prevent childhood adversity and prevent mental problems among these victims. To optimize healthcare responses to unfavorable outcomes of childhood adversities, longitudinal and intervention research findings, more public health initiatives, and awareness are required.