1. Epidemiology and Global Health

Adverse childhood experiences and resilience among adult women: A population-based study

  1. Hilda Björk Daníelsdóttir  Is a corresponding author
  2. Thor Aspelund
  3. Edda Bjork Thordardottir
  4. Katja Fall
  5. Fang Fang
  6. Gunnar Tómasson
  7. Harpa Rúnarsdóttir
  8. Qian Yang
  9. Karmel W Choi
  10. Beatrice Kennedy
  11. Thorhildur Halldorsdottir
  12. Donghao Lu
  13. Huan Song
  14. Jóhanna Jakobsdóttir
  15. Arna Hauksdóttir
  16. Unnur Anna Valdimarsdóttir
  1. Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
  2. Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Sweden
  3. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
  4. Institute of Environmental Medicine, Karolinska Institutet, Sweden
  5. Department of Psychiatry, Massachusetts General Hospital, United States
  6. Harvard T.H. Chan School of Public Health, United States
  7. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Sweden
  8. Department of Psychology, Reykjavík University, Iceland
  9. West China Biomedical Big Data Center, West China Hospital, Sichuan University, China
https://doi.org/10.7554/eLife.71770
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Cite this article
  1. Hilda Björk Daníelsdóttir
  2. Thor Aspelund
  3. Edda Bjork Thordardottir
  4. Katja Fall
  5. Fang Fang
  6. Gunnar Tómasson
  7. Harpa Rúnarsdóttir
  8. Qian Yang
  9. Karmel W Choi
  10. Beatrice Kennedy
  11. Thorhildur Halldorsdottir
  12. Donghao Lu
  13. Huan Song
  14. Jóhanna Jakobsdóttir
  15. Arna Hauksdóttir
  16. Unnur Anna Valdimarsdóttir
(2022)
Adverse childhood experiences and resilience among adult women: A population-based study
eLife 11:e71770.
https://doi.org/10.7554/eLife.71770
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10 figures, 13 tables and 3 additional files

Figures

Figure 1
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Associations between different types of ACEs and perceived coping ability (A) and psychiatric resilience (B) (β and 95% CI).

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs. *Coefficients are standardized.

Figure 2
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Prevalence Ratios (with 95% CI) of high perceived coping ability (A) and high psychiatric resilience (B) in relation to individual ACEs.

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs.

Appendix 1—figure 1
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Sociodemographic characteristics of SAGA participants vs. the general female population of Iceland (see further: https://www.afallasaga.is/nidurstodur).
Appendix 1—figure 2
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Flow-chart of the analytic sample.
Appendix 1—figure 3
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Proposed causal model with alternative pathways of how ACEs could influence resilience in adulthood.

Note: Boxes in green indicate potential confounders of the association between ACEs and adult resilience, whereas boxes in red indicate potential mediators of the association.

Appendix 1—figure 4
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Flow-chart of the analytic sample (complete case analysis).
Appendix 1—figure 5
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Associations between different types of ACEs and perceived coping ability (A) and psychiatric resilience (B) (β and 95% CI).

Models were corrected for age, childhood deprivation, education level, civil status, employment status and income. *Coefficients are standardized.

Appendix 1—figure 6
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Prevalence Ratios (with 95% CI) of high perceived coping ability (A) and high psychiatric resilience (B) in relation to individual ACEs.

Models were corrected for age, childhood deprivation, education level, civil status, employment status and income.

Appendix 1—figure 7
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Associations between different types of ACEs and perceived coping ability (A) and psychiatric resilience (B) (β and 95% CI), complete case analyses (n = 19,637).

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs. *Coefficients are standardized.

Appendix 1—figure 8
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Prevalence Ratios (with 95% CI) of high perceived coping ability (A) and high psychiatric resilience (B) in relation to individual ACEs, complete case analyses (n = 19,637).

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs.

Tables

Table 1
Descriptive characteristics of the study population by number of adverse childhood experiences (ACE-IQ) (n = 26,198).
Number of ACEsACE-IQ sum score
Total
N (%)		0 ACE
N (%)		1 ACE
N (%)		2 ACEs
N (%)		3–4 ACEsN (%)≥ 5 ACEsN (%)p-value global*Mean (SD)p-value global†
Total26,1985,149 (19.7)5,567 (21.3)4,491 (17.1)5,640 (21.5)5,351 (20.4)2.6 (2.4)
Age, mean (SD)44.0 (13.6)43.7 (13.9)44.7 (13.9)44.6 (13.6)44.1 (13.4)43.1 (12.8)< 0.001
Age groups
18–29 years4,881 (18.6)1,043 (20.3)993 (17.8)805 (17.9)1,045 (18.5)995 (18.6)< 0.0012.6 (2.5)< 0.001
30–39 years5,309 (20.3)1,074 (20.9)1,128 (20.3)864 (19.2)1,107 (19.6)1,136 (21.2)2.7 (2.4)
40–49 years5,923 (22.6)1,092 (21.2)1,167 (21.0)1,003 (22.3)1,301 (23.1)1,360 (25.4)2.8 (2.5)
50–59 years6,055 (23.1)1,091 (21.2)1,281 (23.0)1,088 (24.2)1,356 (24.0)1,239 (23.2)2.7 (2.4)
≥ 60 years4,030 (15.4)849 (16.5)998 (17.9)731 (16.3)831 (14.7)621 (11.6)2.3 (2.2)
Educational level
Primary education3,739 (14.3)442 (8.6)662 (11.9)602 (13.4)889 (15.8)1,144 (21.4)< 0.0013.4 (2.61)< 0.001
Secondary education8,013 (30.6)1,402 (27.2)1,658 (29.8)1,360 (30.3)1,744 (30.9)1,849 (34.6)2.8 (2.32)
Tertiary A (BSc or equivalent)8,359 (31.9)1,856 (36.0)1,872 (33.6)1,488 (33.1)1,782 (31.6)1,361 (25.4)2.3 (2.09)
Tertiary B (MSc or above)5,990 (22.9)1,437 (27.9)1,360 (24.4)1,022 (22.8)1,210 (21.5)961 (18.0)2.3 (2.08)
Unknown97 (0.4)12 (0.2)15 (0.3)19 (0.4)15 (0.3)36 (0.7)3.7 (2.59)
Civil status
Married/in a relationship19,750 (75.4)4,061 (78.9)4,309 (77.4)3,442 (76.6)4,173 (74.0)3,765 (70.4)< 0.0012.5 (2.3)< 0.001
Single/widowed6,314 (24.1)1,070 (20.8)1,241 (22.3)1,030 (22.9)1,432 (25.4)1,541 (28.8)2.9 (2.5)
Unknown134 (0.5)18 (0.3)17 (0.3)19 (0.4)35 (0.6)45 (0.8)3.6 (2.8)
Employment status
Employed/studying22,088 (84.3)4,639 (90.1)4,826 (86.7)3,888 (86.6)4,734 (83.9)4,001 (74.8)< 0.0012.5 (2.3)< 0.001
Retired/disability/sick leave3,941 (15.0)494 (9.6)718 (12.9)573 (12.8)854 (15.1)1,302 (24.3)3.5 (2.8)
Unknown169 (0.6)16 (0.3)23 (0.4)30 (0.7)52 (0.9)48 (0.9)3.5 (2.6)
Income
Low income7,723 (29.5)1,206 (23.4)1,532 (27.5)1,216 (27.1)1,750 (31.0)2019 (37.7)< 0.0013.0 (2.6)< 0.001
Low-medium income7,862 (30.0)1,478 (28.7)1,663 (29.9)1,406 (31.3)1,717 (30.4)1,598 (29.9)2.6 (2.4)
Medium income6,050 (23.1)1,352 (26.3)1,363 (24.5)1,081 (24.1)1,236 (21.9)1,018 (19.0)2.3 (2.2)
High-medium income2,636 (10.1)654 (12.7)567 (10.2)466 (10.4)534 (9.5)415 (7.8)2.2 (2.2)
High income929 (3.5)250 (4.9)226 (4.1)141 (3.1)196 (3.5)116 (2.2)2.0 (2.0)
Unknown998 (3.8)209 (4.1)216 (3.9)181 (4.0)207 (3.7)185 (3.5)2.5 (2.4)
Childhood deprivation
Never19,727 (75.3)4,843 (94.1)4,919 (88.4)3,628 (80.8)3,954 (70.1)2,383 (44.5)< 0.0012.0 (2.0)< 0.001
Rarely2,929 (11.2)218 (4.2)430 (7.7)516 (11.5)833 (14.8)932 (17.4)3.5 (2.4)
Sometimes2,320 (8.9)71 (1.4)193 (3.5)278 (6.2)627 (11.1)1,151 (21.5)4.6 (2.5)
Often1,169 (4.5)15 (0.3)21 (0.4)60 (1.3)206 (3.7)867 (16.2)6.3 (2.6)
Unknown53 (0.2)2 (0.0)4 (0.1)9 (0.2)20 (0.4)18 (0.3)3.8 (2.0)
Perceived social support
Low6,332 (24.2)747 (14.5)995 (17.9)972 (21.6)1,582 (28.0)2036 (38.0)< 0.0013.5 (2.7)< 0.001
Moderate12,831 (40.0)2,487 (48.3)2,833 (50.9)2,282 (50.8)2,762 (49.0)2,467 (46.1)2.5 (2.3)
High6,151 (23.5)1,790 (34.8)1,579 (28.4)1,102 (24.5)1,075 (19.1)605 (11.3)1.8 (1.9)
Unknown884 (3.4)125 (2.4)160 (2.9)135 (3.0)221 (3.9)243 (4.5)3.2 (2.5)
  1. *

    p-values were obtained by χ2 tests, except for mean age which was compared with an ANOVA.

  2. †

    p-values were obtained by ANOVA.

Table 2
Distribution of perceived coping ability (CD-RISC) and psychiatric resilience scores by sociodemographic characteristics.
Perceived coping abilityPsychiatric resilience
Mean (SD)p-value global*Mean (SD)p-value global*
Total28.0 (7.5)3.6 (1.5)
Age groups
18–29 years24.8 (7.9)< 0.0013.1 (1.6)< 0.001
30–39 years26.8 (7.5)3.5 (1.6)
40–49 years27.8 (7.4)3.7 (1.5)
50–59 years28.5 (7.2)3.8 (1.4)
≥ 60 years28.8 (6.9)4.0 (1.3)
Educational level
Primary education24.2 (8.3)< 0.0013.1 (1.6)< 0.001
Secondary education26.3 (7.6)3.4 (1.5)
Tertiary A (BSc or equivalent)28.0 (7.0)3.8 (1.4)
Tertiary B (MSc or above)29.8 (6.5)4.0 (1.3)
Unknown23.6 (8.1)3.1 (1.7)
Civil status
Married/in a relationship27.7 (7.4)< 0.0013.7 (1.4)< 0.001
Single/widowed26.3 (7.9)3.3 (1.6)
Unknown24.7 (8.5)2.7 (1.8)
Employment status
Employed/studying28.0 (7.2)< 0.0013.7 (1.4)< 0.001
Retired/disability/sick leave23.9 (8.5)3.0 (1.6)
Unknown23.3 (9.0)2.8 (1.6)
Income
Low income24.5 (8.0)< 0.0013.1 (1.6)< 0.001
Low-medium income27.0 (7.2)3.6 (1.5)
Medium income29.3 (6.5)4.0 (1.3)
High-medium income30.9 (6.1)4.1 (1.2)
High income31.9 (6.1)4.1 (1.2)
Unknown26.6 (7.9)3.7 (1.5)
Childhood deprivation
Never27.9 (7.3)< 0.0013.8 (1.4)< 0.001
Rarely26.4 (7.6)3.3 (1.6)
Sometimes25.4 (7.9)3.1 (1.6)
Often25.0 (8.4)2.6 (1.6)
Unknown24.0 (8.9)2.6 (1.6)
Perceived social support
Low24.5 (8.0)< 0.0013.1 (1.6)< 0.001
Moderate27.2 (7.1)3.7 (1.5)
High30.9 (6.4)4.1 (1.2)
Unknown24.7 (8.0)3.2 (1.6)
  1. *

    p-values were obtained by ANOVAs.

Table 3
Associations between the number of ACEs and perceived coping ability (CD-RISC) and psychiatric resilience (β and 95% CI)*.
Perceived coping abilityPsychiatric resilience
N (%)Model 1†Model 2 ‡Model 1†Model 2 ‡
ACE-IQ total score **26,198–0.19 (-0.20,–0.17)–0.14 (-0.15,–0.13)–0.32 (-0.34,–0.31)–0.28 (-0.29,–0.27)
Number of ACEs
0 ACE5,149 (19.7)0 (ref.)0 (ref.)0 (ref.)0 (ref.)
1 ACE5,567 (21.3)–0.07 (-0.08,–0.05)–0.05 (-0.07,–0.04)–0.09 (-0.10,–0.07)–0.07 (-0.09,–0.06)
2 ACE4,491 (17.1)–0.10 (-0.11,–0.08)–0.08 (-0.10,–0.07)–0.13 (-0.15,–0.12)–0.12 (-0.13,–0.10)
3–4 ACE5,640 (21.5)–0.16 (-0.17,–0.14)–0.13 (-0.14,–0.11)–0.22 (-0.23,–0.20)–0.19 (-0.21,–0.18)
≥ 5 ACEs5,351 (20.4)–0.22 (-0.24,–0.20)–0.16 (-0.18,–0.15)–0.36 (-0.37,–0.34)–0.31 (-0.33,–0.30)
  1. *

    Coefficients are standardized; **per 1 SD unit increase in ACE-IQ scores.

  2. †

    adjusted for age and childhood deprivation.

  3. ‡

    additionally adjusted for education level, civil status, employment status and income.

Table 4
Prevalence Ratios (with 95% CI) of high perceived coping ability (CD-RISC ≥35) and high psychiatric resilience (absence of psychiatric morbidity) in relation to the number of ACEs.
Perceived coping abilityPsychiatric resilience
N (%)Model 1†aModel 2 ‡Model 1†Model 2 ‡
ACE-IQ total score*26,1980.91 (0.90, 0.92)0.93 (0.92, 0.94)0.85 (0.84, 0.86)0.87 (0.86, 0.87)
Number of ACEs
0 ACE5,149 (19.7)1.00 (ref.)1.00 (ref.)1.00 (ref.)1.00 (ref.)
1 ACE5,567 (21.3)0.83 (0.77, 0.89)0.87 (0.81, 0.93)0.82 (0.79, 0.84)0.84 (0.81, 0.87)
2 ACE4,491 (17.1)0.71 (0.66, 0.77)0.75 (0.70, 0.81)0.73 (0.70, 0.76)0.75 (0.72, 0.78)
3–4 ACE5,640 (21.5)0.61 (0.56, 0.66)0.66 (0.61, 0.71)0.59 (0.56, 0.61)0.62 (0.60, 0.65)
≥ 5 ACEs5,351 (20.4)0.56 (0.51, 0.61)0.64 (0.59, 0.70)0.38 (0.35, 0.40)0.42 (0.39, 0.45)
  1. *

    per 1 SD unit increase in ACE-IQ scores.

  2. †

    adjusted for age and childhood deprivation.

  3. ‡

    additionally adjusted for education level, civil status, employment status and income.

Appendix 1—table 1
List of the 30 ACE-IQ items used to derive the 13 different ACEs and their response options.
ACE itemScoring*
Neglect 
Emotional neglect 
Did your parents/guardians understand your problems and worries?Always = 0, Most of the time = 1, Sometimes = 2, Rarely = 3, Never = 4
Did your parents/guardians really know what you were doing with your free time when you were not at school or work?Always = 0, Most of the time = 1, Sometimes = 2, Rarely = 3, Never = 4
Physical neglect 
How often did your parents/guardians not give you enough food even when they could easily have done so?Never = 0, Once = 1, A few times = 2, Many times = 3
Were your parents/guardians too drunk or intoxicated by drugs to take care of you?Never = 0, Once = 1, A few times = 2, Many times = 3
How often did your parents/guardians not send you to school even when it was available?Never = 0, Once = 1, A few times = 2, Many times = 3
Abuse 
Emotional abuse 
Did a parent, guardian or other household member yell, scream or swear at you, insult or humiliate you?Never = 0, Once = 1, A few times = 2, Many times = 3
Did a parent, guardian or other household member threaten to, or actually, abandon you or throw you out of the house?Never = 0, Once = 1, A few times = 2, Many times = 3
Physical abuse 
Did a parent, guardian or other household member spank, slap, kick, punch or beat you up?Never = 0, Once = 1, A few times = 2, Many times = 3
Did a parent, guardian or other household member hit or cut you with an object, such as a stick (or cane), bottle, club, knife, whip etc?Never = 0, Once = 1, A few times = 2, Many times = 3
Sexual abuse 
Did someone touch or fondle you in a sexual way when you did not want them to?Never = 0, Once = 1, A few times = 2, Many times = 3
Did someone make you touch their body in a sexual way when you did not want them to?Never = 0, Once = 1, A few times = 2, Many times = 3
Did someone attempt oral, anal, or vaginal intercourse with you when you did not want them to?Never = 0, Once = 1, A few times = 2, Many times = 3
Did someone actually have oral, anal, or vaginal intercourse with you when you did not want them to?Never = 0, Once = 1, A few times = 2, Many times = 3
Household dysfunction 
Domestic violence 
Did you see or hear a parent or household member in your home being yelled at, screamed at, sworn at, insulted or humiliated?Never = 0, Once = 1, A few times = 2, Many times = 3
Did you see or hear a parent or household member in your home being slapped, kicked, punched or beaten up?Never = 0, Once = 1, A few times = 2, Many times = 3
Did you see or hear a parent or household member in your home being hit or cut with an object, such as a stick (or cane), bottle, club, knife, whip etc.?Never = 0, Once = 1, A few times = 2, Many times = 3
Lost a parent / separation of parents 
Were your parents ever separated or divorced?No = 0, Yes = 1
Did your mother, father or guardian die?No = 0, Yes = 1
Mental illness in household 
Did you live with a household member who was depressed, mentally ill or suicidal?No = 0, Yes = 1
Household substance abuse 
Did you live with a household member who was a problem drinker or alcoholic, or misused street or prescription drugs?No = 0, Yes = 1
Incarcerated household member 
Did you live with a household member who was ever sent to jail or prison?No = 0, Yes = 1
Other violence 
Community violence 
Did you see or hear someone being beaten up in real life?Never = 0, Once = 1, A few times = 2, Many times = 3
Did you see or hear someone being stabbed or shot in real life?Never = 0, Once = 1, A few times = 2, Many times = 3
Did you see or hear someone being threatened with a knife or gun in real life?Never = 0, Once = 1, A few times = 2, Many times = 3
Collective violence 
During the first 18 years of your life, were you exposed to war/collective violence (e.g. from gangs or police)?†No = 0, Yes = 1
Were you forced to go and live in another place due to any of these events?Never = 0, Once = 1, A few times = 2, Many times = 3
Did you experience the deliberate destruction of your home due to any of these events?Never = 0, Once = 1, A few times = 2, Many times = 3
Were you beaten up by soldiers, police, militia, or gangs?Never = 0, Once = 1, A few times = 2, Many times = 3
Was a family member or friend killed or beaten up by soldiers, police, militia, or gangs?Never = 0, Once = 1, A few times = 2, Many times = 3
Bullying 
How often were you bullied?Never = 0, Once = 1, A few times = 2, Many times = 3
  1. *

    all items also had the option „can‘t/don‘t want to answer“.

  2. †

    this is a screening question, only participants that responded yes got the following four questions.

Appendix 1—table 2
Rank order correlations for perceived coping (CD-RISC) and different measures of psychopathology used to derive the psychiatric resilience phenotype (n = 26,198).
CD-RISCPHQ-9GAD-7PCL-5PSQI-ABinge drinking
CD-RISC1
PHQ-9–0.551
GAD-7–0.510.761
PCL-5–0.480.700.661
PSQI-A–0.410.620.620.631
Binge drinking–0.040.100.090.070.091
Appendix 1—table 3
Rank order correlations for ACE subtypes (n = 26,198).
Emotional abusePhysical abuseSexual abuseEmotional neglectPhysical neglectDomestic violenceLost a parent/ separationMental illness in householdHousehold substance abuseIncarcerated household memberCommunity violenceCollective violenceBullying
Emotional abuse1
Physical abuse0.461
Sexual abuse0.190.141
Emotional neglect0.360.230.221
Physical neglect0.290.180.140.271
Domestic violence0.510.310.180.340.301
Lost a parent/separation of parents0.160.090.120.190.190.211
Mental illness in household0.330.180.140.260.230.370.191
Household substance abuse0.200.110.160.240.290.360.260.311
Incarcerated household member0.140.110.090.120.180.220.140.180.251
Community violence0.200.200.100.130.140.180.080.120.110.111
Collective violence0.090.080.060.070.080.090.060.070.060.100.111
Bullying0.210.160.130.150.110.150.060.160.080.060.120.081
Appendix 1—table 4
Associations between the number of ACEs and perceived coping ability (CD-RISC) and psychiatric resilience stratified by social support (n = 25,314) (β and 95% CI).
Perceived coping abilityPsychiatric resilience
N (%)Low supportModerate supportHigh supportLow supportModerate supportHigh support
Number of ACEs*
0 ACE5,024 (19.8)0 (ref.)0 (ref.)0 (ref.)0 (ref.)0 (ref.)0 (ref.)
1 ACE5,407 (21.3)–0.06 (–0.10,–0.02)–0.05 (–0.06,–0.03)–0.02 (–0.05,–0.00)–0.10 (–0.14,–0.06)–0.07 (–0.09,–0.05)–0.05 (–0.07,–0.03)
2 ACE4,356 (17.2)–0.08 (–0.12,–0.05)–0.06 (–0.08,–0.04)–0.06 (–0.08,–0.03)–0.13 (–0.16,–0.09)–0.11 (–0.13,–0.09)–0.09 (–0.11,–0.07)
3–4 ACE5,419 (21.4)–0.11 (–0.14,–0.07)–0.09 (–0.11,–0.07)–0.08 (–0.11,–0.06)–0.22 (–0.25,–0.17)–0.16 (–0.18,–0.14)–0.13 (–0.16,–0.10)
≥ 5 ACEs5,108 (20.2)–0.14 (–0.17,–0.10)–0.10 (–0.12,–0.08)–0.08 (–0.11,–0.05)–0.32 (–0.36,–0.28)–0.27 (–0.29,–0.25)–0.21 (–0.24,–0.1)
  1. *

    Coefficients are standardized; adjusted for age, childhood deprivation, education level, civil status, employment status and income.

Appendix 1—table 5
Associations between the number of ACEs (excluding parental divorce/separation) and perceived coping ability (CD-RISC) and psychiatric resilience (β and 95% CI)*.
N (%)Perceived coping abilityPsychiatric resilience
Model 1aModel 2bModel 1aModel 2b
Number of ACEs*
0 ACE6,095 (23.3)0 (ref.)0 (ref.)0 (ref.)0 (ref.)
1 ACE6,201 (23.7)–0.08 (–0.09,–0.06)–0.06 (–0.08,–0.05)–0.10 (–0.11,–0.08)–0.08 (–0.10,–0.07)
2 ACE4,877 (18.6)–0.12 (–0.13,–0.10)–0.10 (–0.11,–0.08)–0.16 (–0.17,–0.14)–0.14 (–0.16,–0.13)
3–4 ACE5,582 (21.3)–0.18 (–0.19,–0.16)–0.14 (–0.16,–0.13)–0.25 (–0.27,–0.24)–0.23 (–0.24,–0.21)
≥ 5 ACEs3,443 (13.1)–0.20 (–0.21,–0.19)–0.15 (–0.15,–0.12)–0.33 (–0.35,–0.32)–0.29 (–0.30,–0.28)
  1. *

    Coefficients are standardized; aadjusted for age and childhood deprivation; badditionally adjusted for education level, civil status, employment status and income.

Appendix 1—table 6
Associations between the number of ACEs and perceived coping ability (CD-RISC) and psychiatric resilience excluding participants with ≈10% lowest and highest happiness values (raw scores 1–5 and 10) (n = 15,449) (β and 95% CI)*.
Perceived coping abilityPsychiatric resilience
N (%)Model 1aModel 2bModel 1aModel 2b
Number of ACEs*
0 ACE4,088 (20.38)0 (ref.)0 (ref.)0 (ref.)0 (ref.)
1 ACE4,384 (21.86)–0.05 (–0.07,–0.04)–0.04 (–0.06,–0.02)–0.09 (–0.10,–0.07)–0.08 (–0.09,–0.06)
2 ACE3,573 (17.82)–0.08 (–0.09,–0.06)–0.06 (–0.08,–0.05)–0.12 (–0.14,–0.11)–0.11 (–0.13,–0.10)
3–4 ACE4,341 (21.65)–0.12 (–0.14,–0.10)–0.10 (–0.12,–0.08)–0.19 (–0.20,–0.17)–0.17 (–0.19,–0.16)
≥ 5 ACEs3,669 (18.29)–0.15 (–0.17,–0.13)–0.12 (–0.13,–0.10)–0.31 (–0.33,–0.29)–0.28 (–0.30,–0.27)
  1. *

    Coefficients are standardized; aadjusted for age and childhood deprivation; badditionally adjusted for education level, civil status, employment status and income.

Appendix 1—table 7
Associations between the number of ACEs and perceived coping ability (CD-RISC) and psychiatric resilience (β and 95% CI)*, complete case analyses.
Perceived coping abilityPsychiatric resilience
N (%)Model 1aModel 2bModel 1aModel 2b
ACE-IQ total score*19,637–0.18 (-0.19,–0.16)–0.13 (-0.15,–0.12)–0.31 (-0.32,–0.30)–0.28 (-0.29,–0.26)
Number of ACEs
0 ACE4,377 (22.3)0 (ref.)0 (ref.)0 (ref.)0 (ref.)
1 ACE4,496 (22.9)–0.07 (-0.09,–0.05)–0.06 (-0.07,–0.04)–0.08 (-0.10,–0.06)–0.07 (-0.09,–0.05)
2 ACE3,437 (17.5)–0.10 (-0.11,–0.08)–0.08 (-0.10,–0.06)–0.13 (-0.14,–0.11)–0.11 (-0.13,–0.10)
3–4 ACE3,985 (20.3)–0.14 (-0.16,–0.13)–0.12 (-0.14,–0.10)–0.20 (-0.21,–0.18)–0.18 (-0.19,–0.16)
≥ 5 ACEs3,342 (17.0)–0.20 (-0.22,–0.18)–0.15 (-0.17,–0.14)–0.33 (-0.35,–0.31)–0.29 (-0.31,–0.27)
  1. *

    Coefficients are standardized; **per 1 SD unit increase in ACE-IQ scores; aadjusted for age and childhood deprivation; badditionally adjusted for education level, civil status, employment status and income.

Appendix 1—table 8
Prevalence Ratios (with 95% CI) of high perceived coping ability (CD-RISC ≥35) and high psychiatric resilience (absence of psychiatric morbidity) in relation to the number of ACEs, complete case analyses.
High perceived coping abilityHigh psychiatric resilience
N (%)Model 1*Model 2bModel 1*Model 2b
ACE-IQ total score*19,6370.92 (0.90, 0.93)0.94 (0.92, 0.95)0.86 (0.85, 0.87)0.87 (0.87, 0.88)
Number of ACEs
0 ACE4,377 (22.3)1.00 (ref.)1.00 (ref.)1.00 (ref.)1.00 (ref.)
1 ACE4,496 (22.9)0.83 (0.77, 0.89)0.87 (0.81, 0.93)0.84 (0.81, 0.87)0.86 (0.83, 0.89)
2 ACE3,437 (17.5)0.73 (0.67, 0.79)0.77 (0.71, 0.83)0.74 (0.71, 0.78)0.76 (0.73, 0.80)
3–4 ACE3,985 (20.3)0.66 (0.60, 0.71)0.70 (0.65, 0.76)0.62 (0.59, 0.65)0.65 (0.62, 0.68)
≥ 5 ACEs3,342 (17.0)0.59 (0.53, 0.65)0.67 (0.60, 0.74)0.41 (0.38, 0.44)0.44 (0.41, 0.48)
  1. *

    adjusted for age and childhood deprivation; badditionally adjusted for education level, civil status, employment status and income.

Author response table 1
Associations between the number of ACEs and perceived coping ability (CD-RISC) and psychiatric resilience (β and 95% CI)* Analytic sample is not restricted to women exposed to lifetime trauma.
Perceived coping abilityPsychiatric resilience
N (%)Model 1aModel 2bModel 1aModel 2b
Number of ACEs
0 ACE4650 (23.09)0 (ref.)0 (ref.)0 (ref.)0 (ref.)
1 ACE4628 (22.98)-0.07 (-0.09, -0.05)-0.05 (-0.07, -0.04)-0.08 (-0.10, -0.07)-0.07 (-0.09, -0.06)
2 ACE3486 (17.31)-0.10 (-0.11, -0.08)-0.08 (-0.10, -0.07)-0.13 (-0.15, -0.12)-0.12 (-0.13, -0.10)
3-4 ACE4021 (19.97)-0.15 (-0.16, -0.13)-0.12 (-0.14, -0.11)-0.20 (-0.22, -0.19)-0.18 (-0.20, -0.17)
≥ 5 ACEs3350 (16.64)-0.20 (-0.22, -0.18)-0.15 (-0.17, -0.14)-0.33 (-0.35, -0.32)-0.30 (-0.31, -0.28)

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R scripts for the main analyses.

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  1. Hilda Björk Daníelsdóttir
  2. Thor Aspelund
  3. Edda Bjork Thordardottir
  4. Katja Fall
  5. Fang Fang
  6. Gunnar Tómasson
  7. Harpa Rúnarsdóttir
  8. Qian Yang
  9. Karmel W Choi
  10. Beatrice Kennedy
  11. Thorhildur Halldorsdottir
  12. Donghao Lu
  13. Huan Song
  14. Jóhanna Jakobsdóttir
  15. Arna Hauksdóttir
  16. Unnur Anna Valdimarsdóttir
(2022)
Adverse childhood experiences and resilience among adult women: A population-based study
eLife 11:e71770.
https://doi.org/10.7554/eLife.71770