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Kim -

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Children and Youth Services Review




The purpose of this study is to investigate the independent and cumulative impacts of Adverse Childhood Experiences (ACEs) on the subgroups of anxiety and depression among 12–17 aged adolescents in the U.S. A sample of 21,496 cases was derived from the 2017–2018 National Survey of Children’s Health (NSCH). Four adolescent subgroups were identified depending on their mental health condition: Anxiety-only (7.2%), Depression-only (1.5%), Anxiety-Depression (6.3%), and None (85.0%). All sociodemographic characteristics such as sex, age, race/ethnicity, and family structure had significant associations with the subgroups. Two multinomial logistic regression analyses were conducted to examine the independent and cumulative effects of ACEs on the subgroups. The findings suggested having a family member with severe mental illness showed the strongest relationship with the development of anxiety, depression, and both. A dose–response relationship was found between cumulative ACEs and the subgroups, with Anxiety-Depression as the most prevalent group when adolescents had multiple ACEs. Implications for service providers and future research are discussed.


This is an Accepted Manuscript of an article published by Elsevier in Children and Youth Services Review on January 19, 2021 , available online:

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.