# Exposure frequencies of single adverse childhood experiences and their association with psychological distress: evidence from a cohort study among emerging Swiss adults

## TL;DR

This study finds that specific types of childhood adversity affect mental health differently, depending on how often they occur.

## Contribution

The study introduces a detailed analysis of individual adverse childhood experiences and their exposure frequencies in relation to psychological distress.

## Key findings

- Emotional neglect and abuse were reported by 38.4% and 30.8% of participants, respectively.
- Physical and sexual abuse showed strong associations with psychological distress even at low frequencies.
- Type 2 SACEs (e.g., emotional neglect) have a larger population-level impact due to their high prevalence.

## Abstract

Adverse childhood experiences (ACE) are significant transdiagnostic risk factors for impaired psychosocial functioning throughout life. Most research on ACE has relied on composite scores, limiting conclusions about specific adverse experiences. The aim of the present study was to describe in detail the exposure frequencies of a wide range of single adverse experiences (SACEs) and investigate their association with psychological distress among emerging adults at the individual and the population levels.

A total of 2528 emerging Swiss adults aged 18 to 22 years from a random population sample participated in the first wave of a cohort study. ACE measures included 39 specific experiences covering neglect (emotional, physical), abuse (emotional, physical, sexual), witnessing violence, peer maltreatment and parental psychopathology. ANOVA models estimated bivariate associations between SACE exposure frequencies and psychological distress.

The most frequently reported child maltreatment subtypes were emotional neglect and abuse (38.4% resp. 30.8%). Regarding SACEs, more than 75% reported “witnessing the parents arguing fiercely” and verbal maltreatment by peers. SACEs were strongly associated with psychological distress in emerging adulthood, though the strength varied by type and frequency of exposure. Physical and sexual abuse experiences were strongly associated with psychological distress even when experienced only rarely. In contrast, SACEs in the domains of emotional abuse, emotional neglect and verbal abuse by peers correlated with psychological distress primarily at higher exposure frequencies. At the population level, frequently occurring SACEs, such as verbal abuse by family, explained the largest proportion of variance in psychological distress.

The impact of adverse childhood experiences on psychological distress among emerging adults depends on the type of SACE and their exposure frequency. These findings highlight the importance of analyzing single adversities and their frequencies alongside dimensional and pattern-based approaches in ACE research.

NCT05122988; November 17, 2021.

The online version contains supplementary material available at 10.1186/s12889-025-25999-6.

Most research on adverse childhood experiences (ACE) relies on composite scores or dimensional approaches. This study examines the detailed prevalence of exposure frequencies for specific adverse experiences (ranging from “never” to “very often”) and their association with psychological distress in emerging adults.The impact of ACE on psychological distress varies greatly depending on the specific adverse experience and its exposure frequency. Type 1 SACEs (e.g. physical or sexual abuse) show a strong association with psychological distress even at low exposure frequencies. Type 2 SACEs (e.g. emotional neglect or witnessing parents fighting) were reported by a large proportion of participants and show weaker associations with psychological distress at low frequency levels. However, these associations increase at higher exposure levels.At the individual level, the highest risk of psychological distress is linked to exposure to Type 1 SACEs. Conversely, at the population level, Type 2 SACEs have the most significant impact on psychological distress. While their individual effect is less severe, their prevalence is sufficient to influence the mental health of a substantial portion of the population.

Most research on adverse childhood experiences (ACE) relies on composite scores or dimensional approaches. This study examines the detailed prevalence of exposure frequencies for specific adverse experiences (ranging from “never” to “very often”) and their association with psychological distress in emerging adults.

The impact of ACE on psychological distress varies greatly depending on the specific adverse experience and its exposure frequency. Type 1 SACEs (e.g. physical or sexual abuse) show a strong association with psychological distress even at low exposure frequencies. Type 2 SACEs (e.g. emotional neglect or witnessing parents fighting) were reported by a large proportion of participants and show weaker associations with psychological distress at low frequency levels. However, these associations increase at higher exposure levels.

At the individual level, the highest risk of psychological distress is linked to exposure to Type 1 SACEs. Conversely, at the population level, Type 2 SACEs have the most significant impact on psychological distress. While their individual effect is less severe, their prevalence is sufficient to influence the mental health of a substantial portion of the population.

The online version contains supplementary material available at 10.1186/s12889-025-25999-6.