180 - Associations between Adverse Childhood Experiences and Severe Mental Health Disorders among Children Enrolled in a Patient Navigation Program

Publication Number: 1169.180

J. Blakely Amati, Prisma Health/University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Xiaofang Lai, Prisma Health/Clemson University, Clemson, SC, United States; Caitlin Koob, Medical University of South Carolina, Charleston, SC, United States; Osman Yousufzai, University of South Carolina School of Medicine Greenville, Greenville, SC, United States; Kerry Sease, Furman University, Greenville, SC, United States; Sarah Griffin, Clemson University, Clemson, SC, United States

Background: Adverse Childhood Experiences (ACEs) have been linked to poor mental health outcomes in adulthood, however little is known about the impact of ACEs exposure on diagnosed mental health disorders among children and differences across minority groups. Pediatric Support Services (PSS) is a Patient Navigation Program (PNP) that triages mental and behavioral health referrals and connects children and adolescents with tailored health and community-based resources within a large health system in a southeastern state.

Objective: This study examines associations between ACEs and severe mental health disorders (SMDs) in children and examines differences by patients' sex and race/ethnicity.

Design/Methods: Data is sourced from the PSS program, from January 1st, 2019, through March 21, 2024. The study population included children (0-18 years old) referred for behavioral and mental health needs to the PSS. The outcome was clinician-diagnosed mental health disorder categorized as mild/moderate, 1SMD, ≥2SMDs. For this analysis, SMDs comprised homicidal ideation, suicidal ideation or self-harm, trauma, emergency or inpatient hospital admission, hallucinations, oppositional defiant disorder, and self-injury. Additionally, exposure was measured via seven categories of self-reported ACEs: parent's mental illness, parents' substance use, parents' separation and divorce, death of parents and family members, domestic violence, family economic constraints, abuse and neglect history (yes/no). Cumulative ACEs were included in the modification analysis by sex and race/ethnicity. Multivariate ordinal regression analyses were applied.

Results: Of the 7,131 children included in this sample, more than one in four (26.49%) were referred to PSS with at least one SMD. Children with parental substance use (OR=3.03, 95%CI: 1.77, 5.15), domestic violence (OR=2.48, 95%CI: 1.33, 4.51), and one type of abuse or neglect history (OR=3.90, 95%CI: 3.10, 4.90), and two types of abuse or neglect history (OR=5.05, 95%CI: 2.31, 10.91), and with each increase in cumulative ACEs (OR=1.37, 95%CI: 1.24, 1.51) were more likely to have SMDs. Notably, the association between cumulative ACEs and SMDs were stronger among girls and Non-Hispanic Black children.

Conclusion(s): Our findings demonstrate that specific ACEs are strongly associated with SMDs among children who referred to the PSS program. Integrating ACEs-informed approaches and strengthening family-centered support, particularly addressing parental substance use and domestic violence, may help reduce mental health disparities in children.

Table 1
Characteristics of children who are referred to PSS program with a behavioral/mental health need.

Table 2
The association between adverse childhood experiences and severe mental health disorders (each adverse childhood experience as exposure evaluates separately in model and control age, race/ethnicity, gender and health insurance).



Table 3
Gender and race difference in the association between adverse childhood experiences and severe mental health disorders.