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Revisiting the use of adverse childhood experience screening in healthcare settings

Nature Reviews Psychology volume 3, pages 729–740 (2024)Cite this article

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Abstract

Adverse childhood experiences (ACEs) are key modifiable risk factors for mental illness. The potential to detect and mitigate ACEs to improve population mental health has led to large public health efforts. However, basing public mental health decisions on ACE screening has revealed several conspicuous challenges. In this Review, we provide a critical overview of these challenges, focusing on the validity of ACE screening measures, their accuracy in classifying individuals at risk for poor mental health outcomes, their utility in facilitating the delivery of targeted interventions, their acceptability by respondents and interviewers, and the overall financial sustainability of this screening approach. There are clear research opportunities to address these challenges and improve current practices. For example, basic measurement research could improve the validity and acceptability of ACE measures, individual risk modelling approaches could be adopted to improve the accuracy of ACE screening to predict mental health conditions and guide intervention selection, and promising interventions could be tested to ensure that vulnerable individuals detected through ACE screening receive effective support.

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Fig. 1: ACEs and modifiers of impact on mental health.
Fig. 2: Problems with intervention delivery based on ACE screening.
Fig. 3: Risk configurations in individuals with high ACE scores.
Fig. 4: Types of preventative interventions.

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Acknowledgements

A.D. received funding from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London (NIHR203318). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHS, the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Andrea Danese

  2. Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Andrea Danese

  3. National and Specialist Child & Adolescent Mental Health Services (CAMHS) Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, UK

    Andrea Danese & Patrick Smith

  4. Foundations — What Works Centre for Children & Families, London, UK

    Kirsten Asmussen

  5. Yale Child Study Center, Yale University, New Haven, CT, USA

    Jelena MacLeod

  6. Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Alan Meehan & Patrick Smith

  7. Department of Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Jessica Sears & Angela Sweeney

  8. Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA

    Natalie Slopen

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Danese, A., Asmussen, K., MacLeod, J. et al. Revisiting the use of adverse childhood experience screening in healthcare settings. Nat Rev Psychol 3, 729–740 (2024). https://doi.org/10.1038/s44159-024-00362-5

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