Association of Adverse Childhood Experiences With Health-Related Quality of Life and Quality-Adjusted Life-Years Among Adolescents in the United Kingdom: Findings From Two General Population Cohorts

Background: Evidence on the impact of adverse childhood experiences (ACEs) on multidimensional wellbeing, including health-related quality of life (HRQoL) and quality-adjusted life-years (QALYs), remains inadequate, particularly among young people. This study examines how ACEs and their interactions with sex, ethnicity, and socioeconomic status (SES) are associated with HRQoL and QALYs in United Kingdom (UK) adolescents.

Methods: Baseline and follow-up data from the Determinants of Adolescent Social Well-being and Health (DASH) Study (N = 6648) and HeadStart Cornwall (HeadStart) (N = 4575) were used. ACE data were sourced from self-reports and official records and measured as binary and count variables. The Strengths and Difficulties Questionnaire (SDQ) was mapped to the Child Health Utility 9D (CHU9D) to calculate utility values for QALY estimation.

Results: Over the 3- and 2-year follow-up periods, mean accumulated QALYs were 2.30 (standard error [SE]: 0.002) (DASH) and 1.45 (SE: 0.004) (HeadStart). The occurrence of any ACEs, self-reported and officially recorded, respectively, reduced QALYs by 0.064 (SE: 0.021) (DASH) and 0.060 (SE: 0.021) (HeadStart). These translate to losses of 23 (DASH) and 22 (HeadStart) days over the follow-up period. A greater count of ACEs was associated with stronger effects. Dose-dependent interactions were significant only for ACEs-ethnicity and ACEs-sex (≥2 ACEs), with White adolescents and females experiencing greater QALY losses as the number of ACEs increased.

Conclusions: ACEs, whether self-reported or officially recorded, were associated with greater QALY losses, with the strength of association increasing as the number of ACEs increased. Furthermore, White and female adolescents exposed to a greater number of ACEs had the highest QALY losses. Further studies are needed to investigate the moderation of these associations and the mechanisms underlying the associations between ACEs and HRQoL/QALYs to inform targeted interventions.