The Effects of Adverse Childhood Experiences on Adult Mental Health Across Gender, Race/Ethnicity, and Economic Status in the United States: A Systematic Review and Meta-Analysis

Associations between Adverse childhood experiences (ACEs) and poor mental health are well documented, but it remains unclear to what degree these associated effects vary among demographic subgroups. This systematic review and meta-analysis aims to synthesize the evidence linking ACEs to depression, anxiety, and posttraumatic stress disorder (PTSD) while exploring whether these associations vary by gender, race/ethnicity, and economic status. We searched studies published from January 1998 to January 2025 in PubMed/MEDLINE, PsycINFO, CINAHL, Web of Science, ProQuest Dissertations and Theses Global, and Sociological Abstracts. Included studies reported associations between ACEs and depression, anxiety, and PTSD among specific subgroups of U.S. adults. This review used a 13-item assessment tool to evaluate study methodological quality. We conducted random-effects robust variance estimation meta-analyses to pool effect sizes and used Wald tests to compare subgroup differences. A systematic literature search yielded 45 studies with 110,556 participants. ACEs were positively associated with depression, anxiety, and PTSD. Associations were significant across genders, economic statuses, and most racial/ethnic groups. Wald tests showed that there were no statistically significant subgroup differences. Findings confirmed that ACEs are significantly linked to adult mental health outcomes, with an especially strong connection to PTSD. The lack of subgroup differences suggests that ACEs are universally harmful, underscoring the urgent need for ACE prevention strategies and trauma-responsive interventions that can be scaled at the population level.