Adverse Childhood Experiences (ACEs) and Internalizing Mental Health, Pain, and Quality of Life in Youth With Chronic Pain: A Longitudinal Examination

  • Sarah Nelson
    Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts

    Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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  • Jaimie K. Beveridge
    Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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  • Richelle Mychasiuk
    Department of Psychology, University of Calgary, Calgary, Alberta, Canada

    Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada

    Hotchkiss Brain Institute, Calgary, Alberta, Canada

    Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
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  • Melanie Noel
    Address reprint requests to Melanie Noel, PhD, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
    Department of Psychology, University of Calgary, Calgary, Alberta, Canada

    Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada

    Hotchkiss Brain Institute, Calgary, Alberta, Canada
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      • Over time, youth with 3+ versus 0 adverse childhood experiences (ACEs) reported poorer quality of life.
      • Youth with 3+ versus 0 ACEs reported higher symptoms of PTSD, depression, and anxiety.
      • Functioning differed between youth exposed to different types of ACEs.
      • PTSD symptoms moderated the association between ACEs and anxiety symptoms.
      • ACEs influence the long-term functioning of youth with chronic pain.


      The aims of this longitudinal study were to 1) identify categories of adverse childhood experiences (ACEs) (ie, neglect, abuse, household dysfunction in childhood) that increase risk for internalizing mental health problems, pain-related impairment, and poorer quality of life and 2) examine the moderating role of posttraumatic stress symptoms (PTSS) in these associations, in a clinical sample of youth with chronic pain. At 2 timepoints, youth (N = 155; aged 10–18 years) completed measures of exposure to ACEs, PTSS, depressive and anxiety symptoms, pain intensity, pain interference, and quality of life. Multivariate analyses of variance, linear mixed modeling, and moderation analyses were conducted. Results from cross-sectional and longitudinal analyses were similar; youth with a history of 3+ ACEs reported significantly higher PTSS, depressive and anxiety symptoms, and poorer quality of life than youth with no ACE history. Results also revealed differences in functioning between youth exposed to different types of ACEs (ie, maltreatment only, household dysfunction only, both, none). Finally, PTSS was found to moderate the association between ACEs and anxiety and depressive symptoms. Findings underscore the influence that ACEs can have on the long-term functioning of youth with chronic pain as well as the important role of current PTSS in this association.


      This study found that the risk of poorer outcomes imposed by ACEs at baseline remains longitudinally and that posttraumatic stress symptoms (PTSS) moderate the relationship between ACEs and anxiety and depressive symptoms in youth with chronic pain. These results underscore the importance of assessing for ACEs and PTSS alongside chronic pain in youth.

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