Quotes from: Associations of the ten original Adverse Childhood Experiences (ACEs) with mental health impairments after controlling for the other ACEs (meta-analysis)

Schuster, Filip
Type of WorkMeta-analysis

The complete text of this meta-analysis and its Abstract are here:
< https://www.ipce.info/library/web-article/schuster-meta-analysis-associations-ace-mental-health >

Some Quotes

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 Table 5: Rank order of the associations of the ten original ACEs with mental health impairments [...] after controlling for more than each of the nine other original ACEs
(Pearson correlation coefficient r, median of the effect sizes reported in
the individual studies or the medians of these effect sizes, respectively)
ACE > r
Emotional abuse > 0,10
Emotional neglect > 0,10
Mental problems household member > 0,08
Physical neglect > 0,07
Physical abuse > 0,06
Alcohol/drug dependence household member > 0,04
"Sexual abuse" > 0,04
Separation/divorce of parents > 0,04
Witnessing violence against the mother/parents > 0,01
Incarceration household member >-0,01

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The main finding of this meta-analysis is an overall very small association between the ten original ACEs and mental health impairments after controlling for more than each of the nine other original ACEs (median r=0.05). 

This relationship is larger for the five abuse and neglect ACEs at r=0.07 (median) than for the five other original ACEs in the household dysfunction domain at r=0.04 (median). For the ACEs witnessing violence against the mother/parents (r=0.01) and incarceration of a household member (r=-0.01), there is no association with (long-term) mental health impairment according to the results of this meta-analysis. 

The corresponding associations are also very small for the ACEs "sexual abuse" (r=0.038), divorce/separation of parents (r=0.037), and alcohol/drug problem of a household member (r=0.038), and in a range that does not allow reliable conclusions about long-term important mental health impairments, also because of the failure to completely control for confounding variables. 

Accordingly, according to the results of this meta analysis, long-term important negative health consequences cannot be assumed with certainty for five of the ten original ACEs. 

In addition, the voluntary sexual acts of "minors" and (much older) adults that predominantly constitute the ACE "sexual abuse" in its original conception (Rind, 2022; Rind, 2023a) do not seem to cause any health impairments in the affected former "minors" overall, according to the majority of the few studies available on this question (... ... ...) The current ACEs approach should be fundamentally reconsidered.

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This meta-analysis identified only a very small association between the ACE "sexual abuse" of "minors" and mental health impairments after controlling for more than the nine other original ACEs, at r=0.04 (unrounded r=0.03775). 


[...] six of the eight studies were consistent in finding minimal or very small associations. [... ...] ... the numbers are consistent with the state of research. Many other individual studies, after controlling for confounding variables, have found no statistically significant association between (variously defined) "sexual abuse" of "minors" and health and other impairments.

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Rind et al. (1998) found a small association (r=0.09) of "sexual abuse" of "minors" and impairments in college samples bivariately. After controlling for a portion of the relevant confounding variables, the associations with the various impairments were
predominantly no longer statistically significant.

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According to representative studies (Felson et al., 2019; Rind, 2022; Rind, 2023a), the sexual acts of "minors" and adults classified as "sexual abuse" are predominantly noncoerced sexual acts that are frequently enjoyed by the "minors," which contributes to the very small multivariate effect sizes.

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The very small association (r=0.04) between the ACE "sexual abuse" of "minors" and mental health impairments, identified by this meta-analysis and often based on Cohen (1988, p. 104) referred to as "trivial" in other contexts, was identified for this variable as a whole and may not apply, in principle, to subgroups of this variable. 

Whether specifically the voluntary sexual acts of "minors" and (much older) adults have positive or negative consequences for the mental (including sexual) health of "minors" has not been scientifically clarified by quantitative studies comprehensively controlling for genes and confounding variables. The current state of research does not allow for an effect size to be specified for voluntary acts, which is also important for justice processes.

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The view, apparently prevalent in the literature, that voluntary sexual acts by "minors" and adults would have negative health consequences for the "minors" involved is only conjecture and not supported by meaningful scientific studies.

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Voluntary sexual relationships of "minors" and adults currently take place in an extremely pedophobic-poisoned climate, which has consequences for the formation and consequences of these relationships. Empirical studies can necessarily only measure the health and other consequences of these relationships in the real existing social climate and not the consequences that would be evident in a society that respects and encourages these relationships. Empirical studies, then, do not measure the consequences of these relationships and sexual acts per se, but only ever measure the consequences of these relationships and sexual acts under the given social conditions.

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From my point of view, this must also be considered: The association between the ACE "sexual abuse" with mental health impairments after controlling for the other nine original ACEs is r=0.081 in this meta-analysis.
Already when additionally controlling for a single-digit number of other ACEs
thereafter, this association is reduced to r=0.036 [...]
One cannot rule out, rather it seems likely, that when additional ACEs and other confounding variables and genes are controlled for, the effect size of the ACE "sexual abuse" will approach zero. 

This is another reason why there is currently no scientific evidence that the ACE "sexual abuse" (or the sexual acts attributed to it) would cause mental impairment to any important degree in the long term. Scientific evidence shows only a very small association of the independent variable "sexual abuse" and various dependent variables. The causes of these associations are unexplained.

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The fundamental question arises as to what effect sizes ACEs research should regard as evidence of an important causal relationship. According to Cohen (1988), effect sizes of r=0 are not achievable in the practice of behavioral science; effect sizes up to r=0.10 were described by Cohen as "trivial" ("trivially small", Cohen (1988) p: 104) in one context and as evidence of a non-existent relationship. 

Also, since possible causal consequences of ACEs could relate to very many different impairments, the threshold of r=0.10 seems clearly too high for importance. It seems important whether the corresponding effect size was determined after comprehensive control of confounding variables. 

This is not the case in the studies of this meta-analysis, as apparently in the other ACEs studies. Metaanalytically determined causal effect sizes of ACEs research in the range of
r=0 to r=0.050 are, in my view, currently evidence of a nonexistent or at least an uncertain important causal relationship. With these very small effect sizes, it currently remains unclear whether the associations were caused by residual confounding and other bias (Christenfeld et al., 2004).

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Because of the many uncontrolled confounding variables (including genes, other ACEs, health differences before experiencing ACEs, protective factors, and confounding variables in adulthood), the multivariate associations identified in the meta-analysis do not reflect the causal relationships between ACEs and mental impairments and must be interpreted in the overall context.