Prevalence of Adverse Childhood Experiences (ACEs) and its association with current mental wellbeing among young adults in Pakistan

Background: Adverse Childhood Experiences (ACEs) are significant stressors that can have lasting effects on an individual's health, especially on mental wellbeing. While ACEs affect up to 91 % of individuals in low- and middle-income countries (LMICs) such as Uganda and India, research in Pakistan remains sparse and underdeveloped, limiting cross-country comparisons. Objective: To determine the prevalence of ACEs among young adults aged 18 to 25 in Pakistan and their impact on current mental wellbeing. Participants and setting: Students aged 18-25 years enrolled in grade 13th-16th of selected public and private colleges of Rawalpindi, Pakistan. Methods: Participants were recruited through convenience sampling. ACE exposure was assessed using a modified version of the ACE-International Questionnaire. Mental wellbeing was evaluated using the Short Warwick-Edinburgh Mental Wellbeing Scale. Descriptive statistics were used to characterize participants' socio-demographics including age, gender, type of institution (public vs. private), parents' marital status, parental education, monthly household income, and number of siblings. Multivariable logistic regression was conducted to determine association between ACEs and the mental wellbeing of the students. Results: Among 454 participants (203 males, 251 females; mean age 22.1 +/- 2.2 years), 98 % experienced at least one ACE during their lifetime, with 82.4 % experiencing three or more ACEs. The most common ACEs were witnessing community (88 %), peer (83 %), and household (73 %) violence. Emotional abuse (60 %) was more prevalent than physical (47 %) and sexual (37 %) abuse. Students experiencing 6 or more ACEs had 3.39 times higher odds of inadequate mental wellbeing compared to those with 0-2 ACEs (AOR = 3.39; CI 1.44-8.0; p < 0.01). Conclusions: The study reveals a concerning ACEs prevalence among Pakistani students, with higher ACE exposure correlating with poorer mental wellbeing. Addressing ACEs requires a broader public health approach, urging policy interventions to mitigate long-term health impacts.