Young adults who experienced multiple forms of childhood adversity were substantially more likely to face mental health, substance use, relationship, and other challenges, according to a new study. Emerging adults, with an average age of 19, who reported four or more adverse childhood experiences (ACEs) had considerably higher rates of depression, suicidal thoughts, hard drug use, and interpersonal violence than those who reported no childhood adversity.

Among the different types of adversity examined, emotional abuse, sexual abuse, discrimination, and witnessing domestic violence showed some of the strongest and most consistent associations with poorer health and other negative outcomes. The study was published in JAMA Network Open.

First author Jeff Temple, PhD, professor and associate dean for clinical research at UTHealth Houston School of Behavioral Health Sciences, said the findings are particularly notable because participants were assessed relatively close in time to the childhood adversity they experienced. Many previous ACE studies have relied on adults recalling childhood experiences several decades later.

“Emerging adulthood is a particularly important developmental period, and what happens during these years can have implications for health, relationships, and education well into adulthood,” said Temple, who is also the Betty and Rose Pfefferbaum Chair in Child Mass Trauma and Resilience at McGovern Medical School at UTHealth Houston. The transition from adolescence to young adulthood can be especially important for identity development and risk-taking behaviours.

The researchers studied 1,850 emerging adults using the Philadelphia ACEs survey, a 21-item measure designed to capture both conventional adverse childhood experiences and adversity occurring within the broader community. This approach allowed the researchers to examine a wider range of potentially harmful childhood experiences than is typically considered in traditional ACE research.

Conventional ACEs included emotional or physical abuse, sexual abuse, emotional or physical neglect, witnessing domestic violence, household substance abuse, household mental illness, and having an incarcerated family member. Community-level adversity included witnessing violence, experiencing discrimination, being bullied, and feeling unsafe in one’s neighbourhood.

The researchers found a clear cumulative pattern: as the number of adverse childhood experiences increased, outcomes generally worsened. Young adults who were still relatively close in time to these experiences were already showing substantial differences in mental health, interpersonal relationships, substance use, and educational outcomes. The findings suggest that the effects of childhood adversity can become evident relatively early rather than emerging only later in adulthood.

Temple said the findings highlight the importance of both preventing childhood adversity and providing support during the transition to adulthood. Emerging adulthood may offer an important opportunity to intervene before harmful patterns become more firmly established. This could include identifying young people who have experienced significant adversity, connecting them with trauma-informed supports, and addressing broader community factors, including neighbourhood safety and discrimination, that may contribute to poorer outcomes.

More information: Jeff Temple et al, Childhood Adversity and Health in Emerging Adulthood, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.35834

Journal information: JAMA Network Open Provided by University of Texas Health Science Center at Houston