Accumulation of Adverse Childhood Experiences, School Performance and Psychiatric Morbidity in Young Adults in Sweden

Emma Bjorkenstam, University of California, Los Angeles
Christina Dalman, Karolinska Institutet
Bo Vinnerljung, Stockholm University
Gunilla Ringback Weitoft, National Board of Health and Welfare, Sweden
Deborah Walder, City University of New York (CUNY)
Bo Burstrom, Karolinska Institutet

Objective: To investigate the association between accumulation of adverse childhood experiences (ACE), school performance and later psychiatric morbidity. Methods: This register-based cohort study comprises all birth cohorts between 1987 and 1991 in Stockholm, Sweden. We followed nearly 100 000 individuals from birth until December 2011. Final school grades from the 9 years of compulsory school, and risk of psychiatric morbidity in young adulthood were analyzed with Cox regression. Results: Accumulation of ACE was more common groups with lower school grades. A positive relationship was found between accumulation of ACE and psychiatric morbidity, i.e. the more ACE the higher the risk. Individuals with incomplete grades who had experienced more than three ACE had nearly four times higher risk for psychiatric morbidity. Conclusion: The association between low school grades, accumulation of ACE, and psychiatric morbidity in young adults emphasizes the importance of both primary and secondary preventions in school.