Associations of adverse childhood experiences with mental health and behaviors among adolescents.

BACKGROUND: Mental health and behavioral problems among adolescents are growing public health concerns, particularly in low- and middle-income countries (LMICs) like Bangladesh. Adverse childhood experiences (ACEs) are key contributors to adolescent mental health and behavioral problems, yet evidence from LMIC contexts remains limited. This study aimed to estimate the prevalence of mental health and behavioral problems and their associations with ACEs among Bangladeshi adolescents. METHODS: A cross-sectional survey was conducted among 1,159 adolescents using multistage sampling. Data were collected on sociodemographic and psychosocial characteristics, ACEs, health-behaviors, and the Strengths and Difficulties Questionnaire. Logistic regression analyses were performed to assess associations between ACEs and emotional and behavioral problems (EBPs), smoking, physical activity, and suicidal ideation. RESULTS: Overall, 40.6% of adolescents experienced at least one ACE, with psychological abuse (19.1%) being the most common. EBPs were prevalent: 9.6% had emotional problems, 22.3% had conduct problems, 6.8% had hyperactivity, and 14.2% had peer problems. Lifetime smoking and suicidal ideation were reported by 6.8% and 12.4%, respectively. Daily physical activity was reported among 71.9% of adolescents. ACEs were significantly associated with male gender, high maternal education, poor parental supervision, lack of peer support, parental tobacco or drug use, school truancy, being bullied, exposure to school violence, and loneliness. Exposure to psychological abuse [OR = 1.81 (95% CI: 1.11 - 2.94)], household mental illness [OR = 1.65 (1.00 - 2.70)], and maternal exposure to violence [OR = 2.21 (1.10 - 4.41)] were associated with a higher likelihood of suicidal ideation. Sexual abuse was associated with higher odds of peer problems [OR = 3.13 (1.52 - 6.43), while maternal exposure to violence [OR = 3.86 (1.53 - 9.70)] was associated with higher odds of hyperactivity. Household mental illness was associated with higher odds of emotional problems [OR = 2.19 (1.30 - 3.67)]. A dose-response association was observed, with multiple ACEs being associated with increased odds of EBPs, smoking, and suicidal ideation. CONCLUSION: The high burden and cumulative association of ACEs with adolescent mental health and behavioral outcomes underscore the need for trauma-informed, culturally appropriate mental health interventions to support adolescent well-being in Bangladesh.