Comparison of adverse childhood experience analytic approaches and associations with emotional and behavioral problems: A nationwide study among Chinese middle school students

Background: Adverse childhood experiences (ACEs) are demonstrated to be strongly associated with many health related problems, which have aroused extensive public attention. But the variety of analytic approaches of ACEs has limited researchers to differentiate those approaches across the outcomes.Methods: A total of 22,686 middle school students were surveyed, and their ACEs and health related behaviors were collected. Four different analytic approaches were used to compare the effects of ACEs on four outcomes (non-suicidal self-injury, suicidal ideation, depression and anxiety symptoms). Logistic regression models were applied to verify the associations of adversities and four outcomes. R2 and the areas under the Receiver Operator Characteristic (ROC) curve were computed to compare the effects of four approaches.Results: It was suggested that four measures of ACEs were significantly associated with all the outcomes in both the unadjusted and adjusted models (Ps all <0.05). R2 and areas under ROC curve showed that the contributions of four analytical approaches to different outcomes were diverse in this study. ACEs were more impactive to girls than to boys.Conclusion: ACEs are profound influencing factors of emotional and behavioral problems among middle school students. The selection of analytic approaches of ACEs depends on the need of research, and our study con-tributes to the choice of suitable analytic methods for future research of ACEs.