Pediatric ACEs and Related Life-Events Screener (PEARLS-BR) latent domains and child health in a Brazilian sample: a confirmatory factor analysis and correlation study

ABSTRACT Objectives Adverse Childhood Experiences (ACEs) significantly affect health outcomes. This study evaluates the psychometric properties of the Pediatric ACEs and Related Life Events Screener (PEARLS-BR) in Brazil, identifies latent domains, and explores their associations with pediatric health outcomes. Methods A cross-sectional study was conducted in Reference Clinical Centers in Brazil, involving 202 caregivers of children and adolescents aged 0-18. Caregivers completed the PEARLS-BR, and additional questions regarding child health. Confirmatory Factor Analysis (CFA) identified latent domains, and measurement invariance was evaluated across age and gender. Logistic regression models were used to examine associations between ACEs domains and health outcomes. Results The CFA supported a three-factor model encompassing maltreatment, household challenges, and social context, with good internal consistency and reliability. Measurement invariance was confirmed across age and gender. Higher scores in the social context domain significantly increased the odds of worse global health, while maltreatment and household challenges domains showed non-significant associations with most health outcomes. Conclusions The PEARLS-BR is a valid and reliable instrument for assessing childhood adversities in Brazilian children. The findings highlight its potential for early identification and intervention, supporting public health initiatives to mitigate the long-term effects of ACEs.