Associations between adverse childhood experiences and family health in adulthood: a national cross-sectional analysis

Whether adverse childhood experiences (ACEs) influence family health relationships in adulthood remains an understudied area. The aim of this study was to assess the relationship between ACEs and family health and the mediating effect of adulthood socioeconomic status (SES). The 2023 Psychology and Behavior Investigation of Chinese Residents (PBICR) enrolled 30,048 Chinese adults aged ≥18 years. ACEs were assessed via a 7-item questionnaire, and family health via the Family Health Simplified Scale. Generalized linear models explored associations between the number/type of ACEs and family health, with mediation analysis examining the role of adulthood SES. Emotional abuse was the most common ACE (25.5%). All ACE types were negatively associated with family health, with incarceration (male: β = −4.51, 95% CI: −5.11 to −3.91; female: β = −3.18, 95% CI: −3.86 to −2.51), sexual abuse (male: β = −4.09, 95% CI: −4.53 to −3.65; female: β = −2.39, 95% CI: −2.80 to −1.98), and family mental illness (male: β = −3.95, 95% CI: −4.41 to −3.49; female: β = −2.70, 95% CI: −3.15 to −2.25) showing the strongest negative associations (all p < 0.0001). A graded association, indicating a dose–response pattern, was observed between ACEs and family health, excluding the family health resources dimension. Moreover, mediation analysis showed that adulthood SES explained only 2.15% of the association, and participants with ACEs demonstrated distinct family health outcomes across residential, regional, and social contexts. ACEs were gradedly associated with poorer family health in adulthood, excluding the family health resources dimension. These findings underscore the need for multidimensional strategies to mitigate the adverse effects of childhood trauma and coordinated supports at the individual, family, and community levels, so as to promote family health and well-being.