Adverse childhood experiences and their impact on mental and physical health among university students in Erbil city

Background and objective: Adverse childhood experiences (ACEs) have been linked to a broad spectrum of long-term health and behavioral consequences. Despite growing global research, limited evidence exists from Middle Eastern and conflict-affected settings such as Iraq. This study aimed to determine the prevalence and types of ACEs among university students in Erbil City, and to examine their associations with mental and physical health outcomes, as well as selected sociodemographic characteristics. Methods: A cross-sectional study was conducted among 400 undergraduate students from Salahaddin University and Hawler Medical University between November 2024 and February 2025. Eight colleges were randomly selected, and convenience sampling method was used to recruit participants. Data were collected using a culturally adapted version of the WHO ACE-International Questionnaire and a modified CDC Health Appraisal form. ACE scores were grouped into low (0–1), moderate (2–3), and high (≥4). Descriptive statistics, chi-square tests, and multivariable logistic regression were applied. Results: The mean ACE score was 3.5 (SD = 2.39), with 94.5% of students reporting at least one ACE and 42.8% reporting four or more. The most commonly reported ACEs were community violence (85.8%), bullying (56.8%), and witnessing domestic violence (51.7%). Significant associations were observed between ACE exposure and a range of health outcomes. Students with ≥4 ACEs had significantly higher odds of depression (AOR = 4.94), fatigue (AOR = 3.02), headaches (AOR = 2.53), and indigestion (AOR = 2.55). Male students reported higher rates of childhood physical abuse and bullying, while ethnic minority and rural-background students experienced disproportionately greater exposure to several ACE categories. Conclusion: The high prevalence of ACEs and their strong associations with adverse health outcomes highlight a significant public health concern among university students in Erbil. These findings underscore the need for trauma-informed interventions in educational and healthcare settings and for policies addressing early-life adversity. Keywords: Child Abuse, Depression, Gastrointestinal Diseases, Pain, Violence.