A systematic review of the impact of adverse childhood experiences on U.S. Service Members and military readiness

Adverse childhood experiences (ACEs) are well-documented risk factors for poor social, behavioral, and physical health outcomes, yet their impact on U.S. Service Members has not been comprehensively reviewed. This systematic review, registered with PROSPERO and conducted in accordance with PRISMA guidelines, examined the health outcomes associated with ACE exposure in military populations. A search across eight databases identified 707 articles; 21 peer-reviewed studies met inclusion criteria after screening. Most studies focused on Army personnel, with smaller representations of Marines, Air Force, and mixed-Service groups; no studies specifically examined Navy or Coast Guard personnel. Findings indicate that Service Members report higher ACE exposure than civilians, with consistent associations to adverse behavioral and health outcomes that threaten individual well-being and mission readiness. Despite increasing recognition of ACE-related challenges, gaps persist in military-specific policy, education, and intervention strategies. Efforts to standardize ACE screening protocols across national and international military collaborations could further strengthen prevention and intervention approaches. Additionally, expanding research into cross-cultural military contexts would provide valuable insight into how ACEs manifest differently across diverse environments. These results underscore the urgent need for ACE-informed policies and practices in recruitment, training, and ongoing support to mitigate the long-term effects of ACEs and sustain the resilience and readiness of the force.