Adverse childhood experiences and depressive symptoms among Thai medical students: a cross-sectional study

BACKGROUND: Adverse childhood experiences (ACEs) are associated with increased risk of depressive symptoms across the life course. Medical students are exposed to sustained academic and psychosocial stress, which may interact with earlier adversity to influence mental health outcomes. However, evidence from non-Western contexts remains limited. This study examined the prevalence of ACEs and their association with depressive symptoms among Thai medical students. METHODS: A cross-sectional study was conducted between April and July 2025 among medical students at one faculty of medicine and two affiliated medical education centers in Southern Thailand. All participants completed an anonymous online survey that included the Thai version of the Adverse Childhood Experiences questionnaire and the validated Thai version of the Patient Health Questionnaire-9 (PHQ-9). ACE exposure was categorized as low (0-1), moderate (2-3), and high (≥ 4). Depressive symptoms were defined as PHQ-9 scores ≥ 9. Multivariable logistic regression analyses were performed to examine associations between ACE exposure and depressive symptoms, adjusting for demographic variables, physical illness, and recent life stress. RESULTS: Among 540 participants (median age 21 years; 60.4% female), 54.6% reported at least one ACE. Moderate and high ACE exposure were observed in 20.2% and 6.7% of students, respectively. The most commonly reported ACE domains were physical neglect (31.9%), parental divorce or separation (28.8%), and household mental illness (26.8%). Depressive symptoms were present in 17.6% of participants. In multivariable analyses, moderate ACE exposure was independently associated with depressive symptoms (adjusted odds ratio [aOR] = 2.26; 95% CI: 1.29-3.93; p = 0.004). High ACE exposure showed a similar magnitude of association but did not reach statistical significance. Current life stress (aOR = 5.83; 95% CI: 2.77-14.31; p < 0.001) and physical illness (aOR = 2.30; 95% CI: 1.19-4.36; p = 0.012) were also independently associated with depressive symptoms. CONCLUSION: ACEs were common among Thai medical students and were associated with higher odds of depressive symptoms after adjustment for current stressors. These findings highlight the role of early-life adversity as a potential vulnerability factor for psychological distress in medical training. Longitudinal research is warranted to clarify temporal pathways and inform culturally appropriate mental health support strategies in medical education settings.