Association Between Expanded Adverse Childhood Experiences and Presenteeism Among Japanese Workers: A Cross-Sectional Study

BACKGROUND: Presenteeism is an occupational health challenge. Although adverse childhood experiences (ACEs) have been linked to adult health, evidence on comprehensive ACE exposure and presenteeism remains limited. METHODS: We analyzed data from working adults in the 2022 Japan COVID-19 and Society Internet Survey (JACSIS). ACEs were assessed using an expanded Japanese ACE questionnaire and categorized as 0, 1, 2, 3, and ≥4 ACEs. Presenteeism was measured using the Work Functioning Impairment Scale (WFun), and high presenteeism was defined as WFun ≥21. Using logistic regression, we examined the association between ACE counts (0, 1, 2, 3, and ≥4) and high presenteeism. We further evaluated the cumulative effect of increasing ACE counts. Models were adjusted for age, sex, educational attainment, marital status, weekly working hours, and job stress. Stratified analyses were conducted by current mental disorder status. RESULTS: Among 19,409 workers included in the analytic sample, those with any ACE exposure had higher odds of high presenteeism than those reporting no ACEs, and the association displayed a dose-response pattern with increasing ACE counts. This graded relationship was also observed in stratified analyses, irrespective of the presence or absence of a current mental disorder. CONCLUSIONS: This study suggests that expanded childhood adversity is relevant to presenteeism among working adults, regardless of current mental disorder status. These findings reveal the value of a life-course perspective in occupational health and point to the need for future research to clarify the mechanisms linking ACE exposure to presenteeism and to examine trauma-informed approaches for reducing presenteeism.