Adverse Childhood Experiences and Internalizing Symptoms Among American Indian Adults with Type 2 Diabetes

Jessica H.L. Elm

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Decades of evidence link adverse childhood experiences (ACEs) to worse health. Despite disproportionate rates of ACEs and health disparities in tribal communities, a gap exists in understanding the effects of ACEs on American Indian (AI) health. The purpose of this study is to estimate frequencies of eight categories of ACEs, assess the risk for internalizing symptoms by each ACE category, and determine if moderate and high levels of ACEs exposures have differential, increasing risk associated with internalizing symptoms for a sample of AI adults with T2D. Methods: Five tribal communities participated in a community-based participatory research study. Data from AI adults with T2D were analyzed (N = 192). Frequencies of eight childhood events and situations were assessed, and exposure levels of low (0–1), moderate (2–3), and high levels (4 +) of ACEs were calculated. Odds of screening positive for depression and generalized anxiety disorder (GAD) by each ACE type and moderate and high levels of ACEs were estimated using regression analyses. Results: Relative to other studies, exposure estimates for each of the eight ACE categories and moderate and high levels of ACEs were high. Sexual and physical abuse, neglect, and household mental illness were positively associated with depressive symptoms, and physical abuse was positively associated with anxiety symptoms. Exposures to moderate and high levels of ACEs were associated with increased odds of screening positive for current depression in a dose-response fashion. A high level of ACEs exposure was also associated with an increased odds of a positive GAD screening. Conclusions: This research extends limited knowledge about ACEs and health among AIs. More research is needed to understand the health consequences of ACEs for a population exhibiting health inequities. Components of strategies for addressing ACEs, mental health, T2D complications, and comorbidities are proposed for AIs generally and AI adults with T2D specifically.

Original languageEnglish (US)
Pages (from-to)958-966
Number of pages9
JournalJournal of Racial and Ethnic Health Disparities
Issue number5
StatePublished - Oct 1 2020


  • ACEs
  • Adversity
  • Anxiety
  • Child abuse
  • Depression
  • Diabetes mellitus
  • Health disparities
  • Health equity
  • Historical trauma
  • Intimate partner violence
  • Native American
  • Stress

ASJC Scopus subject areas

  • Health(social science)
  • Anthropology
  • Sociology and Political Science
  • Health Policy
  • Public Health, Environmental and Occupational Health


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