The Frequency and type of Adverse Childhood Events (ACEs) in Patients with known Psychiatric Illness
Abstract
Objective
To determine the frequency and types of adverse childhood experiences (ACEs) among psychiatric outpatients in Karachi, Pakistan, and assess associations with sociodemographic and clinical factors.
Study Design Cross-sectional analysis of 300 psychiatric outpatients from January to May 2025.
Place and Duration of Study
Conducted at the Psychiatry Outpatient Department of Jinnah Postgraduate Medical Centre, Karachi, over five months.
Methods
Participants completed a culturally adapted Adverse Childhood Experiences-International Questionnaire (ACE-IQ), which assesses 13 ACE domains. ICD-11-diagnosed patients(excluding active psychosis) were evaluated. Data analysis using SPSS v23.0 included chi-square tests to examine associations between ACEs, diagnoses, and sociodemographics.
Results
Emotional neglect was the most prevalent ACE (26.57%), followed by physical abuse (17.87%) and emotional abuse (17.87%). Sexual abuse was underreported (6.7%). Household dysfunction included physical neglect (11.11%) and household mental illness (11.11%), while parental separation/divorce was rare (0.48%). Major depressive disorder patients reported higher emotional abuse/neglect, and generalized anxiety disorder patients showed elevated physical abuse, though no ACE reached statistical significance across diagnoses (p > 0.05). Preliterate participants had higher emotional neglect rates (p = 0.019), and parental conflicts marginally correlated with suicidal attempts in schizophrenia (p = 0.019).
Conclusion
ACE patterns in Pakistani psychiatric patients reflect cultural norms, including normalized emotional neglect and familial preservation despite dysfunction. Trauma-informed careaddressing these culturally mediated adversities is critical for improving mental health outcomes.
Keywords
Adverse childhood experiences; Mental disorders; Cross-sectional studies; Pakistan; Trauma-
informed care.
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References
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