Adverse childhood experiences (ACEs) reflect stressful or traumatic early life events such as abuse, neglect, and significant household challenges. These experiences are increasingly appreciated as factors that exert influence on physical and mental functioning throughout the lifespan. Numerous studies have demonstrated dose–response relationships between the number of ACEs reported and negative health outcomes in adulthood (Anda et al., Reference Anda2006). At the same time, evidence points to the role of ACEs in the development of heightened biological reactivity to stress that may serve to increase vulnerability to the development of mental and substance use disorders (e.g., Heim et al., Reference Heim, Shugart, Craighead and Nemeroff2010). Furthermore, the existence of sex differences in both stress reactivity and the prevalence of various forms of psychopathology in adulthood (Doom et al., Reference Doom, Cicchetti, Rogosch and Dackis2013) raises the question of whether men and women are differentially vulnerable to the health risks posed by ACEs. Much of the work concerning ACEs has focused on outcomes as they present in middle adulthood, which may not generalize to later life, as there may be cohort effects in the prevalence of (or likelihood of reporting) ACEs. Studies finding that the newly old report greater numbers of ACEs than their more senior counterparts imply that rates of ACEs are increasing over time and may be contributing to the development of mental and substance abuse disorders (MSUDs) in the growing population of aging adults, and make a case for better understanding these associations in later life.

This issue's Paper of the Month by Choi and colleagues (Choi et al., Reference Choi, DiNitto, Marti and Choi2016) presents important evidence pertaining to the link between ACEs and MSUDs in older adulthood. Using data from 14,738 individuals age 50 years and older who took part in the 2012–2013 U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), the authors found that nearly 35% of older women and 36% of older men experienced one or two ACEs (most commonly parental/other adult substance abuse, physical abuse, and emotional neglect), over twice as many women as men reported having experienced sexual abuse (15.7% vs. 6.4%), and women reported a greater number of ACEs overall. The rates of ACEs reported by this older adult cohort were generally in line with those endorsed by individuals across the adult age span, suggesting that cohort effects may now be diminishing. As expected, each additional ACE reported by older adults was associated with increased odds for lifetime MSUDs. The risk associated with total ACE burden did not differ by gender; however, unlike prior studies examining younger adults, and contrary to their hypotheses, the authors found that the associations between individual ACEs and MSUDs were more likely to be found in men than in women, and when found in both genders, the associations were stronger in men than in women.

The findings by Choi and colleagues urge future work aimed at characterizing the trajectory of ACE-MSUD relationships across the lifespan. As well, studies aimed at identifying the mechanisms by which specific ACEs are differentially linked to mental and substance use disorders in men and women as they age represent next logical steps. Such studies will require the consideration of factors that are challenging to measure, such as the onset, chronicity, temporal sequence, and overlap of early-life stressors, as well as the experience of trauma during adulthood as they relate to the development of mental disorders in later life.

In order to advance this research, future studies must incorporate statistical methods that can bolster the assertion that these associations between ACEs and late-life MSUDs are more likely causal than not. Such approaches will need to grapple with the question of which variables are most appropriate to model when examining the complex interplay between biological and environmental risk factors for later mental health outcomes. Models that control for the presence of MSUDs in a parent, for example, will be useful in differentiating the contributions of adverse experiences from those related to genetic factors. Demonstrating residual associations between ACEs and later MSUDs in such models will provide a more detailed understanding of the outcomes specifically associated with early environmental risk. Alternatively, comparing matched groups of individuals (such as siblings) who differ only in their experience of ACEs may lead to stronger evidence in support of the negative influences specific to ACEs, rather than to the myriad factors associated with their presence.

If the associations reported by Choi and colleagues represent the negative consequences of ACEs to late-life MSUDs, then their findings would indicate not only that childhood adversity can have lifelong consequences to mental health, but also that sex differences in vulnerability to the negative influences of adversity during childhood extend well into late life. These findings thus underscore the potentially far-reaching influences of ACEs and suggest that efforts aimed at preventing, detecting, and intervening early in the face of ACEs may benefit a larger proportion of the population than previously appreciated. The possibility of mitigating negative mental health outcomes related to ACEs has an ever greater impact on public health as the population of older adults continues to expand. This study by Choi and colleagues lays the foundation for important work affecting future generations of older adults.