Self-Acceptance and Purpose in Life Are Mechanisms Linking Adverse Childhood Experiences to Mortality Risk

Objective Adverse childhood experiences (ACEs) are associated with an increased risk of premature mortality, but it is not clear why. Individuals with ACEs tend to have lower self-acceptance and purpose in life, which may be pathways between ACEs and risk of premature mortality. As such, we tested whether purpose and self-acceptance are mechanisms that link ACEs to mortality risk. Methods We used the Midlife in the United States Survey (N = 6218; mean [standard deviation] = 46.89 [12.94] years) to test whether these factors were indirect pathways between ACEs and mortality hazards over 24 years of follow-up. We used a comprehensive ACE measure that included 20 possible childhood adversities including emotional and physical abuse, household instability, socioeconomic climate, and ill health. Results ACEs significantly increased mortality risk (hazard ratio = 1.028, 95% confidence interval = 1.008-1.047, p =.006). Self-acceptance and purpose accounted for an estimated 15% and 4% of the ACEs-mortality relation, respectively. These effects withstood a range of adjustments and sensitivity analyses. Conclusions ACEs may affect mortality risk partially through lower self-acceptance and purpose during adulthood. Given that self-acceptance and purpose may change through intervention, these factors may be useful targets for individuals with ACEs that could lead to a longer life.