Evidence map›Paper›PMID 40740113›Full record

ArticlePsychological medicine2025

Direct and indirect associations of childhood adversities with functional impairment and life stress among military personnel.

Laura Campbell-Sills, Emily R Edwards, Sam D Strizver, Karmel W Choi, Jason D Kautz, Santiago Papini, James A Naifeh, Pablo A Aliaga, Paul B Lester, Ronald C Kessler and 3 more

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Article in Psychological medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

13 authors.

Laura Campbell-SillsDepartment of Psychiatry, University of California San Diego, La Jolla, CA, USA.ORCID 0000-0002-2716-5441
Emily R EdwardsVISN 2 MIRECC, Department of Veterans Affairs, Bronx, NY, USA.
Sam D StrizverDepartment of Management, Darla Moore School of Business, University of South Carolina, Columbia, SC, USA.
Karmel W ChoiCenter for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Jason D KautzDepartment of Organizations, Strategy, and International Managementhttps://ror.org/049emcs32, University of Texas at Dallas, Dallas, TX, USA.
Santiago PapiniDepartment of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA.
James A NaifehCenter for the Study of Traumatic Stress, Department of Psychiatryhttps://ror.org/04r3kq386, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Pablo A AliagaCenter for the Study of Traumatic Stress, Department of Psychiatryhttps://ror.org/04r3kq386, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Paul B LesterGraduate School of Defense Managementhttps://ror.org/033yfkj90, Naval Postgraduate School, Monterey, CA, USA.
Ronald C KesslerDepartment of Health Care Policy, Harvard Medical School, Boston, MA, USA.
Robert J UrsanoCenter for the Study of Traumatic Stress, Department of Psychiatryhttps://ror.org/04r3kq386, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Murray B SteinDepartment of Psychiatry, University of California San Diego, La Jolla, CA, USA.
Paul D BlieseDepartment of Management, Darla Moore School of Business, University of South Carolina, Columbia, SC, USA.

Funding

Modifiable Risk and Protective Factors for Suicidal Behaviors in the US ArmyU01MH087981 · NIMH · HENRY M. JACKSON FDN FOR THE ADV MIL/MED · PI STEIN, MURRAY B., URSANO, ROBERT J. · 2009 to 2013
$65.0M
NIMH NIH HHS U01 MH087981NIMH NIH HHS U01MH087981U.S. Department of Defense HU0001-15-2-0004
6 · The paper itself

Abstract

backgroundAdverse childhood experiences (ACEs) are associated with physical and mental health difficulties in adulthood. This study examines the associations of ACEs with functional impairment and life stress among military personnel, a population disproportionately affected by ACEs. We also evaluate the extent to which the associations of ACEs with functional outcomes are mediated through internalizing and externalizing disorders.

methodsThe sample included 4,666 STARRS Longitudinal Study (STARRS-LS) participants who provided information about ACEs upon enlistment in the US Army (2011-2012). Mental disorders were assessed in wave 1 (LS1; 2016-2018), and functional impairment and life stress were evaluated in wave 2 (LS2; 2018-2019) of STARRS-LS. Mediation analyses estimated the indirect associations of ACEs with physical health-related impairment, emotional health-related impairment, financial stress, and overall life stress at LS2 through internalizing and externalizing disorders at LS1.

resultsACEs had significant indirect effects via mental disorders on all functional impairment and life stress outcomes, with internalizing disorders displaying stronger mediating effects than externalizing disorders (explaining 31-92% vs 5-15% of the total effects of ACEs, respectively). Additionally, ACEs exhibited significant direct effects on emotional health-related impairment, financial stress, and overall life stress, implying ACEs are also associated with these longer-term outcomes via alternative pathways.

conclusionsThis study indicates ACEs are linked to functional impairment and life stress among military personnel in part because of associated risks of mental disorders, particularly internalizing disorders. Consideration of ACEs should be incorporated into interventions to promote psychosocial functioning and resilience among military personnel.

Indexed as

Adverse Childhood ExperiencesMental DisordersMilitary PersonnelStress, PsychologicalAdultFemaleHumansLongitudinal StudiesMaleUnited StatesYoung Adultadverse childhood experiencesmediation analysismental disordersmilitary personnelpsychological stresspsychosocial functioning

Identifiers

PMID40740113
PMCPMC12331149

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.