Adverse childhood experiences, resilience and mental health among young people aged 16-29 years in Nepal: a population-based household survey (2025).

Background: Mental health conditions are a major public health challenge for young people globally. Although adverse childhood experiences (ACEs) are established risk factors for poor mental health, population burden of ACEs and their association with modifiable psychosocial factors and mental health outcomes among young people remain limited in South Asian countries, including Nepal, thereby constraining the development of evidence-informed prevention strategies. To address this gap, this study examines the associations of ACEs and protective psychosocial factors with mental health outcomes, including depression, anxiety, psychological distress, and suicide attempts among young people in Nepal. Methods: A cross-sectional survey of Nepali residents aged 16-29 years was conducted using a multi-stage cluster sampling design across three randomly selected provinces, with survey estimates applied to generate population-level estimates. An interviewer administered questionnaire was used to collect data on socio-demographic factors, ACEs, psychosocial characteristics, health behaviours, and mental health outcomes. ACEs were examined as a cumulatively and by domain, along with resilience and perceived social support assessed as potential protective factors. Weighted multilevel logistic regression models were used to estimate the odds ratios (ORs) for associations with mental health outcomes. Findings: The study included a weighted sample of 6055 individuals, with mean age of 21.1 (±4.1) years and 54.3% were female. A total of 62.4% reported exposure to at least one ACE, with 10.4% experiencing four or more. The overall prevalence of anxiety was 24.3% (95% CI: 23.2-25.4), depression was 6.0% (95% CI: 5.4-6.6), psychological distress was 9.8% (95% CI: 9.0-10.6) and suicide attempt was 1.9% (95% CI: 1.6-2.3), with the rates higher among female participants. Those with four or more ACEs had significantly higher prevalence of anxiety (44.9%), depression (15.4%), psychological distress (26.4%), and suicide attempts (9.48%). Individuals with four or more ACEs were associated with increased odds of anxiety (OR = 2.72; 95% CI: 2.05-3.62), depression (OR = 2.61; 95% CI: 1.74-3.91), psychological distress (OR = 4.67; 95% CI: 3.22-6.77), and suicide attempts (OR = 9.60; 95% CI: 4.44-20.75). Those with lower household wealth, current smokers and belonging to the female sex were associated with higher odds of anxiety, depression, and psychological distress. Perceived social support accounted for 14.2%, 26.1%, 13.8%, and 21.6% of the associations between ACEs and anxiety, depression, psychological distress, and suicide attempts. Interpretation: The findings suggest that addressing childhood adversity is important and may contribute to reduction of the burden of mental health conditions among young people in Nepal. ACEs screening and prevention, alongside interventions that strengthen resilience and promote social support, are urgently needed, particularly for young women and economically disadvantaged young populations. Funding: This work was funded by a grant from the Charles Sturt University, Australia.