Research Article: Adverse Childhood Experiences in Medical Students: Implications for Wellness

Date Published: March 8, 2019

Publisher: Springer International Publishing

Author(s): Andrés F. Sciolla, Michael S. Wilkes, Erin J. Griffin.


The primary purpose of the study was to assess the prevalence of adverse childhood experiences (ACEs) in a cohort of third-year medical students and characterize their childhood protective factors.

The authors developed a web-based anonymous survey distributed to all third-year medical students in one school (N = 98). The survey included the 10-item ACE Study questionnaire, a list of childhood protective factors (CPF) and questions to assess students’ perception of the impact of ACEs on their physical and mental health. The medical school’s IRB approved the student survey as an exempt study. The authors computed descriptive and comparative statistical analyses.

Eighty-six of 98 students responded (88% response rate). Forty-four students (51%) reported at least one ACE exposure and 10 (12%) reported ≥ 4 exposures. The latter were all female. The average difference in the ACE score between male and female medical students was − 1.1 (independent t test with unequal variances t(57.7) = − 2.82, P = .007). Students with an ACE score of ≥ 4 were significantly more likely to report a moderate or significant effect on their mental health, compared with students with scores ≤ 3 (chi-square test, P = < .0001). Most students reported high levels of CPF (median score = 13 of a maximum score = 14). ACEs and CPF were inversely associated (Pearson correlation = − 0.32, P = .003). A sizeable minority of medical students reported exposure to multiple ACEs. If replicated, findings suggest a significant vulnerability of these medical students to health risk behaviors and physical and mental health problems during training and future medical practice.

Partial Text

The response rate was 88% (86 of 98 students) of whom 44 (51%) were female. Six nonrespondents were on personal or academic leave at the time the survey was administered. Responses to the ACE Study questionnaire are listed in Table 1. Across all 10 items, 42 students (49%) had a total of zero; 17 (20%) had a score of one; 10 (12%) had a score of two; 7 (8%) had a score of three; and 10 (12%) had a score ≥ 4. Students with a score ≥ 4 were all women.Table 1Distribution of ACE scores and responses to ACE Study questionnaire items by gender. The average total number ACE items and the frequency distribution of the number of ACE items (number and percent) are shown by gender and overall in the upper portion of the table. The frequency distribution (number and percent) for each ACE item is shown by gender and overall in the lower portion of the tableMale no. (%)Female no. (%)Total no. (%)ACE scoreMean = .76Mean = 1.86Mean = 1.33*  023 (54.76)19 (43.18)42 (48.8)  19 (21.43)8 (18.18)17 (19.8)  27 (16.67)3 (6.82)10 (11.6)  33 (7.14)4 (9.09)7 (8.1)  404 (9.09)4 (4.6)  501 (2.27)1 (1.2)  6003 (3.5)  703 (6.82)0 (0)  801 (2.27)1 (1.2)  901 (2.27)1 (1.2)  10000ACE category  Emotional abuse4 (10)14 (32)18 (21)**  Physical abuse2 (5)9 (11)11 (13)**  Sexual abuse4 (10)9 (20)13 (15)  Emotional neglect1 (2)6 (14)7(8)  Physical neglect2 (5)3 (7)5 (6)  Mother treated violently0 (0)6 (14)6 (7)**  Substance abuse in household4 (10)9 (21)13 (15)  Mental illness in household9 (21)16 (36)25 (29)  Household member going to prison2 (5)4 (9)6 (7)  Parental separation or divorce4 (10)6 (14)10 (12)*t test of overall mean difference by gender. For men, M = .76 ACEs, SD = 0.98; for women, M = 1.86 ACEs, SD = 2.39; t(57.7) = − 2.82, P = .007**P < .05 Fisher’s exact test by gender Our study from one medical school class suggests that one in five (20%) students have been exposed to three or more ACEs and one in 10 (12%) to more than four. These prevalence rates suggest an increased risk for burnout and depression on one hand and, on the other, problems in academic performance, as suggested by research in college students [22]. Disturbingly, students with an ACE score ≥ 4 were all women. However, almost one in four (23.8%) male medical students had an ACE score ≥ 2, and it is unknown whether a certain ACE score or exposure to a specific type of ACE increases significantly men’s risk to burnout. Moreover, nondisclosure of sexual abuse may be higher among male medical students as suggested by studies of adults in the general population [23]. Contrary to our expectations, the prevalence of ACEs in a class of third-year medical students was comparable to rates in the general population: in one study of five US states, 55.4% reported ≥ 1 ACEs and 13.7% reported ≥ 4 ACEs [24]. As a point of comparison, the corresponding rates in the landmark ACE Study conducted in a primary care setting were 52.1% and 6.2%, respectively [25].   Source: