UCL Great Ormond Street Institute of Child Health


Great Ormond Street Institute of Child Health


Adverse childhood experiences (ACEs) and trajectories of mental health presentations to health care

Supervisors: Dr Leah Li, Professor Ruth Gilbert

Adverse childhood experiences (ACEs) and trajectories of mental health presentations to health care across the life courses of mothers and siblings of children in the UK


Adverse childhood experiences (ACEs), such as maltreatment (abuse and neglect) and household dysfunction (e.g. domestic violence, maternal substance misuse), can have a profound and long-term impact on the health and wellbeing of children. There is a large body of research on the association between exposure to ACEs and adverse mental health through childhood and adolescence. However, family members share genetic and environmental risk factors, which may also influence the risk of adverse mental health. Few have explored the impact of ACEs on family members, e.g. mothers and siblings of children from the same family, especially on their age-related changes (trajectories) in mental wellbeing. 


This PhD project aims to explore a range of indicators of ACEs recorded in healthcare records and their associations with patterns of mental health-related presentations across the life course for mothers and their children. The project will explore how much of the mother-child and child-child correlations are attributable to ACEs within the household.  


The project will use electronic health records for over half a million children and their mothers registered in the UK CPRD mother-baby link database between 2002-18, which is linked to the Hospital Episode Statistics (HES), Index of Multiple Deprivation (IMD), and ONS mortality data. The primary outcomes will be longitudinal measures of maternal and child mental health trajectories from birth onwards for children and before and after each delivery for the mother. Indicators of mental health presentations will be derived from read codes, prescriptions, or referrals/admissions. These include psychiatric disorders, depression, anxiety, psychosis, alcohol/substance misuse. Six key domains of ACEs, identified from our previous work (Syed et al 2022), will be considered. These are child maltreatment, adverse family environment, maternal mental health problems, maternal substance misuse, high-risk presentations of child maltreatment (birth to up to 5 years after birth), and maternal intimate partner violence (up to 2 years before birth to 5 years after birth). Data on ACEs are obtained from recording in children or mothers, such as neglect/abuse by a caregiver, social service referrals, codes indicating high risk of maltreatment, and prenatal exposure to drugs/alcohol.  

The student will apply joint (multivariate multilevel) models to estimate the association between ACEs and trajectories of mental health of mothers and siblings of children, to account for the within individual correlations (due to repeated measures) as well as within family correlations (i.e. between mother-child and between siblings). 

The findings from the project will inform strategy for developing intervention on families exposed to ACEs.

Syed, S., Gonzalez-Izquierdo, A., Allister, J., Feder, G., Li, L., & Gilbert, R. (2022). Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study. Lancet Digit Health. doi:10.1016/S2589-7500(22)00061-9