Intergenerational transmission of adverse childhood experiences: Differential maternal and paternal associations with offspring mental health in Chinese school-aged children by multi-method.

BACKGROUND: While parental adverse childhood experiences (ACEs) are recognized risk factors on offspring's mental health, particularly depression and anxiety, critical gaps persist regarding: (1) differential maternal vs paternal effects, (2) dimensional versus cumulative risk effects, and (3) buffering roles of parental and offspring factors. This study firstly, aimed to investigate the associations between parental ACEs and depression and anxiety symptoms in their school-aged children using five complementary ACEs approaches: the single adversity model, accumulating risk model, dimensional model (threat- and deprivation-related ACEs), Latent Class Analysis, and network analysis. A secondary aim was to examine whether this association were moderated by parental resilience, and offspring's sex and age.

METHOD: We conducted a cross-sectional study based on the 2023 Healthy Development and Influencing Factors Survey of School-aged Students in a city of Guangdong Province, China (n = 6146). Parental self-reported their ACEs between 0 and 18 years, through the Kaiser-CDC ACEs Scale. Offspring's depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and the 7-item Generalized Anxiety Disorder Instrument, respectively.

RESULTS: Among maternal-child pairs, maternal ACEs, especially family dysfunction, exposure to ≥1 or, ≥2 accumulative ACEs, threat- and deprivation-related ACEs, abuse-related ACEs, and a latent "emotional abuse, physical abuse and emotional neglect" ("EPE") cluster, were significantly associated with higher risks of offspring depressive symptoms (odds ratio, OR ranging between 1.46 and 1.81), but not with anxiety symptoms. Maternal ACEs also predicted higher depression and anxiety scores in offspring (β ranging from 0.28 to 1.02). In paternal-child pairs, only a marginal association was observed between paternal threat-related ACEs and offspring depression scores (β: 0.43, 95% CI: 0.00, 0.86). Network analysis identified physical abuse as central in the maternal-child network, whereas both physical and sexual abuse as central in the paternal-child network. Stratification analyses revealed effect modification by parental resilience, offspring's sex and age.

CONCLUSIONS: Our findings highlight the complex intergenerational effects of parental ACEs on child mental health, demonstrating distinct maternal versus paternal influence. Maternal physical abuse, and paternal physical and sexual abuse appeared to be key intergenerational risks. Multisectoral prevention strategies are urgently needed to interrupt the transmission of early life adversity across generations.