Adverse childhood experiences, family functioning, and duration of untreated illness among adolescents with anxiety and depressive disorders: A nationwide study in China.

OBJECTIVE

Treatment delay in adolescents with anxiety and depressive disorders may adversely affect outcomes. Although adverse childhood experiences (ACEs) are established risk factors, the family-level mechanisms linking ACEs to duration of untreated illness (DUI) remain unclear. This study examined whether family functioning statistically accounted for associations between specific ACEs and delayed help-seeking.

METHODS

This nationwide cross-sectional study recruited 1,051 adolescents with first-episode anxiety and depressive disorders from eight Chinese clinical centers. Participants completed the ACE questionnaire and the FACES II-CV; DUI was ascertained through structured clinical interviews. Mediation analyses using PROCESS examined indirect associations of family adaptability and cohesion in the ACE-DUI association.

RESULTS

The median DUI was 6.0 months (IQR: 1.0-21.0). ACEs were positively associated with longer DUI. Mediation analyses indicated that family functioning may partly account for statistical associations between specific ACEs and DUI. Indirect-only association patterns were observed for physical neglect, physical abuse, parental separation/death, household substance abuse, and household mental illness (B = 0.02-0.04, all 95% CIs excluding zero), suggesting that these ACEs were associated with treatment delay mainly through lower family adaptability and cohesion. In contrast, emotional neglect, domestic violence, and household incarceration showed significant direct associations with prolonged DUI (B = 0.13-0.36, all 95% CIs excluding zero), with household incarceration also showing an additional indirect association through cohesion.

CONCLUSIONS

Family dysfunction may be a potentially modifiable factor linking ACEs to treatment delay. Indirect association patterns indicate that lower family adaptability and cohesion may partly explain why certain ACE domains are associated with longer DUI, supporting family-focused early identification strategies while causal interpretations require confirmation in longitudinal studies.