Revisiting the use of adverse childhood experience screening in healthcare settings

Adverse childhood experiences (ACEs) are key modifiable risk factors for mental illness. The potential to detect and mitigate ACEs to improve population mental health has led to large public health efforts. However, basing public mental health decisions on ACE screening has revealed several conspicuous challenges. In this Review, we provide a critical overview of these challenges, focusing on the validity of ACE screening measures, their accuracy in classifying individuals at risk for poor mental health outcomes, their utility in facilitating the delivery of targeted interventions, their acceptability by respondents and interviewers, and the overall financial sustainability of this screening approach. There are clear research opportunities to address these challenges and improve current practices. For example, basic measurement research could improve the validity and acceptability of ACE measures, individual risk modelling approaches could be adopted to improve the accuracy of ACE screening to predict mental health conditions and guide intervention selection, and promising interventions could be tested to ensure that vulnerable individuals detected through ACE screening receive effective support. Screening for adverse childhood experiences can improve mental health outcomes through personalized treatments in at-risk individuals or preventative strategies at the population level. In this Review, Danese et al. synthesize the challenges and opportunities of these screening measures and related analytical methods.