Racial/Ethnic Differences in the Role of Childhood Adversities for Mental Disorders Among a Nationally Representative Sample of Adolescents

Background: Childhood adversities may play a key role in the onset of mental disorders and influence patterns by race/ethnicity. We examined the relations between childhood adversities and mental disorders by race/ethnicity in the National Comorbidity SurveyAdolescent Supplement. Methods: Using targeted maximum likelihood estimation, a rigorous and flexible estimation procedure, we estimated the relationship of each adversity with mental disorders (behavior, distress, fear, and substance use), and estimated the distribution of disorders by race/ethnicity in the absence of adversities. Targeted maximum likelihood estimation addresses the challenge of a multidimensional exposure such as a set of adversities because it facilitates "learning" from the data the strength of the relationships between each adversity and outcome, incorporating any interactions or nonlinearity, specific to each racial/ethnic group. Cross-validation is used to select the best model without over fitting. Results: Among adversities, physical abuse, emotional abuse, and sexual abuse had the strongest associations with mental disorders. Of all outcomes, behavior disorders were most strongly associated with adversities. Our comparisons of observed prevalences of mental disorders to estimates in the absence of adversities suggest lower prevalences of behavior disorders across all racial/ethnic groups. Estimates for distress disorders and substance use disorders varied in magnitude among groups, but some estimates were imprecise. Interestingly, results suggest that the adversities examined here do not play a major role in patterns of racial/ethnic differences in mental disorders. Conclusions: Although causal interpretation relies on assumptions, growing work on this topic suggests childhood adversities play an important role in mental disorder development in adolescents.