Prevalence and Correlates of Adverse Childhood Experiences in LGBTQ+ Populations: A Narrative Review and Meta-Analysis

Abstract

Adverse childhood experiences (ACEs) research suggests that marginalized populations experience more ACEs, but there is limited work on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) populations. To (a) systematically review the literature on ACEs in LGBTQ+ populations via a narrative review and meta-analyses; (b) compare the prevalence of 0, 1, 2, 3, and 4+ ACEs, as well as individual ACE items, between LGBTQ+ and reference populations; and (c) describe the correlates of ACEs within LGBTQ+ populations. MEDLINE, Embase, CINAHL, and PsycINFO were searched for empirical studies that used a 6- to 12-item ACEs questionnaire and assessed maltreatment and household dysfunction. The meta-analyses included 38 samples encompassing 24,133 LGBTQ+ individuals. The prevalence of ACEs was 15.8% for 0 ACE, 16.8% for 1 ACE, 14.9% for 2 ACEs, 13.8% for 3 ACEs, and 38.7% for 4+ ACEs. Compared to the reference samples, LGBTQ+ individuals were less likely to experience 0 ACE and more likely to experience 4+ ACEs. The prevalence of 4+ ACEs was slightly higher in gender-diverse than sexually diverse individuals. LGBTQ+ individuals had higher prevalence of psychological, physical, and sexual violence and household mental health difficulties compared to the reference samples. Correlates of ACEs in LGBTQ+ populations included mental health difficulties and increased engagement in risk-taking behaviors. Comparatively less evidence was available regarding protective factors. LGBTQ+ populations experience a disproportionately high prevalence of ACEs, accompanied by adverse mental and behavioral health outcomes. To guide prevention and intervention efforts, more research is needed on the protective factors that may mitigate these effects.