Psychometric properties of expanded adverse childhood experiences assessment questionnaire at a wellness centre in India

Abstract

The original Adverse Childhood Experiences (ACEs) assessment questionnaire with 10 items has been extensively used to assess and identify associations with long-term negative outcomes in mental health, physical health, and behaviour globally. The past three decades of research has also identified a few additional categories of ACEs beyond the original ten questions. However, there is a gap in the Indian context to establish the psychometric properties of the expanded ACE Assessment Questionnaire and explore associations with mental health parameters.

Objective

This study evaluated the psychometric properties of an expanded ACE Assessment Questionnaire at a wellness centre in India, incorporating culturally relevant modifications to the original 10 items.

Method

An additional six questions (Dangerous neighbourhood, Loss of parent or guardian, Peer bullying or victimization, Peer isolation or rejection, financial difficulty, and Parental fights) based on decades of evidence since the original 10-item questionnaire were added. Internal validity, internal consistency using McDonald’s Omega and item-total correlation followed by principal component analysis were carried out, and confirmatory factor analysis was used to validate the factor structure and model fit indices. Questions which did not contribute to the construct were removed and predictive analysis was conducted using linear regression to predict depression and anxiety using the expanded questionnaire.

Result

Two questions (incarceration in the family from the original 10-items questionnaire and loss of parent or guardian from the additional six questions) were removed since they did not contribute significantly to the psychometric properties. The results of the remaining 14-item questionnaire confirm that it is reliable (McDonald’s Omega) and meets content validity criteria based on three-factor structure (Factor 1 - Childhood Maltreatment, Factor 2 - Resource Scarcity & Environmental Distress, Factor 3 - Household Challenges).

Conclusion

The findings highlight that additional questions are relevant in the Indian context, and the revised 14-item questionnaire has better psychometric properties while maintaining its conceptual scope in that context. The findings validate these modifications in larger, representative Indian samples to ensure the questionnaire's reliability in assessing childhood adversity and its association with long-term effects.