Adverse childhood experiences and adult health
Population of interest has
and
Age
Sex
Race/Ethnicity
Education
Income
BRFSS changed its income question after 2020. Through 2020 the top bucket is an open-ended $75K+; from 2021 that range is split into four narrower ones. The two are never combined, so selecting $75K+ restricts the data to 2020 and earlier, and selecting any of the four restricts it to 2021 onward.
Estimates are
Age-adjusted: every group is compared as if it had the same mix of ages (the 2000 U.S. standard population).
Age-adjusted (2000 U.S. standard population).
The share of adults who report that a doctor, nurse or other health professional once told them they had a depressive disorder. It is a lifetime measure of diagnosis, so it counts adults who were diagnosed years ago and are well now, and it does not count adults who have never been diagnosed.
The denominator is the adults in the selected population who gave a usable answer to this question, weighted using BRFSS survey weights. Adults who refused or answered that they did not know are left out of both the numerator and the denominator rather than counted as a no.
This measure rests on fewer survey years than most of the others. BRFSS did not ask this question until 2010, so 2009 contributes nothing to it, and in 2010 it ran as an optional module that not every state fielded. That end of the series is thin as well as short, and a state whose only ACE module years fall before the question existed shows no value here rather than a low one.
Frequent Mental Distress is the closer measure of current mental health, and the two are not interchangeable.
About the dashboard
The ACE-BRFSS dashboard is built around an interactive grid-map of the United States (plus territories). While comparing ACEs, choose a population of interest and a specific map display, which includes two variables for comparison. Compare the average ACE score, percent of adults, or prevalence of ACE indicators (x-variable) to other ACE indicators and outcomes (y-variable) among the selected population.
The right-hand column starts with a scatterplot view of the data displayed in the map. Each dot on the chart is a US State. An additional bar chart shows how ACEs accumulate among adults with and without the selected ACE or outcome (dependent y-variable): the share with 1 or more, 2 or more, 3 or more, and 4 or more ACEs. Larger gaps indicate stronger co-occurrence.
How to read this map
This map shows geographic patterns in the relationship between average ACE score and depression. It is based on a population of adults that have any ACE score and any demographic profile.
Dark purple indicates high average ACE score and depression. Light purple indicates low average ACE score and depression. Red indicates high depression and low average ACE score. Blue indicates high average ACE score and low depression. Alaska, Colorado, Connecticut, and Illinois have no ACE module data in CDC's public BRFSS files and appear gray. States with fewer than 30 respondents, or too few in one age group, are also shown in gray and should be interpreted with caution.
These are age-adjusted estimates: every group is compared as if it had the same mix of ages (the 2000 U.S. standard population). That matters here because older adults report fewer ACEs and have more long-term health conditions. Read them as comparisons, not as the share of adults in a state: for that, switch to crude estimates.
ACE data are self-reported: adults answer survey questions about their own childhoods. A state with higher values has not necessarily had more ACEs. Differences between states can also reflect how readily adults recognize and report these experiences, which can vary with cultural factors and awareness of ACEs, among other reasons.
The ACE score follows CDC's scoring of the BRFSS ACE module, collapsing 11 survey items into 8 categories: sexual abuse (3 items), physical abuse, substance abuse (2 items), emotional abuse, witnessed intimate partner violence, household mental illness, incarceration, and parental divorce. Only respondents with valid responses to all 11 survey items are scored. The average is weighted using BRFSS survey weights to be representative of each state's adult population.
Survey years 2009 through 2012 and 2019 onward are pooled. One caution about comparing across that gap: CDC changed the wording of the physical-abuse question between the two periods. Even in states that took part in both periods, the share of adults who reported it was about nine percentage points higher from 2019 onward than in 2009 through 2012. The question about adults hurting each other barely changed, and no other ACE question rose by more than about half as much. So physical abuse, and to a lesser degree the overall score, cannot be compared cleanly across the two periods.
Age matters when comparing states: older adults report fewer ACEs and have more long-term health conditions, and states differ in how old their adults are. Figures on the Explore page are not adjusted for age, so differences between states there partly reflect age. The Compare page adjusts for age by default (to the 2000 U.S. standard population), so every state is compared as if it had the same mix of ages, and it can be switched to show unadjusted figures.
Higher scores indicate more types of adversity experienced during childhood. Read more about adverse childhood experiences.
Scatterplot view
Each dot represents a US state or territory. Age-adjusted estimates.
Hover over a dot to see which state it is and highlight it on the map.
Co-occurrence overview: number of ACEs with and without depression
Population has any ACE score. Age-adjusted estimates.
Change the y variable above the map to see co-occurrence with a different ACE or outcome.
Each row is the share of adults who reported at least that many ACEs, among adults with depression and among adults without it.
The ACE score counts how many of 8 categories an adult reported: emotional/verbal abuse, physical abuse, sexual abuse, witnessed intimate partner violence, household mental illness, household member incarcerated, household substance abuse, and parental separation/divorce. It needs an answer to all 11 questions behind them, so adults who skipped any are left out of both bars. The two neglect items are not part of it.
Prevalence gap (%)
The ACE score follows CDC's scoring of the BRFSS ACE module, collapsing 11 survey items into 8 categories: sexual abuse (3 items), physical abuse, substance abuse (2 items), emotional abuse, witnessed intimate partner violence, household mental illness, incarceration, and parental divorce. Only respondents with valid responses to all 11 survey items are scored. The average is weighted using BRFSS survey weights to be representative of each state's adult population.
Survey years 2009 through 2012 and 2019 onward are pooled. One caution about comparing across that gap: CDC changed the wording of the physical-abuse question between the two periods. Even in states that took part in both periods, the share of adults who reported it was about nine percentage points higher from 2019 onward than in 2009 through 2012. The question about adults hurting each other barely changed, and no other ACE question rose by more than about half as much. So physical abuse, and to a lesser degree the overall score, cannot be compared cleanly across the two periods.
Age matters when comparing states: older adults report fewer ACEs and have more long-term health conditions, and states differ in how old their adults are. Figures on the Explore page are not adjusted for age, so differences between states there partly reflect age. The Compare page adjusts for age by default (to the 2000 U.S. standard population), so every state is compared as if it had the same mix of ages, and it can be switched to show unadjusted figures.
Higher scores indicate more types of adversity experienced during childhood. Read more about adverse childhood experiences.