This study has focused on expanding an understanding of unique associations and cumulative impact of ACEs, IPV, and lifetime traumatic events on the development of PTSD among war-affected populations. Our findings from a 2018 sample of Ukrainian college students demonstrated a significant positive relationship between ACEs and PTSD as well as between ACEs and IPV, but did not support the role of IPV as a mediator in this link. In this sample, adverse childhood events appeared to lead to subsequent traumatic stress symptoms as well as partner violence victimization, in line with extant literature [15–17, 29, 30].
Our study provided a high prevalence of PTSD among our sample, almost one in four screened positive for PTSD (compared with near 8% among U.S. population). Overall, this suggests trauma impact beyond what is usually seen in civilian populations and is in line with previous research on prevalence of PTSD in countries affected by wars [7]. This high prevalence could be due to the trauma and stress related to Russian invasion of Ukraine, political turmoil the prior to the war, family dynamics, or individual experiences [2]. The results of this study suggest that early life adversities may have a cumulative impact on the development and severity of PTSD symptoms during later stages of life. Our results highlight the enduring influence of ACEs on mental health outcomes and emphasize the importance of addressing and mitigating the impact of early life adversities to prevent or reduce the risk of PTSD.
In contrast to expectations, IPV did not then predict subsequent PTSD when controlling for other lifetime traumas. This suggests that respondents’ PTSD symptoms were more closely tied to their adverse childhood experiences and other traumatic events than to intimate partner violence victimization, and/or that ACEs were associated with PTSD symptoms through mechanism(s) other than IPV victimization.
A number of factors potentially account for these findings. Firstly, the ACEs portion of the survey asked respondents about their experiences throughout their first 18 years of life, while the IPV questions were limited to experiences in the last 12 months. The ACEs questions thus captured a much longer timespan than the IPV questions, and if respondents’ IPV experiences did not occur in the last 12 months, they were not captured in this survey. This may have led to a more thorough and accurate picture of respondents’ adverse childhood versus partner violence experiences, thus making it easier to accurately link ACEs to PTSD and more difficult to link IPV with PTSD. The lower prevalence of the IPV in our sample compared to another study of mothers of schoolchildren by our own group, suggests the possibility of a larger role of the IPV as people, especially women age through adulthood. Longer duration of exposure to an abusive relationship (or relationships) in older adults leading to cumulative number of IPV incidents, could also be another contributor to a possible stronger role of the IPV in older adults.
Secondly, it is also possible that ACEs have more power to predict IPV than IPV has power to predict PTSD. For instance, it may be that ACEs predict a variety of IPV experiences, from one-time incidences of IPV to ongoing, severe abuse; while only a subset of IPV exposures - such as exposure to particularly severe, long-lasting, and/or variable IPV - go on to predict PTSD. In this case, because the time-limited nature of our questions prevented us from capturing respondents’ IPV experiences outside of a 12-month timeframe, we may not have captured respondents’ IPV experiences with sufficient accuracy to document the weaker relationship between IPV and PTSD.
Thirdly, evidence shows that PTSD can develop as late as years following a traumatic experience, meaning that the full effects of past-year IPV may not have been evident at the time of the study [59]. Additionally, because ACEs definitionally occur in childhood and the IPV questions in this survey measured adulthood experiences, it is possible that respondents’ increased cognitive and emotional maturity and knowledge of and access to helpful resources were protective against PTSD resulting from the trauma of IPV, as compared with childhood trauma during less independent, more formative years.
Fourthly, like all life events, ACEs and IPV occur in broader life and societal contexts that can also significantly impact individuals’ mental health. Of note for this sample is the fact that Ukraine has been at war with the Russian Federation since 2014, when Russia invaded the Crimean Peninsula and pro-Russian militants took control of portions of the Donbas region in Eastern Ukraine. The data for this study was collected in 2018, after the seizure of Crimea and amid ongoing armed conflict in Donbas. In December 2020, Amnesty International published a memorandum on the impact of this war on IPV in Eastern Ukraine, noting that increased IPV rates and lack of perpetrator accountability and survivor services since the start of the war have culminated in an increasingly dire situation for Ukrainian IPV survivors. If survivors are aware of this lack of response and resources, and/or if they are unable to prioritize IPV reporting given the more pressing realities of war, they may generally underreport their IPV experiences, potentially worsening the problem of undercounting IPV discussed above. It is also possible that war-related traumas - such as one’s own and/or loved ones’ participation in armed conflict, witnessed fighting, property destruction, conflict-related sexual violence, worsening economic circumstances, separation from loved ones, and/or concerns about safety and national stability - may be more predictive of PTSD symptoms for survivors in the context of war than recent IPV victimization. Future studies should seek to further elucidate these competing influences.
Traumatic experiences can have varying impacts on the development of post-traumatic stress disorder (PTSD), with different trauma types potentially resulting in distinct manifestations and severity of symptoms. For example, Hinchey et al. [60] found that interpersonal traumas tended to be more predictive of the PTSD than non-interpersonal traumas. Understanding such differential impacts is crucial for tailoring interventions and providing appropriate support to individuals who have experienced specific types of trauma.
A number of lifetime traumatic events was found to be positively associated with PTSD symptomatology, albeit with a smaller effect size compared to ACEs. This indicates that the accumulation of traumatic events throughout one's lifetime contributes to the manifestation and severity of PTSD symptoms. It is worth noting that while the effect size was smaller compared to ACEs, the cumulative impact of lifetime traumatic events should not be overlooked, as it represents an ongoing risk factor for PTSD development.
Interestingly, gender differences emerged in our study, with self-identified males reporting lower levels of PTSD symptomatology. This finding aligns with previous research suggesting that males may exhibit different patterns of PTSD symptoms or may be less likely to seek help for their symptoms [61]. It underscores the need to consider gender-specific factors in understanding and addressing PTSD in clinical practice and future research endeavors.
Importantly, our results revealed significant associations between ACEs and both IPV and lifetime traumatic events. Participants who reported higher numbers of ACEs were more likely to experience IPV and a greater number of lifetime traumatic events. These associations showed similar effect sizes. These findings align with the previous research that suggesting a greater risk of revictimization among individuals who have experienced ACEs [35, 36, 38].
The mediation analysis provided additional insights into the pathways through which ACEs may contribute to PTSD development. Consistent with previous research [30], our results demonstrated that the association between ACEs and PTSD symptomatology was partially mediated by the number of lifetime traumatic events. This indirect association suggests that ACEs may increase the risk for subsequent exposure to traumatic events, which in turn contributes to the development of PTSD symptoms. These findings highlight the importance of considering the cumulative impact of traumatic events as a mediator in the ACEs-PTSD pathway.
Overall, the findings of this study contribute to the growing body of literature on the impact of ACEs, lifetime traumatic events, and IPV on the development of PTSD. The results underscore the significance of early life adversities as risk factors for subsequent traumatic experiences and highlight the cumulative and enduring effects of these experiences on mental health outcomes. The findings have important implications for clinical practice, emphasizing the need for early identification, prevention, and intervention efforts targeting both ACEs and subsequent traumatic events to mitigate the risk of PTSD.
Limitations
Despite the valuable contributions of this study, several limitations should be acknowledged. Firstly, the cross-sectional design restricts our ability to establish causal relationships between variables. Future longitudinal studies could provide more robust evidence regarding the temporal associations between ACEs, traumatic events (including IPV), and PTSD. Secondly, the reliance on self-report measures introduces the potential for recall bias or social desirability bias. Future studies could employ multiple assessment methods, including clinician-administered interviews or objective measures, to enhance the validity of findings. Lastly, the generalizability of the findings may be limited to the specific sample of participants who were affected by the Russian military aggression in Ukraine. Replication of these findings in diverse populations and across different developmental stages is warranted.