Adverse childhood experiences (ACEs) can have a profound effect on the future well-being of individuals (Centers for Disease Control and Prevention, 2019). An estimated 62% of adults surveyed across 23 states reported that they had experienced at least one ACE during childhood and nearly one-quarter reported that they had experienced three or more ACEs (Merrick et al., 2018). ACEs can have negative, lasting effects on health and emotional well-being. These exposures can disrupt social development and lead to substance misuse and other unhealthy coping behaviors in adults (Dube et al., 2005; Chapman et al., 2004).

Felitti et al. (1998) found a strong relationship between childhood abuse and several leading causes of death. Fuller-Thomson et al. (2016) reported that childhood physical abuse was significantly associated with suicidal ideation. Dube et al. (2005) found a positive relationship between adverse childhood experiences and the risk of attempts at suicide throughout life. Angelakis et al. (2020), in a systematic review, found that different types of childhood maltreatment including sexual abuse, physical abuse and emotional abuse were associated with a 2- to 3-fold increased risk for suicide attempts. Herzog and Schmahl (2018) commented that ACEs affect psychological and psychosocial mechanisms known to contribute to mental disorders, comprising disturbances in cognitive and affective processing. The risk for developing a mental disorder after ACEs was highest for depression, borderline personality disorder and substance abuse. Fergusson et al. (2013) found that exposure to ACEs was associated with consistent increases in risks of later mental health problems.

Despite previous research on police mental health, there exists a gap between police mental health outcomes and life course events such as ACEs. The purpose of the present study is to examine cross-sectional associations between ACEs and psychological problems among police officers. Specifically, the hypothesis is focused on the association of ACEs with posttraumatic stress disorder (PTSD), depressive and hopelessness symptoms.

Resiliency will be examined in this study to determine if it modifies the effects of ACEs on PTSD, depression and hopelessness. Resiliency has been described as the process of adapting to and bouncing back from adverse experiences (Southwick et al., 2014; Ozbay et al., 2007). McCanlies et al. (2017) found that resilience to be an important mediator between social support and symptoms of PTSD among police officers working during Hurricane Katrina in New Orleans. Resilient police officers are less likely to experience symptoms of PTSD after a trauma (deTerte and Stephens, 2014) and are more likely to use personal skills in a positive manner to get through experienced trauma (Fredrickson et al., 2003). Goldenson et al. (2021) examined the impact of ACEs on psychological functioning and assessed whether resilience had a moderating effect: participants with four or more ACEs had significantly more psychopathology and lower resilience (Goldenson et al., 2021).

Gender differences in ACE’s exposure will also be examined. It has been suggested that women may be more susceptible to depression because they are more likely to experience ACEs within established relationships (Olff et al., 2007) of family or close relatives (Feletti, 1998). Sweeney et al. (2016) found that sexually abused women reported more lifetime depressive symptoms and mood disorders. In a 10-year review, Putnam (2003) found that child sexual abuse was a significant risk factor for psychopathology, especially depression and substance abuse.

Descriptive statistics were used to characterize the study population. Potential confounders were selected based on the information in the literature or/and their associations with ACE and PTSD/depressive symptoms. These associations, with ACE as an independent variable and PTSD and depression scores as dependent variables, were analyzed using linear regression. Unadjusted and adjusted regression coefficients with standard errors were obtained from regression models. The adjustments were made for age, sex, race/ethnicity and alcohol intake. Associations were also investigated by stratifying on resiliency (using median) and sex to assess effect modification. All statistical tests were performed using a statistical significance level at p < 0.05. All analyses were conducted using SAS software, version 9.4 (SAS, 2008).

Frequencies and means of demographic and lifestyle characteristics are presented in Table 1. The mean age of the officers was 48 (SD = 10) years, 28% were women, 67% were married and 45% had a college degree. Fifty-three percent held the rank of patrol officer, and 74% had served for more than 15 years in the department. The overall ACE score was mean = 1.6 (SD = 1.8) ranging from 0 to 9. The ACE score differed significantly between female and male officers (2.3 vs. 1.3, respectively, p < 0.001; data not shown).

Table 2 illustrates the number of officers responding “yes” with the corresponding percentage for each independent ACE item. The highest reported percentage of ACEs was having divorced parents (38.3%). Being sworn at and insulted (23.5%) and being slapped or grabbed (22.4%) were among the highest-rated adverse experiences.

Table 3 presents unadjusted and multivariable-adjusted associations of ACEs with psychological measures in the study. Regression analyses from the unadjusted model of ACEs with PTSD and depressive symptoms showed positive and significant associations: (β = 1.60, p < 0.001 and β = 1.25, p < 0.001, respectively), corresponding to the increase in 1.6 units in PTSD for every unit increase in ACE. In other words, for every 3 unit increase in ACE, there is a 5-unit increase in PTSD, reflecting the negative effect of having three or more ACEs. No significant associations were found between ACE and hopelessness in the overall sample. When adjusting for covariates in the model (age, sex, race/ethnicity and alcohol consumption), the associations were not attenuated: (β = 1.70, p < 0.001 and β = 1.29, p < 0.001, respectively) (Figure 1).

Table 4 shows associations of ACE with psychological measures stratified by sex. 19.6% of policewomen reported being sexually fondled as children. In a multivariable-adjusted model, the positive association between ACE and PTSD score was stronger among male police officers compared to their female counterparts (β = 2.66, p < 0.001 vs. β = 0.59, p = 0.248, respectively). This difference in the strength of the association was reflected in the corresponding test for interaction (p-interaction = 0.010). A borderline statistically significant association of ACE with hopelessness was observed among female officers only (β = 0.196, p = 0.051 vs. β = 0.127, p = 0.271). p-value for interaction was not significant (p = 0.689).

Analyses stratified by the median value of resiliency scores are presented in Table 5. Resilience modified the relationship between ACEs and PTSD symptoms. The interaction test was significant with p = 0.011. Significant adjusted positive associations were observed between ACEs and PTSD among officers with resiliency scores below the median compared to those above the median (β = 2.65, p < 0.001 vs. β = 0.844, p = 0.064, respectively). Resiliency did not significantly modify associations between ACEs and depression or hopelessness.

The mean number of ACEs among police was 1.6 (SD = 1.8) events. On average, this was higher than seen in the general population study (Felitti et al., 1998) where an estimated 62% of adults surveyed across 23 states reported that they had experienced at least one ACE during childhood. In total, 13.7% of this police sample reported four or more ACEs compared to 12.5% of the general population. ACEs were significantly associated with PTSD and depressive symptoms. Non-significant associations were found between ACEs and hopelessness in the overall sample; however among women ACEs and hopelessness reached near significance. Officers with levels of resilience below the median had a significant positive association between ACEs and PTSD while officers with resilience at or above the median did not.

Parental divorce was the most prevalent type of ACE reported by police (38.3%). As adults, officers exposed to parents’ divorce may have more difficulty dealing with stress, regulating emotions in times of strife and internalizing problems. The extent of risk for mental issues in children of divorced parents is nearly twice that of those in married families (Hetherington, 1999). Exposure to divorce threatens a child’s sense of emotional security within the family which in turn affects the child’s ability to regulate emotions when faced with stress (O’Hara et al., 2019; Cummings et al., 2009). Other studies have found that children who blamed themselves for the divorce tended to internalize problems, which may persist into adulthood (Buchanan et al., 2001). Police work often involves conflict and may exacerbate the internalization of negative emotions and mental health in officers who were exposed to parent’s divorce.

Present results indicated various types of abuse among officers in this sample, but a higher percentage experienced physical and emotional abuse. These events are considered most at risk for depression (Carr et al., 2013). Norman et al. (2012) reported a higher odds ratio for depression when children were exposed to emotional abuse compared to physical abuse and a higher odds ratio for drug abuse when exposed to physical abuse compared to emotional abuse. Romero et al. (2009) found that physical abuse was independently associated with a greater prevalence of PTSD. Mandelli et al. (2015), in a meta-analysis, found emotional abuse showed the strongest association with depression, followed by neglect and sexual abuse. Spertus et al. (2003) found that emotional abuse predicted depressive symptoms after adjusting for physical and sexual abuse, suggesting that emotional abuse is independently related to depression. Verbal abuse was found to increase risk for depression compared with physical abuse (Teicher et al., 2006). Khan et al. (2015) reported that nonverbal emotional abuses are stronger predictors of depression than other types of abuse.

The path of child abuse and the development of PTSD or depression could not be traced through time as this was a cross-sectional study. Larger samples and longitudinal investigation will help to clarify the present results. It was not possible in this study to determine if ACEs occurred simultaneously or together in multiple stages. As Herzog and Schmahl (2018) pointed out, rarely do ACE experiences occur independently but rather in multiple types and times. A recent meta-analysis reported that 19% of individuals with major depression reported more than one form of childhood abuse and, while all childhood experiences have been shown to increase the risk of depression, experiencing multiple forms further elevates the risk (Nelson et al., 2017). Robst and Van Glider (2011) found that the severity and length of abuse has an effect on psychological consequences; however, data were not available in the present study on ACE severity or duration. It is also important to know at what age the experiences occurred as various levels of childhood development may influence the intensity of the effect of ACEs and subsequent PTSD or depression (Robst and Van Glider, 2011). The present sample was primarily white. Future work should include a larger sample of minority participants. Merrick et al. (2018) found significantly higher ACE exposures reported by participants identified as black (mean score, 1.69; 95% CI, 1.62–1.76), Hispanic (mean score, 1.80; 95% CI, 1.70–1.91) or multiracial (mean score, 2.52; 95% CI, 2.36–2.67).

There are a wide range of reasons why someone would want to become a police officer. Robst and VanGlider (2011) found that childhood abuse is a factor related to occupational choice. Johnson (2019) in a survey of 1,673 law enforcement officers from across the USA found that 41% wanted to address an “injustice” and wanted to fight back after being a victim of a crime. As part of the psychological screening process, it would be helpful to determine if child abuse played a part in the candidate’s decision to be an officer as it may affect future psychological complications as well as performance. Conversely, child abuse can have a positive influence on an officer candidate as the experience will motivate the desire to help others who may have been similarly victimized.

Interestingly, the mental health of other first responder occupations appears to be similarly affected by ACEs. Hom et al. (2016) found a significant correlation between early physical abuse and suicide risk in firefighters regardless of the danger and trauma they faced at work. Aronson et al. (2020) examined the relationship between ACEs and the mental health of military veterans. Fifty-nine percent of female and 39% of male veterans reported exposure to one ACE, whereas 44% of female and 25% of male veterans were exposed to multiple ACEs. For males, a higher level of abuse was associated with probable PTSD and anxiety. Combat experiences were associated with an increase in the likelihood of having a mental health problem (Aronson, 2020). Research should be expanded in these occupations in an effort to generalize reasons why these similar types of occupations were selected and what part of ACEs played in that selection.

Intervention is important in mental health issues among police. Such issues can affect performance. PTSD associated with ACEs can affect attention and interpretation of threat (Fani et al., 2012) and can exacerbate emotional regulation in officers. Pollak et al. (2005) found that adults abused as children can experience high reactivity and easy provocation in stressful situations and will have difficulty in calming down. Anger problems have been reported by persons with PTSD and have been directly implicated in interpersonal problems (Hart and Rubia, 2012). In this regard, further research is needed on the tangential effects of childhood abuse on officers’ performance and relations with the public. An inquiry should be expanded regarding the work assignments of officers who were victims of ACEs. An example would be child exploitation and pornography investigators. These officers face a range of exposures to obscene and disturbing images of children being abused and sexually exploited. The tasks of this type of work pose a significant risk for psychological pathology, especially among those officers who have experienced childhood ACEs (Krause, 2019).

There is a need for organizational support for officers who experience mental health difficulties. Many officers are hesitant to come forward with such problems, and sources of help should be confidential. Peer support programs in many police organizations have been helpful in this regard. Training which helps to reduce the stigma associated with mental illness would be beneficial as well. There are other dimensions yet unexplored which contribute to mental problems among police; and experiences that occurred in an officers’ life prior to employment may provide clues to beneficial interventions. It may, therefore, be useful to examine events subsequent to ACEs during both officers personal and work life. Events such as traumatic occurrences at work and off duty that build upon ACE experiences and exacerbate mental health problems among officers are worth of further inquiry.