Self-Acceptance and Purpose in Life Are Mechanisms Linking Adverse Childhood Experiences to Mortality Risk

Páraic S. O'Súilleabháin, Sinéad D'Arcy-Bewick, Milou Fredrix, Máire McGeehan, Emma Kirwan, Meredith Willard, Amanda A. Sesker, Angelina R. Sutin, Nicholas A. Turiano

Research output: Contribution to journalArticleAcademicpeer-review


Objective Adverse childhood experiences (ACEs) are associated with an increased risk of premature mortality, but it is not clear why. Individuals with ACEs tend to have lower self-acceptance and purpose in life, which may be pathways between ACEs and risk of premature mortality. As such, we tested whether purpose and self-acceptance are mechanisms that link ACEs to mortality risk. Methods We used the Midlife in the United States Survey (N = 6218; mean [standard deviation] = 46.89 [12.94] years) to test whether these factors were indirect pathways between ACEs and mortality hazards over 24 years of follow-up. We used a comprehensive ACE measure that included 20 possible childhood adversities including emotional and physical abuse, household instability, socioeconomic climate, and ill health. Results ACEs significantly increased mortality risk (hazard ratio = 1.028, 95% confidence interval = 1.008-1.047, p =.006). Self-acceptance and purpose accounted for an estimated 15% and 4% of the ACEs-mortality relation, respectively. These effects withstood a range of adjustments and sensitivity analyses. Conclusions ACEs may affect mortality risk partially through lower self-acceptance and purpose during adulthood. Given that self-acceptance and purpose may change through intervention, these factors may be useful targets for individuals with ACEs that could lead to a longer life.

Original languageEnglish
Pages (from-to)83-88
Number of pages6
JournalPsychosomatic Medicine
Issue number2
Publication statusPublished - 1 Feb 2024


  • ACEs = adverse childhood experiences
  • adverse childhood experiences
  • adversity
  • Key words/Abbreviations
  • MIDUS = Midlife in the United States
  • mortality
  • purpose
  • self-acceptance
  • socioeconomic status


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