Adverse childhood experiences and impact on quality of life in adulthood: development and validation of a short difficult childhood questionnaire in a large population-based health survey

PURPOSE: A short adverse childhood experiences (ACEs) measure is needed with non-intrusive items that include subjective evaluations of childhood. We validated a short Difficult Childhood Questionnaire (DCQ) that assesses ACEs using personal perceptions of events. METHODS: The study relied on 2019 data from a representative survey (N = 28,047) in Norway. We examined the DCQ’s factor structure, internal consistency, and discriminant validity in a multi-group confirmatory factor analysis. As a group variable, we used whether the respondent had the ACE of parental alcohol use disorder (adult children of alcoholics; ACOA). To assess the DCQ’s convergent validity, we used latent regression analysis with adulthood quality of life (QoL) as the outcome and mental distress and loneliness as potential mediators. RESULTS: The DCQ’s latent mean was 0.86 (95% CI 0.82–0.90, p < 0.001) higher in the ACOA versus the non-ACOA group. The effect size suggested a large magnitude of this difference. The DCQ score was negatively associated with QoL and positively associated with mental distress and loneliness. For the score’s QoL effect [− 0.84 (95% CI − 0.87 to − 0.80, p < 0.001)], − 0.80 was indirect, and − 0.04 was direct. Thus, most of the association of DCQ with QoL occurred via mediators. CONCLUSIONS: The results confirmed the DCQ’s discriminant and convergent validity and highlight this tool as an empirically supported approach to assess ACEs. Because of its brevity and psychometric strengths, the DCQ is useful for research and likely suited to mental health treatment settings.