Unveiling hidden dimensions: A novel bifactor approach to unraveling adverse childhood experiences

Abstract

Background: Adverse Childhood Experiences (ACEs) are associated with diverse negative health outcomes and are commonly screened for in primary care, research, and clinical practice. However, more research is needed surrounding the conceptualization, measurement, and application of ACEs measures.

Objective: This study examines the bifactor structure and internal reliability of a short, practical, and commonly used ACEs questionnaire and assesses how the factor structure is associated with correlates of ACEs.

Participants and setting: Data from Utah's 2020 Behavioral Risk Factor Surveillance System, a telephone survey assessing the prevalence of health-related behaviors among a sample of adults in Utah (N = 8978, Mage = 51.5, SD = 19.4, Range = 18-99; 50 % female, 87.1 % White) was analyzed.

Methods: Exploratory and confirmatory factor analyses were conducted to determine the best-fitting factor structure and examined correlations between the identified factors and poor health and substance use with structural equation modeling.

Results: A three-factor bifactor model best fit the data and its components had associations of different direction and magnitude with outcomes (bifactor: health β = 0.83, p < .001, substance use β = 0.14, p = .025; household hardship: health ß = -0.49, p < .001, substance use ß = 0.23, p < .001; general abuse: health ß = -0.63, p < .001, substance use ß = 0.18, p = .036; sexual abuse: health ß = -0.25, p < .001).

Conclusions: Results highlight the importance of using a bifactor approach to examine and score ACEs measures rather than a traditional total sum score method.

Keywords: Adverse childhood experiences; Bifactor; Health; Substance use; Trauma.