Adverse childhood experiences, psychological well-being, and substance use in Pakistani university students

Adverse childhood experiences are associated with risky health behaviors and adverse health outcomes worldwide, including substance use; yet, relatively fewer studies have examined linkages between adverse childhood experiences and health behaviors and outcomes in low- and middle-income countries, including countries in sub-Saharan Africa and large portions of Asia. Furthermore, fewer studies of adverse childhood experiences have examined the pathways or processes connecting adverse childhood experiences to health behaviors and outcomes. This study addressed these gaps by investigating three competing models of associations between adverse childhood experiences, psychological well-being, and substance use in 595 Pakistani University students (40.5% female; Mean(age) = 21.96, Standard deviation = 2.37) using path analysis. Controlling for the effects of age, sex, and socioeconomic status, adverse childhood experiences were associated with both diminished psychological well-being and higher levels of substance use. However, psychological well-being and substance use were unrelated and neither accounted for indirect effects of adverse childhood experiences on adjustment. Suggestions for furthering research on adverse childhood experiences, particularly in low- and middle-income countries, are discussed.