Adverse childhood experiences among Kenyan adolescents: psychometric properties, prevalence rates and correlates

Background: Adverse Childhood Experiences (ACEs) have been consistently linked to poor mental health outcomes, yet research on their impact in low- and middle-income countries (LMICs) settings of Africa, remains relatively unexplored. In Kenya, where childhood adversity is widespread, there is a critical need to examine the validity of ACE measures and their associations with mental ill health. This study aimed to validate the Adverse Childhood Experiences questionnaire (ACE-10) in a Kenyan adolescent sample and assess its associations with symptoms of depression and anxiety, bullying, and sociodemographic factors. Methods: Data was collected from N = 2,842 adolescents and young adults aged 11 to 25 years attending 42 secondary schools across four counties in Kenya. We conducted Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) to assess the factor structure of the ACE questionnaire. Internal consistency was evaluated using Cronbach’s alpha. Linear mixed-effects models were used to examine associations between ACEs and sociodemographic factors, bullying, depression (PHQ-8) and anxiety (GAD-7) symptoms. Results: EFA initially yielded a three-factor model, but a two-factor model provided better fit (CFI = 0.962, TLI = 0.948, RMSEA = 0.033, SRMR = 0.028). Higher ACE scores were significantly associated with depressive symptoms (β = 0.05, p < 0.001), anxiety symptoms (β = 0.08, p < 0.001), and bullying (β = 0.06, p < 0.001). Bullying was more strongly associated with ACE scores among males (β = 0.05, p < 0.001). Conclusions: This study provides the first validation of the ACE questionnaire in Kenya and highlights the significant associations between childhood adversity and adolescent mental ill health. Findings underscore the need for trauma-informed interventions and further research into protective factors that may mitigate the effects of ACEs in LMICs. Trial registration: This study was pre-registered under a larger study with the Pan African Clinical Trials Registry, trial number: PACTR202305589854478 in accordance with WHO and ICMJE standards.