Top 5 Takeaways

  1. High Prevalence of ACEs: During the COVID-19 pandemic, 73.1% of U.S. high school students reported at least one Adverse Childhood Experience (ACE), with 7.8% reporting four or more.
  2. Impact on Mental Health and Suicide: Adolescents with four or more ACEs had a fourfold increase in poor current mental health and a 25-fold increase in past-year suicide attempts compared to those without ACEs.
  3. Specific ACEs and Their Effects: Specific types of ACEs, particularly emotional abuse, were strongly associated with poor mental health and increased suicidal behaviors.
  4. Dose-Response Relationship: A dose-response relationship was observed between the number of ACEs and the severity of poor mental health and suicidal behavior outcomes.
  5. Need for Comprehensive Strategies: The study emphasizes the need for primary prevention and intervention strategies, including early identification and trauma-informed mental health service and support.

Original Article Author and Citation

Corresponding Author

Kayla N. Anderson,

Suggested Citation

Anderson KN, Swedo EA, Trinh E, et al. Adverse Childhood Experiences During the COVID-19 Pandemic and Associations with Poor Mental Health and Suicidal Behaviors Among High School Students — Adolescent Behaviors and Experiences Survey, United States, January–June 2021. MMWR Morb Mortal Wkly Rep 2022;71:1301–1305. DOI:


The study reveals a significant association between ACEs and poor mental health outcomes and suicidal behaviors among U.S. high school students during the COVID-19 pandemic. The data indicate a worrying prevalence of ACEs and their severe impacts on adolescents’ mental health and suicidality.


The Adolescent Behaviors and Experiences Survey (ABES) conducted during January–June 2021 used a stratified, three-stage cluster sampling to gather nationally representative data. The analysis focused on high school students under 18 years old, assessing ACEs by type, category, and cumulative number.


The findings underscore the acute consequences of ACEs, showing a dose-response relationship with mental health and suicidal behaviors. Emotional abuse emerged as the most impactful ACE type. Comparisons with pre-pandemic data suggest an escalation in these issues during the COVID-19 pandemic.


The study highlights the urgent need for comprehensive, cross-sector approaches for ACE prevention and intervention. It calls for actions to support children and families, emphasizing the necessity of trauma-informed mental health services and suicide prevention strategies.

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