Stress begets stress: the association of adverse childhood experiences with psychological distress in the presence of adult life stress

Table 3 Hierarchical regression results: ACEs as a three-category exposure

	Model 1	Model 2	Model 3	Model 4 (with interaction)
Chi² Δ	103.3 ^a	110.0	123.3	129.6
Level of ACEs
None (0 ACEs)	Ref	Ref	Ref	Ref
Low (1 to 5)	3.21 (1.83–5.63)	3.48 (1.81–6.67)	2.97 (1.53–5.72)	2.49 (0.92–6.72)
High (6 or more)	7.98 (4.28–14.91)	8.57 (4.19–17.53)	6.54 (3.14–13.63)	7.67 (1.90–30.94)
Level of ACEs
No stressful life events#No ACEs				Ref
Low stress#Low ACES				2.02 (0.47–8.59)
Low stress#High ACEs				1.33 (0.22–7.95)
High stress#Low ACEs				0.10 (0.009–0.98)
High stress#High ACEs				0.08 (0.006–0.95)
Age	1.10 (0.85–1.40)	1.09 (0.84–1.44)	1.09 (0.84–1.45)	1.09 (0.83–1.44)
Gender
Male	Ref	Ref	Ref	Ref
Female	2.61 (1.97–3.45)	2.67 (1.97–3.63)	2.71 (2.00–3.71)	2.77 (2.03–3.79)
Marital status
Single	Ref	Ref	Ref	Ref
Relationship	0.70 (0.53–0.93)	0.68 (0.50–0.92)	0.67 (0.49–0.92)	0.66 (0.49–0.91)
SES		0.91 (0.85–0.98)	0.91 (0.84–0.98)	0.91 (0.84–0.98)
Completed matric
No		Ref	Ref	Ref
Yes		0.79 (0.57–1.09)	0.81 (0.58–1.12)	0.81 (0.58–1.13)
Employment
No		Ref	Ref	Ref
Yes		0.79 (0.59–1.07)	0.80 (0.59–1.09)	0.80 (0.59–1.08)
Adult stress
None			Ref	Ref
Low			1.84 (1.26–2.68)	0.99 (0.25–3.98)
High			2.25 (1.35–3.74)	21.92 (2.35–204.86)

^aBold: Likelihood ratio chi-square test significant at p < 0.05; ^#Bold OR: significant at p < 0.05; ^Interaction terms

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