Do Adverse Childhood Experiences Influence Psychological Distress Among Korean-Speaking Immigrants In California? Evidence from the California Health Interview Survey

Background: Adverse childhood experiences (ACEs) have been well-documented as a significant risk factor for mental health outcomes. A prominent critique of the ACEs framework, however, has been its disproportionate emphasis on household dysfunction and intrafamilial violence, largely neglecting the broader socioecological context in which children develop. In response to this limitation, scholarly efforts have sought to expand the conceptual scope of ACEs to encompass community- and societal-level adversities. While the association between ACEs and mental health has been relatively well established within Asian American populations broadly, it remains insufficiently examined within the distinct sociocultural context of South Koreans specifically. To address this gap, the present study investigated the differential effects of a comprehensive set of ACE indicators on psychological distress among first-generation Korean-speaking immigrants in California.

Methods: A secondary data analysis was conducted using the publicly available 2024 California Health Interview Survey dataset. This study focused on 185 foreign-born Korean-speaking immigrant adults. Participants’ ACEs were assessed using a conventional ACEs framework with 10 categories in the household (dysfunction, abuse, neglect) along with four items capturing expanded ACEs (i.e., racism, violence in neighborhood, economic hardship, and a parent’s death). Participants’ psychological distress was assessed using Kessler Psychological Distress Scale-6. All analyses were weighted using survey weights and jackknife error estimates in Stata 19. Multivariate regression analysis was conducted to examine the effects of cumulative conventional ACEs (categorized as none, low [1–3], and high [4 or more]) and four expanded ACEs variables regarding psychological distress. Analyses controlled for gender, age, marital status, educational attainment, employment status, poverty status, U.S. residency duration, and English proficiency.

Results: The sample was 51% female, with most participants younger than 64 years old (76.7%), married (74.6%), college-educated (66.4%), employed (61.6%), high-income (63.5%), lived in the United States for more than 15 years (76.8%), and reporting limited English proficiency (59.6%). The regression model significantly explained 28.7% of the total variance (F = 5.14, p < .001). Compared to those who had never experienced ACEs, individuals with low (b = 1.85, p < .01) and high (b = 3.76, p < .05) levels of conventional ACEs were significantly associated with higher levels of psychological distress. Among the expanded ACEs, experiencing economic hardship was positively associated with psychological distress (b = 2.38, p < .05). Among control variables, being female (b = -2.80, p < 0.01) and under 300% of the federal poverty level (b = -1.84, p < 0.01) were significantly associated with higher levels of psychological distress.

Discussion: A thorough understanding of Korean-speaking immigrants’ childhood adversities—both in the household and across broader familial, community, and societal contexts—is essential for developing culturally competent interventions to improve their mental health. This study provides evidence to inform the development of screening tools for early detection of vulnerable populations at high risk of mental health challenges. Findings also can guide implementation of culturally tailored interventions aimed at supporting Korean-speaking immigrants with a history of ACEs in addressing their trauma and improving their mental health outcomes.