Prevalence of Childhood Adversity and Its Association with Depression, Anxiety, and Psychotic-like Experiences Among Young Indian Adults: A Cross-sectional Study

Abstract

Background:

Childhood adversity is very common and strongly linked to poor mental health; globally, 60% of adults report at least one adverse childhood experience. Though evidence in India is limited, multisite data suggest that one in two young adults reports child maltreatment and family-level adversities. This study estimated the prevalence of childhood adversity and examined its association with depression, anxiety, and psychotic-like experiences among young adults in Chennai, India.

Methods:

This cross-sectional study included 1,000 college students aged 18–24 years from four colleges in Chennai, India. Childhood adversity was assessed using the Childhood Trauma Questionnaire. Depression, anxiety, and psychotic-like experiences were measured using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Community Assessment of Psychic Experiences-15. Correlation and multivariable analyses were performed after adjusting for age and gender.

Results:

Overall, 90.1% reported at least one form of childhood adversity. Physical abuse and emotional neglect were the most common subtypes. Higher childhood trauma scores were significantly associated with higher depression, anxiety, and psychotic-like experience scores. Emotional abuse showed an independent association with depression and anxiety, while physical neglect was significantly associated with psychotic-like experiences.

Conclusions:

Childhood adversity is highly prevalent among young adults in this urban Indian setting and strongly associated with multiple forms of psychopathology. Emotional abuse and physical neglect show subtype-specific mental health effects. These findings underscore the importance of early identification and integration of trauma-informed interventions focused on youth mental health to reduce long-term mental health problems.

Key Messages:

• Question: What is the prevalence of childhood adversity in young Indian adults, and how is it associated with depression, anxiety, and psychotic-like experiences?

• Finding: Nine in 10 young adults reported childhood adversity, which was associated with higher depression, anxiety, and psychotic-like experiences.

• Meaning: Early identification of childhood adversity and trauma-informed care may improve youth mental health outcomes.

Childhood adversity refers to harmful or stressful experiences occurring during childhood— including abuse and neglect—which can disturb emotional, social, and physical development. ¹ These experiences, which encompass emotional, physical, and sexual abuse, as well as emotional and physical neglect, often occur within family or caregiving environments and frequently go unreported by children, leaving their true burden hidden for many years.

Global evidence shows that childhood adversity is highly prevalent.^2–4 Physical abuse affects a large proportion of children, while sexual abuse affects a smaller but significant group.^5,6 Emotional abuse and neglect are also widely reported.^2,7 In India, prevalence estimates vary widely across regions and assessment methods; however, national-level data indicate that a substantial proportion of children experience at least one form of abuse.^8,9 Factors such as social acceptance of harsh discipline, stigma around disclosure, and limited child protection awareness may further influence reporting, highlighting childhood adversity as an important public health concern in India, particularly in rapidly changing urban settings.^9–12

Childhood adversity is strongly associated with increased risk of poor mental health outcomes in later life, including depression, anxiety, post-traumatic stress disorder, personality disorders, and psychotic disorders.^13–15 Early trauma has also been linked to psychotic-like experiences in the general population, potentially indicating vulnerability along the psychosis spectrum.^16–18 Several mechanisms have been proposed to explain these associations. Early stress can dysregulate the hypothalamic– pituitary–adrenal axis, increasing biological sensitivity to stress, while also impairing emotional regulation, threat perception, and reward processing. Together, these changes may heighten the risk of mental health problems during adolescence and young adulthood—a critical period for the onset of many psychiatric conditions.

Addressing childhood adversity early is crucial to mitigate long-term mental health consequences, with early identification, supportive caregiving, and trauma-informed interventions playing a key role in enhancing coping.^19–22 Understanding the context-specific patterns of adversity is essential for developing effective prevention and intervention strategies, particularly for urban Indian youth who face challenges such as rapid urbanization, academic pressure, evolving family structures, and diminished social support. Despite this, systematic evidence on young adult populations in India, particularly in community and college settings, remains limited.

Rationale for the Study

Research on the prevalence of adverse childhood experiences in Indian metropolitan contexts remains limited, particularly in large-sample studies of college populations. The present study, though conducted in the pre-COVID era, provides valuable baseline epidemiological evidence in this regard. While recent studies have begun to report the prevalence of abuse among college students, including a study published in 2025, there is still very little research examining the association between childhood abuse and psychopathology, like psychosis-like experiences, in this population. ²³ Therefore, this study aimed to estimate the prevalence of childhood adversity among youth in Chennai, India, and to examine its association with depression, anxiety, and psychotic-like experiences in this population.

Hypothesis

Higher childhood adversity levels will be significantly associated with increased depression, anxiety, and psychotic-like experiences among young adults.

Aim

To estimate the prevalence of childhood adversity and examine its association with depression, anxiety, and psychotic-like experiences among young adults in Chennai, India.

Objectives

1. To estimate the prevalence of childhood adversity among young adults in Chennai, India.

2. To examine the association between childhood adversity and mental health outcomes, including depression, anxiety, and psychotic-like experiences.

Methods

Ethical Considerations

Ethical approval was obtained from the Institutional Ethics Committee before data collection. All participants were informed of the study’s purpose, and written informed consent was obtained before enrollment. Participants were assured of the confidentiality and anonymity of their responses throughout the data collection process. A trained research assistant was present throughout data collection to monitor for distress and provide immediate support where needed. Participants identified as experiencing significant distress or dysfunction were provided immediate support resources and referred to appropriate mental health institutions for further evaluation and care. This manuscript was prepared in accordance with the STROBE reporting guideline, and the completed STROBE checklist has been provided as supplementary online material (Supplementary file 1).^24,25

Study Design and Setting

This cross-sectional study was conducted among young adults in Chennai, Tamil Nadu, India. Data were collected from four private arts and science colleges that primarily serve students from lower- and middle-income backgrounds. Written informed consent was obtained from all participants before enrollment in the study.

Study Participants and Sampling

Participants were college students aged 18–24 years recruited from selected classrooms at the four participating colleges. Students who were present on the day of data collection were invited to participate. A convenience sampling method was used. All eligible and consenting students in the selected classrooms were included. The inclusion criteria were age between 18 and 24 years, current enrollment in the selected colleges, and willingness to provide informed consent. Students who did not provide consent or who were absent on the day of data collection were excluded. A total of 1,248 students were approached across the four colleges, of whom 1,000 provided fully completed responses and were included in the final analysis; the remaining 248 incomplete responses were excluded.

Sample Size

The sample size was calculated using a prevalence-based formula with an assumed prevalence of 50%, a precision of ±5%, and a confidence level of 99.9%. The required sample size was estimated at 1,082 and rounded to 1,100.

Data Collection Procedure

Permission was obtained from the college authorities before data collection. Data collection was conducted from December 15, 2017 to June 20, 2018. Students in selected classrooms were approached on the day of the survey. They were briefed on the study’s purpose and assured that the collected data would be kept confidential and anonymous. Written informed consent was obtained from all participants before participation.

Data were collected using a structured questionnaire administered through an online survey link. Students completed the questionnaire on their mobile phones in the classroom. A trained research assistant was present during data collection to clarify any doubts and ensure complete responses. Participation was voluntary, and students could choose not to answer any question or could withdraw at any time.

Tools

Exposure Variables

Sociodemographic Characteristics

Sociodemographic information was collected using a semi-structured questionnaire. Details included age, gender, and current college enrollment. These variables were used to describe the sample and as covariates in the analysis.

Childhood Adversity

Childhood adversity was assessed using the childhood trauma questionnaire-short form (CTQ-SF), a 28-item, retrospective self-report instrument that has been validated and used extensively across several Indian studies, demonstrating high internal consistency (Cronbach’s α > 0.85).^26–28 The CTQ measures five domains of childhood maltreatment: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. Each item is rated on a five-point Likert scale. Subscale scores were calculated according to standard scoring procedures. Dichotomous variables indicating the presence of each subtype were created using recommended cut-off scores—emotional abuse ≥13, physical abuse ≥10, sexual abuse ≥8, emotional neglect ≥15, and physical neglect ≥10—which were used for classification.^26,29 The presence of any subtype was considered as exposure to childhood adversity. Total CTQ score and subtype scores were used in the analysis.

Outcome Variables

Depression

Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), which has been validated for use in the Indian population and demonstrated good internal consistency (Cronbach’s α = 0.89).^30–32 This is a nine-item self-report scale assessing symptoms over the past 2 weeks. Each item is scored from 0 to 3. Higher total scores indicate greater severity of depression. PHQ-9 scores were analyzed as continuous variables.

Anxiety

Anxiety symptoms were assessed using the generalized anxiety disorder-7 (GAD-7) scale, a seven-item self-report instrument, which has similarly been validated for use in the Indian population, demonstrating excellent internal consistency (Cronbach’s α = 0.92).^32–34 It measures anxiety symptoms over the past 2 weeks, with items scored from 0 to 3, where higher scores indicate greater anxiety severity. GAD-7 scores were analyzed as continuous variables.

Psychotic-like Experiences

Psychotic-like experiences were assessed using the Community Assessment of Psychic Experiences-15 (CAPE-15). This 15-item self-report scale has been validated and used extensively across varied Indian adult populations, demonstrating good internal consistency (Cronbach’s α = 0.85).^35,36 It measures the frequency of positive psychotic-like experiences in the past 3 months. Items are rated on a four-point Likert scale. Higher scores indicate greater frequency of psychotic-like experiences. CAPE-15 scores were analyzed as continuous variables.

Statistical Analysis

Data were analyzed using Stata version 16.0. ³⁷ Descriptive statistics were used to summarize the sample characteristics. Categorical variables were presented as frequencies and percentages, while continuous variables were summarized using means and standard deviations. The prevalence of childhood adversity and its subtypes was calculated using proportions. Associations between childhood trauma scores and mental health outcomes were first examined using correlation analysis.

Subsequently, univariate linear regression analyses were conducted to assess the relationships between exposure variables and each mental health outcome. Variables that were statistically significant in univariate analysis were included in multivariable linear regression models. Multivariable linear regression was used to estimate the association between childhood adversity and depression, anxiety, and psychotic-like experiences after adjusting for age and gender. Regression coefficients with 95% confidence intervals were reported. A two-sided p value of less than .05 was considered statistically significant. No correction for multiple testing was applied.

Results

Sociodemographic and Clinical Characteristics

A total of 1,000 participants completed the survey and were included in the analysis. The sociodemographic and clinical characteristics of the sample are given in Table 1. The mean age of the participants was 19.4 years (SD 1.3). Males constituted 51.5% (n = 515) of the sample and females 48.5% (n = 485).

Table 1.

Sociodemographic and Clinical Characteristics of the Participants (N = 1,000).

Variable	Mean (SD)
Age (years)	19.4 ± 1.3
Gender, n (%)
Male	515 (51.5)
Female	485 (48.5)
Childhood Trauma Questionnaire	50.1 ± 10.2
Emotional abuse	10.4 ± 2.5
Physical abuse	10.9 ± 3.2
Sexual abuse	7.0 ± 2.1
Emotional neglect	9.8 ± 3.3
Physical neglect	7.4 ± 2.5
PHQ-9 depression	14.9 ± 4.9
GAD-7 anxiety	12.5 ± 4.4
CAPE-15 psychotic-like experiences	20.1 ± 5.2

PHQ-9: Patient health questionnaire-9, GAD-7: Generalized anxiety disorder-7; CAPE-15: Community assessment of psychic experiences-15.

The mean total CTQ score was 50.1 (SD 10.2). The mean depression score measured using PHQ-9 was 14.9 (SD 4.9). The mean anxiety score measured using GAD-7 was 12.5 (SD 4.4). The mean psychotic-like experience score measured using CAPE-15 was 20.1 (SD 5.2).

Prevalence of Childhood Adversity

Overall, 90.1% (n = 901) of participants reported at least one form of childhood adversity (shown in Table 2). Physical abuse was the most reported subtype at 87.4% (n = 874). Emotional neglect was reported by 57.1% (n = 571), physical neglect was reported by 18.7% (n = 187), emotional abuse was reported by 17.7% (n = 177), and sexual abuse was reported by 1.2% (n = 12). The prevalence of childhood adversity and its subtypes was similar among males and females, with no statistically significant gender differences across subtypes.

Table 2.

Prevalence of Childhood Adversity Subtypes Among Participants (N = 1,000).

Childhood Adversity Subtype	Male (n = 515), n (%)	Female (n = 485), n (%)
Emotional abuse	85 (16.5)	92 (18.9)
Physical abuse	441 (85.6)	433 (89.2)
Sexual abuse	7 (1.3)	5 (1.0)
Emotional neglect	280 (54.3)	291 (60.0)
Physical neglect	89 (17.2)	98 (20.2)

Association Between Overall Childhood Adversity and Mental Health Outcomes

The associations between total childhood trauma scores and mental health outcomes are presented in Table 3. Higher CTQ total scores were positively associated with depression, anxiety, and psychotic-like experience scores. Correlation coefficients were ρ = 0.119 for depression (p < .001), ρ = 0.066 for anxiety (p = .037), and ρ = 0.123 for psychotic-like experiences (p < .001).

Table 3.

Association Between Total Childhood Trauma Score and Mental Health Outcomes (N = 1,000).

Outcome Variable	Correlation with CTQ (ρ)	p Value	Adjusted β (95% CI)*	p Value
Depression (PHQ-9)	0.119	<.001	0.06 (0.03–0.09)	<.001
Anxiety (GAD-7)	0.066	.037	0.03 (−0.01 to 0.07)	.128
Psychotic-like experiences (CAPE-15)	0.123	<.001	0.31 (0.06–0.56)	.016

^*Adjusted for age and gender using multivariable linear regression; PHQ-9: Patient Health Questionnaire-9, GAD-7: Generalized anxiety disorder-7, CAPE-15: Community Assessment of Psychic Experiences-15, CTQ: Child Trauma Questionnaire, CI: Confidence interval.

In multivariable linear regression adjusted for age and gender, CTQ score remained significantly associated with depression (β = 0.06, 95% CI = 0.03–0.09, p < .001) and psychotic-like experiences (β = 0.31, 95% CI = 0.06–0.56, p = .016). The adjusted association with anxiety was not statistically significant.

Associations Between Trauma Subtypes and Mental Health Outcomes

Table 4 summarizes the adjusted associations between childhood trauma subtypes and mental health outcomes. Among trauma subtypes, emotional abuse showed a significant independent association with both depression (β = 0.17, 95% CI = 0.04–0.30, p = .011) and anxiety (β = 0.13, 95% CI = 0.02–0.25, p = .018) after adjustment for age and gender.

Table 4.

Adjusted Association Between Childhood Adversity Subtypes and Mental Health Outcomes (N = 1,000).

Childhood Adversity Subtype	Depression (PHQ-9) β (95% CI)*	p Value	Anxiety (GAD-7) β (95% CI)*	p Value	Psychotic-like Experiences (CAPE-15) β (95% CI)*	p Value
Emotional abuse	0.17 (0.04–0.30)	.011	0.13 (0.02–0.25)	.018	0.11 (−0.01 to 0.25)	.077
Physical abuse	0.05 (−0.04 to 0.14)	.281	0.04 (−0.05 to 0.13)	.394	0.07 (−0.02 to 0.16)	.126
Sexual abuse	0.06 (−0.12 to 0.24)	.512	0.05 (−0.11 to 0.22)	.543	0.09 (−0.05 to 0.24)	.214
Emotional neglect	0.05 (−0.05 to 0.14)	.364	0.04 (−0.06 to 0.13)	.421	0.08 (−0.03 to 0.19)	.158
Physical neglect	0.09 (−0.04 to 0.22)	.173	0.09 (−0.02 to 0.21)	.109	0.26 (0.12–0.39)	<.001

^*Adjusted for age and gender using multivariable linear regression; PHQ-9: Patient Health Questionnaire-9, GAD-7: Generalized Anxiety Disorder-7, CAPE-15: Community Assessment of Psychic Experiences-15, CI: Confidence interval.

Physical neglect showed a significant association with psychotic-like experiences (β = 0.26, 95% CI = 0.12–0.39, p < .001). Other trauma subtypes, including physical abuse, sexual abuse, and emotional neglect, were not significantly associated with mental health outcomes after adjustment.

Discussion

This study examined the prevalence of childhood adversity and its association with depression, anxiety, and psychotic-like experiences among young adults in an urban Indian setting. A very high proportion of participants reported experiencing at least one form of childhood adversity; higher childhood trauma scores were associated with greater severity of depression, anxiety, and psychotic-like experiences. Furthermore, subtype-specific patterns were identified; emotional abuse was linked to depression and anxiety, whereas physical neglect was associated with psychotic-like experiences. These findings highlight the broad and differential effects of childhood adversity on the mental health of young adults.

The prevalence of childhood adversity observed in this study is higher than many global estimates but is comparable to several reports from India. Discrepancies in prevalence rates across settings may reflect differences in cultural norms, disciplinary practices, levels of awareness about child protection, and the willingness to report abuse.^9,38,39 In many Indian contexts, physical punishment continues to be socially normative and therefore under-recognized as a form of abuse. ⁴⁰ Corporal punishment continues to be widely practiced in Indian households and schools, often framed as a necessary and acceptable form of discipline rather than abuse. Studies from India have documented extremely high rates of physical punishment by both parents and teachers, with growing evidence that such practices are passed through generations—individuals who experienced corporal punishment in childhood are more likely to employ similar methods with their own children.^41–44 Adding to this, cross-cultural variation in what constitutes physical abuse may influence the framing of what is considered discipline versus abuse in the Indian context. ⁴⁵ Together, these factors may have influenced the high prevalence of physical abuse observed in this study.

Emotional abuse and neglect are also forms of maltreatment that are often overlooked and may go unnoticed within families.^46,47 The low incidence of reported sexual abuse observed in this study could be attributed to the stigma, fear of repercussions, and reluctance to disclose such experiences, rather than a true absence. Together, these findings highlight that childhood adversity remains a major yet often concealed public health concern among urban youth in India.

Consistent with existing literature, this study found that childhood adversity was significantly linked to depression, anxiety, and psychotic-like experiences. Early life stress is known to influence biological stress systems, such as the dysregulation of the hypothalamic–pituitary–adrenal axis, which may heighten vulnerability to later mental health problems. Psychological mechanisms like impaired emotional regulation, heightened threat perception, and altered reward processing may further contribute to the development of depression and anxiety. Extending this perspective, recent studies suggest that psychotic-like experiences in the general population can be better understood through a developmental trauma framework, in which early trauma influences cognitive and perceptual processes.^48,49

The subtype-specific findings provide additional clinical insights. Emotional abuse showed the strongest and most consistent association with depression and anxiety, even after adjustment for covariates. Emotional maltreatment may directly impact self-esteem, interpersonal trust, and emotional regulation. However, due to its less visible nature compared to physical abuse, emotional abuse may remain unrecognized despite its significant psychological impact. On the other hand, physical neglect was found to be significantly associated with psychotic-like experiences. Neglect during childhood development may contribute to insecure attachment, social isolation, and cognitive vulnerabilities, all of which have been linked to outcomes on the psychotic spectrum.^50–52 However, in the current study, self-reported subclinical psychotic-like experiences are not directly indicative of psychosis risk; rather, they may be understood as perceived experiences in a non-clinical population that require further attention and support. These subtype-specific relationships highlight the importance of assessing different forms of childhood adversity rather than considering trauma as a single construct.

The findings of this study have important clinical and public mental health implications. It is crucial to incorporate trauma-informed assessment into services for adolescents and young adults, such as college mental health programs and primary care settings. Early identification of emotional abuse and neglect may help prevent progression to more severe mental health problems. At a public health level, these results support the need to implement prevention strategies, increase parental awareness, establish school-based mental health initiatives, and develop community programs that address childhood adversity in urban Indian contexts.

This study provides a baseline for further exploring the causal pathways between childhood adversity and mental health outcomes in the Indian population, incorporating post-pandemic mental health trends, levels of awareness, and stigma surrounding abuse. Further work is needed to understand mechanisms linking neglect with psychosis-spectrum experiences. Research on the development of preventive and trauma-informed interventions for young people in educational and community settings is also essential.

Strengths

This study included a large community sample of young adults and assessed multiple domains of psychopathology within the same population. It examined subtype-specific associations of childhood adversity, thereby contributing to the limited evidence from Indian settings.

Limitations

The cross-sectional study design prevents causal inference. Several factors may have confounded the reporting of depression, anxiety, and psychotic-like experiences. These include confounders such as socio-economic status, family structure, substance use, prior psychiatric diagnosis/treatment, current stressors, or family psychiatric history, which can be explored in depth in future studies. All measures were based on self-report and may therefore be subject to recall or reporting bias. The use of convenience sampling and recruitment exclusively from private arts and science colleges in an urban setting limits the generalizability of findings. Under-reporting of sensitive experiences such as sexual abuse is also possible, leading to potential underestimation of prevalence.

Conclusions

Childhood adversity is highly prevalent among young adults in this urban Indian setting and is significantly associated with depression, anxiety, and psychotic-like experiences. Emotional abuse and physical neglect show distinct mental health associations. These findings highlight the need for trauma-informed clinical care and preventive public mental health strategies for young people in India. Addressing childhood adversity at both clinical and community levels may help reduce the long-term burden of mental health disorders among youth in India.