Challenging the use of the overall adverse childhood experiences (ACEs) score: Comparing total ACEs, maltreatment, and household dysfunction on mental health problems among White, African American, and Native American women under correctional control.

Adverse childhood experiences (ACEs) have been consistently linked to mental health problems. There have been recent conceptual and empirical critiques that suggest maltreatment and household dysfunction to not be combined to create a composite ACE score. Women in correctional custody demonstrate disproportionately high ACE levels and greater mental health problems as to racial minorities. The present study compared the effects of varying operationalizations of the ACEs measure on women's mental health stratified across race using a sample of White, African American, and Native American women in correctional custody in Oklahoma. The cross-sectional study administered a paper-and-pencil survey to 494 women. Structural equation modeling was used to test hypotheses. Maltreatment was a significant predictor of women's mental health across all racial groups but demonstrated the strongest effect among African American inmates. Household dysfunction was not a significant predictor of mental health for any racial group. When comparing the maltreatment-only model to the maltreatment and household dysfunction model, and the overall ACE score model, there was little explained variance lost. These findings indicate that maltreatment demonstrates unique associations with women's mental health and may be the driving force behind the relationship between ACEs and adult mental health among women within correctional custody. Researchers are advised to not use the overall ACE score and instead break down the measure into the maltreatment and household dysfunction subscales. (PsycInfo Database Record (c) 2025 APA, all rights reserved).