Document Type
Article
Publication Date
7-21-2026
Abstract
Although adverse childhood experiences (ACEs) increase risk for mental illness at the population level, existing ACEs screens are less helpful in forecasting individual outcomes, suggesting they may not capture significant elements of childhood adversity. We have previously identified unpredictable parental and household experiences as an ACE that portends poorer cognitive and mental health. However, the contribution of unpredictability to established ACEs in real-world settings is unknown. Here, leveraging existing ACEs screening in California, we added the five-item Questionnaire on Unpredictability in Childhood (QUIC-5) in 19 pediatric clinics spanning broad sociodemographic constituencies and compared in ~30,000 children the link of each screen with mental health diagnoses. Scores on either the ACEs or QUIC-5 associated with probabilities of depression, externalizing symptoms, sleep disorders, anxiety and somatic symptoms. Each screen provided unique contributions and combining them often doubled the strength of associations. For depression and sleep disorders, the QUIC-5 identified vulnerable individuals missed by ACEs screen, improving risk detection and facilitating future interventions.
Recommended Citation
Glynn, L.M., Liu, S.R., Golden, C. et al. Unpredictability is a childhood adversity that contributes to mental health problems. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00681-x
Reporting Summary (PDF)
44220_2026_681_MOESM2_ESM.jpg (350 kB)
Supplementary Fig. 1 (JPG) Combined predictive contributions (youth self-report). Data summary of the combined and unique predictive contributions of PEARLS and QUIC-5 for youth self-report.
44220_2026_681_MOESM3_ESM.jpg (334 kB)
Supplementary Fig. 2 (JPG) Combined predictive contributions (caregiver report). Data summary of the combined and unique predictive contributions of PEARLS and QUIC-5 for caregiver report.
44220_2026_681_MOESM4_ESM.pdf (167 kB)
Supplementary Table 1 (PDF) Caregiver reports predict child mental health. Caregiver report on PEARLS (n = 20,261) and QUIC (n = 26,804) screens predict child mental health conditions.
44220_2026_681_MOESM5_ESM.pdf (167 kB)
Supplementary Table 2 (PDF) Youth self-reports predict mental health. Youth self-report on PEARLS (n = 8,906) and QUIC (n = 9,870) screens predict mental health conditions.
44220_2026_681_MOESM6_ESM.pdf (168 kB)
Supplementary Table 3 (PDF) Caregiver reports predict child mental health after adjustment for socioeconomic status. Caregiver report on PEARLS (n = 20,261) and QUIC (n = 26,804) screens predict child mental health conditions adjusting for socioeconomic status.
44220_2026_681_MOESM7_ESM.pdf (168 kB)
Supplementary Table 4 (PDF) Youth self-reports predict mental health after adjustment for socioeconomic status. Youth self-report on PEARLS (n = 8,906) and QUIC (n = 9,870) screens predict mental health conditions after adjusting for socioeconomic status.
44220_2026_681_MOESM8_ESM.pdf (114 kB)
Supplementary Table 5 (PDF) Independent contributions of ACEs and unpredictability to child mental health (caregiver). Binary logistic regressions with PEARLS and QUIC caregiver scores (continuous) concurrently entered as predictors (n = 18,486).
44220_2026_681_MOESM9_ESM.pdf (114 kB)
Supplementary Table 6 (PDF) Independent contributions of ACEs and unpredictability to child mental health (youth self-report). Binary logistic regressions with PEARLS and QUIC youth scores (continuous) concurrently entered as predictors (n = 7,149).
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Supplementary Table 7 (PDF) QUIC-5 Items. The Questionnaire on Unpredictability in Childhood brief version (QUIC-5)
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Supplementary Table 8 (PDF) Incidence of child health conditions. Incidence of child mental and somatic health diagnoses (ICD codes used for defining diagnoses shown in parentheses).
Copyright
The authors
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This work is licensed under a Creative Commons Attribution 4.0 License.
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Comments
This article was originally published in Nature Mental Health in 2026. https://doi.org/10.1038/s44220-026-00681-x