*3.1. Sample*

Altogether, 1200 persons aged 18 years or older were interviewed, representing 0.012% of the Hungarian adult noninstitutionalized population according to the census in 2011. Respondents ranged in age from 18 years to 112 years and the mean age for the sample was 53.2 (SD = 16.5) years; 37.65% of the respondents were men. The sample was weighted to represent the Hungarian adult population by gender, age group, education, settlement type, and region. Of all the persons who had been approached, 74.6% were willing to fill out the questionnaire. Twenty-six individuals filled out the screening instrument incompletely: 17 did not complete the full questionnaire, 9 respondents answered all but one question. They were dropped from the analysis, leaving a total sample size of 1174 corresponding to a completion rate of 97.8%.

### *3.2. The prevalence of Adverse Childhood Experiences in Hungary*

The distribution of sociodemographic characteristics overall and by reporting an ACE (no ACE vs at least one ACE) is provided in Table 1. The highest prevalence of any adversity, 28% (n = 82) was found in the younges<sup>t</sup> age group (18–29 years) that was declining and was half of that among the 50–59-year-olds, but somewhat increased in the oldest age group (60+, 23%, n = 67). Experience of childhood adversity was more than twice as high in cities compared to the capital or to villages. Interestingly, the ACE score was by far the lowest among the least-educated group and highest among those with high school qualification. Income was mildly significantly related to the experience of adversity: those in the lowest income quartile had the highest proportion of any adversity. One-quarter more of those who suffered any ACE had been unmarried or divorced compared to persons who did not report any ACE.

Of the adult Hungarian population, 25% (n = 293) reported having experienced some kind of childhood adversity before the age of 18 years; 5% (n = 59) of the respondents had four or more ACEs. There were no significant gender differences regarding the co-occurrence of ACEs (Pearson's chi-squared test, p = 0.29) (Table 2). Considering only those between the ages of 18 and 80 years, the prevalence of any abuse did not change (25%).


**Table 1.** Distribution of sociodemographic characteristics by reporting/not reporting an ACE.

a Indicates the application of the Pearson's chi-squared test, \* *p* < 0.05.


**Table 2.** Distribution of ACE Score overall and by gender.

a Indicates the application of the Pearson's chi-squared test, *p* = 0.29.

The most prevalent form of self-reported child maltreatment was emotional abuse (5%, n = 59), and physical abuse (5%, n = 59) in this nationally representative sample. The least prevalent pattern was sexual abuse (1%, n = 12). The most frequent dysfunctional household condition was parental divorce or separation (13%, n = 153), followed by household substance abuse (11%, n = 129). The least prevalent household dysfunction was having an incarcerated household member (4%, n = 47).

Among women, emotional abuse and physical abuse were more prevalent (7% (n = 51) for emotional abuse and 6% (n = 44) for physical abuse) than among men (4% (n = 18) for physical abuse and 3% (n = 13) for emotional abuse). Male participants witnessed household physical violence more often (violence against their mother or stepmother) according to their self-report. Gender differences in emotional abuse have been shown to be significant (Pearson's chi-squared test, *p* = 0.03) (Table 3).


**Table 3.** Reported prevalence of ACEs in the sample and by gender.

a Indicates the application of the Pearson's chi-squared test, \* *p* < 0.05.

Respondents having experienced four or more ACEs were younger (57% (n = 29) were 18–39 years old), more of them lived outside the capital (75% (n = 38) lived in cities or villages), belonged to the lowest income category (42%, n = 21), were married (49%, n = 24), and had no children (43%, n = 21) (Table 4).

**Table 4.** Distribution of sociodemographic characteristics by ACE Score.


### *3.3. Modeling the Determinants of Adverse Childhood Experiences in Hungary*

Independent determinants of adverse childhood experiences were analyzed by logistic regression defining childhood abuse as a binary variable (experienced vs not experienced). Any childhood maltreatment (5 types of abuse or neglect of any sort), family dysfunction (5 types), and both combined, that is, any adverse experience (10 types), as described in Methods, as outcome variables were modeled. Marital status was defined in three different ways. In Model 1, all respondents were divided into two categories: those in an actual relationship (married or cohabiting) and those not currently in a relationship (single, divorced, widowed) (Table 5). One quartile increase of income decreased the odds of reporting any childhood maltreatment by 24% in Model 1, but income did not remain a significant determinant of reporting childhood adversity in either of the models.

In Model 2, only persons with a living present or past partner were included. Those in actual relationships (married or cohabiting) were compared to those who were divorced (Table 6). The latter produced a better model in which living in a relationship decreased the odds of reporting maltreatment by 35%. In the same model, one year increase in age decreased the odds of reporting any childhood maltreatment by 2.3%, and living in a city compared to a village increased the odds of reporting any maltreatment by 76%. Age, type of permanent residence, and marital status were found to be independent determinants of family dysfunction or any adverse childhood experience in the best adjusted logistic regression model (Model 2).

In Model 3, persons with relationship experience were included. Those in actual relationships (married or cohabiting) were compared to those who were divorced or widowed (Table 6). Model 2 and 3 both were statistically significant, showing that currently living in a relationship decreased the odds of reporting any childhood adversity by at least 40% compared to those who had relationship experience but did not currently live in one.

Other variables such as education, gender, number of children, type of work (manual, nonmanual) were not found to be significant determinants of reporting any childhood maltreatment, any family dysfunction, or a combination of both (data not shown).


**Table 5.** Independent determinants of experiencing any of the five types of maltreatment or five types of dysfunctions in the family (Model 1).

**Table 6.** Independent determinants of experiencing any of the five types of maltreatment or five types of dysfunctions in the family (Model 2 and Model 3).



**Table 6.** *Cont.*
