Introduction: Which adverse childhood experiences are causally associated with anxiety in adulthood is unclear. Sensitive Period Model states that early adverse experiences can influence anxiety levels in adulthood. However, it remains unknown which adverse experience is the most important early adverse factor for anxiety in adulthood, and whether early alleviation or aggravation of this adverse experience predicts a decrease or increase in anxiety levels in adulthood.

Methods: A national cross-sectional survey was conducted from 20 June 2023 to 31 August 2023, with a total of 30,054 adults aged 18 years or older recruited on questionnaires that completed the Adverse Childhood Experiences Scale and Generalised Anxiety Disorder Scale. We used network analysis and computer simulation techniques to simulate aggravating and simulate alleviating interventions to observe changes in anxiety levels to identify early adverse experiences causally associated with anxiety levels in adulthood.

Results: The results of both the network analysis and the nodeIdentifyR algorithm (NIRA) indicated that in the Adverse Childhood Experiences-Anxiety Network (ACE-GAD Network), being cursed and insulted (CUR) by parents in childhood was the most severe early adverse experience contributing to anxiety in adulthood. In particular, simulated aggravation interventions targeting CUR in young and middle-aged adults resulted in significantly higher levels of anxiety in adulthood.

Conclusions: This suggests that preventing verbal curses or insults in childhood can be an early preventive measure for future anxiety interventions. This study has important theoretical and practical implications, providing new insights for early prevention of anxiety and family education.