Background Research demonstrates that poor sleep quality is a predictor of chronic mental and physical health problems. The link between adverse childhood experiences (ACEs) and poor health outcomes is also well established; however, few studies have examined the relationships between ACEs, sleep quality, and physical and mental health. Methods The current study used structural equation modeling to assess the direct and indirect relationships between ACEs, sleep quality, symptoms of depression and anxiety, and general health perception in a sample of college undergraduates (N = 399), a group of individuals whose age is notable for only recently transitioning out of childhood. Results Indirect (ie, mediation) effects indicated with 95% confidence that sleep quality mediated the relationship between ACEs and general health perception, depressive symptoms, and symptoms of anxiety. Sleep quality did not account for the entire relationship between ACE score and these health outcomes, indicating partial mediation. When reversing the mediator and outcome variables, depression and anxiety fully mediated the relationship between ACE score and sleep quality. Conclusion The results of this study suggest that sleep quality may be an important intermediary mechanism by which ACEs might contribute to poor health outcomes and especially poor general health perception. Prospective longitudinal research is needed to examine the directionality of the relationships between ACEs, sleep quality, and physical and mental health outcomes over time
