How does growing up as a TCK affect mental health in adulthood?

Growing up as a Third Culture Kid significantly affects adult mental health, with outcomes determined largely by Adverse Childhood Experience (ACE) scores and Positive Childhood Experience (PCE) scores. TCKs with 4 or more ACEs are 3.6x more likely to have anxiety, 11.7x more likely to have PTSD, 15x more likely to experience suicidal ideation, and 18x more likely to self-harm compared to TCKs with no ACEs. Nearly 1 in 3 TCKs (29%) have been diagnosed with depression and 3 in 4 struggle with belonging as adults. However, TCKs with 7 PCEs are 86% less likely to be diagnosed with PTSD and 62% less likely to be diagnosed with anxiety compared to those with 0-2 PCEs. (Crossman et al., 2025b; Bethell et al., 2019)

What percentage of TCKs are diagnosed with depression or anxiety?

Among TCKs with 4 or more ACEs: 29% are diagnosed with depression (nearly 1 in 3), 27% with anxiety (more than 1 in 4), 13% with PTSD (1 in 8), 12% with suicidal ideation, 7% with self-harm, and 6% with disordered eating. Critically, many more experience these conditions without formal diagnosis — 47% experienced suicidal ideation (only 12% diagnosed) and 30% engaged in disordered eating behaviors (only 6% diagnosed). Almost half of all TCKs (44%) were diagnosed with a mental health condition in their lifetime. (Crossman et al., 2025b)

Do Positive Childhood Experiences reduce mental health risks for TCKs?

Yes, dramatically. Compared to TCKs with 0-2 PCEs, those with 7 PCEs are 86% less likely to be diagnosed with PTSD, 85% less likely to be diagnosed with self-harm, 62% less likely to be diagnosed with anxiety, 55% less likely to be diagnosed with an eating disorder, 91% less likely to abuse prescription drugs, and 72% less likely to abuse alcohol and drugs. Adults who consistently had 6-7 PCEs as children are more than 3.5 times as likely to have strong emotional support and relationships in adulthood. (Crossman et al., 2025b; Bethell et al., 2019)

Which expat sector has the highest ACE risk for TCKs?

Business families have the highest rate of TCKs with 4 or more ACEs at 29%, followed by diplomats at 27%, military at 25%, education or NGO at 19%, and missions at 17%. Overall, 1 in 5 TCKs have high ACE scores, rising to 1 in 3 for highly mobile TCKs — compared to 1 in 10 in the general population across multiple countries. (Crossman & Wells, 2022)

Research Reference · Mental Health Data

TCK Mental Health by the Numbers — ACE Score Tier and PCE Score Tier

Every mental health statistic from the research on Third Culture Kids, organized by adversity tier and protective experience tier. No narrative. All data.

Anna Danforth

Nourished, 2026

Sources: Crossman et al. (2025b) · Bethell et al. (2019) · Crossman & Wells (2022)

How to Read This Page

Statistics are organized into two tiers: ACE Score (Adverse Childhood Experiences — risk factors) and PCE Score (Positive Childhood Experiences — protective factors). High ACE scores show what happens without support. High PCE scores show what becomes possible with it. Both tiers measure the same population — TCKs — from opposite directions.

Population Overview

How TCKs Compare to the General Population

21%

High ACE Rate

of TCKs reported 4 or more ACEs — nearly double the general population rate of 12.5%.

1 in 3

Highly Mobile TCKs

Highly mobile TCKs have a 1 in 3 chance of high ACE scores — vs. 1 in 10 in the general population.

44%

Lifetime Diagnosis

of all TCKs were diagnosed with a mental health condition in their lifetime.

74%

Adequate PCEs

of TCKs had 5 or more PCEs — nearly 3 in 4 are getting the connections they need to flourish.

ACE Score Tier

What High ACE Scores Produce

All statistics in this tier compare TCKs with 4 or more ACEs against TCKs with no ACEs, unless otherwise noted. Source: Crossman et al. (2025b).

4+ ACEs vs. 0 ACEs

Relative Risk Multipliers

How many times more likely a TCK with 4+ ACEs is to experience each outcome

3.6×

Anxiety more likely vs. TCKs with no ACEs

4.7×

Depression more likely vs. TCKs in the U.S. and Ireland

11.7×

PTSD more likely vs. TCKs with no ACEs

2.5×

PTSD more likely vs. general ACE populations in other countries

15×

Suicidal ideation more likely vs. TCKs with no ACEs

18×

Self-harm more likely vs. TCKs with no ACEs

4+ ACEs — Diagnoses

Formal Diagnosis Rates

Percentage of TCKs with 4+ ACEs who received a clinical diagnosis

Mental Health

29%

Depression — nearly 1 in 3

Crossman et al., 2025b

27%

Anxiety — more than 1 in 4

Crossman et al., 2025b

13%

PTSD — 1 in 8

Crossman et al., 2025b

12%

Suicidal ideation — more than 1 in 10

Crossman et al., 2025b

Self-harm — 1 in 14

Crossman et al., 2025b

Disordered eating — 1 in 17

Crossman et al., 2025b

The Diagnosis Gap

Experienced vs. Formally Diagnosed

Many TCKs experience these conditions without receiving a diagnosis — due to mobility, finances, and limited access to care

Condition	Formally Diagnosed	Actually Experienced	Gap
Suicidal Ideation	12%	47%	35 pts
Disordered Eating	6%	30%	24 pts
Self-Harm	7%	22%	15 pts

4+ ACEs — Physical Health

Physical Health Outcomes

Increased risk vs. TCKs with no ACEs — comparable risk level to heavy smoking for heart disease and cancer

2×

Asthma

Crossman et al., 2025b

2.4×

Migraines

Crossman et al., 2025b

2.5×

Heart disease

Crossman et al., 2025b

2.7×

Diabetes

Crossman et al., 2025b

3×

Autoimmune disease

Crossman et al., 2025b

3.3×

Other chronic illnesses

Crossman et al., 2025b

4+ ACEs — Lifestyle

Lifestyle Risk Factors in Adulthood

Increased risk vs. TCKs with no ACEs — not moral failures; survival strategies without support

11×

Prescription drug abuse

Crossman et al., 2025b

7×

25+ sexual partners

Crossman et al., 2025b

3.9×

Alcohol abuse

Crossman et al., 2025b

3.5×

Smoking

Crossman et al., 2025b

3.2×

Illicit drug use

Crossman et al., 2025b

Adult Relational Outcomes

Belonging and Adult Struggles

Reported across all TCKs with high ACE scores in adulthood

75%

Belonging — nearly 3 in 4 adult TCKs struggle with a sense of belonging. The single most commonly reported adult challenge.

Crossman et al., 2025b

34%

Childhood mental health crisis — 1 in 3 TCKs experienced a mental health crisis during childhood.

Crossman et al., 2025a

Additional Reported Adult Struggles (all TCKs with high ACEs)

—

Perpetual restlessness and inability to settle

Crossman et al., 2025b

—

Identity uncertainty and difficulty answering "where are you from?"

Crossman et al., 2025b

—

Fear of commitment in relationships

Crossman et al., 2025b

—

Unexpected sadness or anger tied to the global upbringing

Crossman et al., 2025b

—

Ambiguous loss and unresolved grief

Crossman et al., 2025b

—

Difficulty regulating emotions

Crossman et al., 2025b

ACEs by Sector

Percentage of TCKs with 4+ ACEs by Expat Sector

Source: Crossman & Wells, 2022

Business

29%

Diplomats

27%

Military

25%

Education / NGO

19%

Missions

17%

General population

10%

PCE Score Tier

What High PCE Scores Protect Against

All statistics compare TCKs with 7 PCEs against TCKs with 0–2 PCEs. This is the protective effect of building a connected village. Source: Crossman et al. (2025b).

0–2 PCEs

27%

of TCKs have fewer than 5 PCEs — including 8% at critically low connection of 0–2

7 PCEs

3.5×

more likely to have strong emotional support and relationships in adulthood — Bethell et al., 2019

7 PCEs vs. 0–2 PCEs

How Much Less Likely — Across Four Domains

Percentage reduction in risk for TCKs with 7 PCEs compared to TCKs with 0–2 PCEs

Mental Health Diagnoses

86%

less likely to be diagnosed with PTSD

85%

less likely to be diagnosed with self-harm

62%

less likely to be diagnosed with anxiety

55%

less likely to be diagnosed with an eating disorder

Emotional Wellbeing

82%

less likely to deal with unexpected anger related to growing up abroad

72%

less likely to struggle to regulate emotions

63%

less likely to experience unexpected sadness related to growing up abroad

54%

less likely to struggle with fear of commitment

Physical Health

65%

less likely to be diagnosed with autoimmune disease

38%

less likely to be diagnosed with heart disease

28%

less likely to be diagnosed with migraines

Lifestyle Choices in Adulthood

91%

less likely to abuse prescription drugs

80%

less likely to have 25+ sexual partners

72%

less likely to abuse alcohol and drugs

63%

less likely to smoke

PCEs + ACEs Combined

PCEs Protect Even When ACEs Are High

The protective effect of PCEs holds regardless of adversity score

98%

of TCKs with high PCE scores rated the global upbringing as a good experience overall — regardless of their ACE score.

Crossman et al., 2025b

27%

more likely to feel a sense of purpose for TCKs with a low ACE score who also had a high PCE score.

Crossman et al., 2025b

35%

more likely to feel a sense of purpose for TCKs with a high ACE score who also had a high PCE score. PCEs help most when children need it most.

Crossman et al., 2025b

72%

less likely to experience depression for children with 6–7 PCEs vs. 0–2, regardless of other factors.

Bethell et al., 2019

50%

reduction in depression for children who could talk to their family about feelings — PCE #1 alone.

Bethell et al., 2019

Building positive experiences helps most when children need it most — creating pathways to purpose and belonging even in difficult circumstances.
Anna Danforth · Nourished, Chapter 4 — citing Crossman et al., 2025b

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