Objective: To investigate the relationship between adverse childhood experiences with depression and anxiety prevention and intervention among middle school students, so as to provide evidence for preventing and intervening in depression and anxiety among adolescents. Methods: From October to November 2020, a total of 4 861 middle school students from 12 schools in a province in central China, including junior high schools, senior high schools, secondary vocational schools, and vocational high school selected by using convenient sampling method. Demographic information, adverse childhood experiences, depression and anxiety symptoms were collected. The Chi square test and multivariate Logistic regression analysis were used to analyze the data. Results: The detection rates of depression and anxiety of students in middle school were 39.0% and 52.3%, respectively. Univariate analysis showed that the total scores of adverse childhood experiences and dimensions of childhood maltreatment and neglect, family dysfunction, parent absence, and violence outside the home were significantly associated with depressive and anxiety symptoms ( χ 2=105.36, 147.12, 43.69, 46.61, 196.48; 100.06, 132.28, 26.53, 24.32, 169.94, P <0.01). After controlling variables such as age, only child, sex and economic status of family, Logistic regression showed that childhood maltreatment and neglect, family dysfunction,family absence and violence outside the home were positively associated with depressive symptoms ( OR =1.61, 1.62, 1.06,2.08, P <0.01) and anxiety symptoms ( OR =1.66, 1.50, 1.98, P <0.05). Conclusion Depressive and anxiety symptoms among middle school students are associated with adverse childhood experiences, and those who experienced childhood maltreatment and neglect and violence outside the home are at higher risk.