Resilience in ACE-Affected Adult Psychological Health: Complex Roles of Protective Resources

Background/Purpose: Results from the original CDC demonstrate a dose-response relationship between childhood adverse experiences (ACEs) and adult mental health (Edwards et al., 2003). Subsequent research has suggested the need to embed analyses within broader risk and protective factor frameworks to achieve a more distilled characterization (Schilling et al., 2008). Although the buffering effects of protective factors relative to ACEs are just now being assessed for adulthood consequences, investigations in earlier life point to inclusion of these as critical to advancing understanding (Rosenthal et al., 2009). Our analysis builds on conceptual integration, acknowledging social stratification of stress exposure, yet also focusing on mutable protective factors that may mute the toxicity of ACEs and inform community and practice efforts to foster life course resilience.

Methods: A population-based state survey through the Behavioral Risk Factor Surveillance System (BRFSS) constitutes the sample (stratified random sampling of household adults, CDC, 2011). The study sample (n=13,593) consisted of 60.7% females, average age of 57 (SD=16.0), with income and education levels representative of the region. Four sets of variables with established psychometric properties were used in this examination: 1) demographics (age, sex, race/ethnicity), 2) socioeconomic factors (education, income), 3) aggregated ACE scores (sums across 8 categories of adversity experienced before age 18), and 4) two protective factor domains: socioemotional (satisfaction with life conditions, receive emotional/social support) and positive habits (sufficient sleep, physical activity). Psychological health outcomes included: mental health symptomology (mean of 6 current symptoms), well-being (assessed across 5 dimensions), and number of days of impaired daily living due to a mental/emotional health issue. Moderator terms are the multiplication of protective factors with the ACE aggregate.

Results: Hierarchical regressions of the three psychological health indicators sequentially tested the explanatory utility of each of the above-identified four predictor sets followed by a final block: 5) interaction terms of protective factors with ACEs to test for moderating effects. For each of the psychological health outcomes, the full regression models achieved significance, and each of the 5 predictor blocks added significantly to the R² change. As hypothesized, both ACEs and protective factors significantly explained mental health, controlling for shared variance with all other predictors. Notably, protective factors demonstrated direct, moderating, and suppression effects of the pathway from ACEs to mental health.

Conclusions/Implications:  This study extends assessment of early life adversity effects on psychological health by: a) controlling for demographic and SES factors for a more conservative test of unique and sustained ACE effects in later life and b) predicating ACE effects within the context of two forms of protective factors that alter the picture of these ACE pathways. In the discussion, we elaborate the theoretical basis for interpreting ACEs relative to both social determinant covariates and resilience resources, distinguishing implications of observed direct, moderating, and suppression effects for health-restorative and preventive interventions. These moderating and suppression effects demonstrate dynamic interplays between ACEs and protective factors not yet well documented. Finally, we address applications of findings across stages of adulthood and, thus, a wide range of social work service provision.