Mental Health Pathways between Adverse Childhood Experiences and School Achievement in Adolescence: Results from a Sequential Mediation Model

Background and Purpose: Three decades of research in the USA on adverse childhood experiences (ACEs), including stressful or traumatic events such as family separation or abuse, have shown a strong relationship between ACEs and the development of poor behavioral, health, and psychological outcomes, including PTSD and depressive symptoms. Studies also consistently link more ACEs to lower school achievement, but the pathways that contribute to academic outcomes for vulnerable populations of youth is limited. Studies indicate PTSD symptoms may not only be an outcome of trauma exposure, but may also be a potential mediator between traumatic events and other problems such as depression. Orphaned and vulnerable children in orphanages may experience a number of adverse experiences including trauma-related experiences like separation from parents, abuse, and institutional neglect. Studies have also found orphaned students have lower school achievement than non-orphaned peers. The purpose of the current study was to understand the pathways by which ACEs may influence school achievement among adolescents growing up in orphanages in South Korea. This study explored the following questions: 1) Do mental health problems (PTSD and depressive symptoms) mediate the relationship between ACEs and lower school achievement? 2) Are ACEs indirectly associated with lower school achievement through PTSD and then depression?

Method: A cross-sectional study of a convenience sample of 170 adolescents ages 10 to 18 (M=16.1, SD=1.9) were recruited from 10 orphanages located in the Seoul Capital Area and a southern province in South Korea. The sample was 67% male, and the mean age of entering their current institution was 8.2 (SD=4.1). Structured face-to-face interviews included the following: (1) ACEs (UCLA PTSD index); (2) depression (CDI); (3) PTSD symptoms (Foa, 2001); (4) school achievement (4 items, 5-point scale with higher scores indicating above average grades across subjects ); and (5) demographic and placement control variables (gender, age, total number of placements, age entered care, contact with birth parents). Three mediation models were analyzed: single mediation models for each mental health mediator (PTSD and depression); and a sequential mediation model that tested the pathway by which ACEs (X) was indirectly associated with school achievement (Y) through PTSD symptoms (M1) and then depression (M2), controlling for demographic and placement factors. Mediation models were analyzed using the Hayes process macro (SAS 9.4) bootstrapping methodology to yield significance tests of the indirect effects of ACES on school achievement.

Results: Adolescents reported an average ACE score of 2.69 (SD= 2.21). In the simple mediation models, PTSD and depressive symptoms were not significant mediators in the relationship between ACEs and school achievement, controlling for demographic and placement factors. In the final sequential model, the relationship between more ACEs and lower school achievement was fully mediated by the link between PTSD and depression symptoms, controlling for demographic and placement factors (total indirect effect = - 0.15, Boostrap 95% CI [-0.256, -0.007].

Conclusions. Findings suggest that among adolescents in orphanages, improving PTSD and depression may be a potential target for intervention that can help mitigate the negative influence of ACEs on school achievement.