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.