Adverse Childhood Experiences and Depression Among Multiracial Adolescents: Is Anxiety a Mediator?

Purpose: Previous research has documented a link between adverse childhood experiences (ACEs) and depression.  These studies, however, rarely focus on multiracial adolescents. Addressing this dearth in the literature is critical because the number of multiracial adolescents in the U.S. is growing. Moreover, research has shown that multiracial youth are likely to need and seek mental health services than other racial/ethnic groups.  In addition to assessing whether a link between ACEs and depression exists, it is also important to examine mediators.  One potential mediator is anxiety. Indeed, previous research has indicated that anxiety is a critical area for intervention when treating youth with depression and a history of ACEs.  Despite the need to understand ACEs, depression, and anxiety among multiracial adolescents, these gaps in the literature have remained largely unaddressed.

The purpose of this study was to understand the relationship among ACEs, depression, and anxiety.  We addressed the following research questions: (1) Do ACEs have a direct effect on the diagnosis of depression among multiracial adolescents? (2) If so, is the relationship between ACEs and depression mediated by anxiety?

Methods:  We used cross-sectional data collected in 2016 from caregivers who completed the National Survey of Children’s Health.  Although data from this study are often nationally representative, because of the small sample size, data from multiracial adolescents are not nationally representative. However, within group variance estimators are trustworthy because we accounted for the complex sampling design by considering stratification, clustering, and sampling weights. A subpopulation of youth (12-17) who reported more than one race was analyzed (N=1,231). The sample was 52% female.

Mplus 8.0 was used to conduct structural equation modeling.  We used the WLSMV estimator and accounted for missing data using FIML. We first examined a measurement model for ACEs, using conventional fit critieria.  Next, we examined whether there was a direct effect of ACEs on depression.  Then, we examined whether this relationship was mediated by anxiety.  We also conducted sensitivity analysis (e.g., Does depression mediate the relationship between ACEs and anxiety?).

Results:  Similar to studies using samples comprised of black and white adolescents, the measure of ACEs in the sample of multiracial adolescents demonstrated good fit [RMSEA = .016 (90% CI .000, .029); CFI = .982; TLI = .963; and WRMR = .881]. We found that ACEs was associated with depression.  The mediation model demonstrated good fit [RMSEA = .015 (90% CI .000, .026); CFI = .973; TLI = .964; and WRMR = .849]. In the mediation model, the direct effect was not significant (OR=.121, CI 95% (-.153, .396), whereas the indirect effect was significant (OR=.61, 95% CI (.212, 1.030).  Thus, we found that anxiety fully mediated the relationship between ACEs and depression.

Conclusions and Implications:  Although finding full mediation is rare, results from this study suggest that the relationship between ACEs and depression may be fully mediated by anxiety among multiracial adolescents.  Clinicians may want to focus on addressing anxiety among multiracial youth with depression who have a history of adverse childhood experiences.