Examination of the Relationships Among Adverse Childhood Experiences, Stress and Self-Care

Background and Purpose: A CDC study found 59.4% of the adults experienced at least one ACEs prior to age 18 (Bynum et al., 2010). Previous studies revealed ACEs are likely to contribute health risk such as depression (54%), alcoholism (65%), suicide attempts (67%), and substance use (50%) (Dude et al., 2003). ACEs are also highly prevalent among social work students or professionals (Lee et al., 2017). However, little research has examined the relationships between ACEs profiles and their relationships with current stress and self-care among young adults. Thus, the study aims to examine profiles of ACEs among social work students, the characteristics of ACEs profiles, and their relationships with perceived stress and self-care.

Methods: Data were collected at one mid-size university using an online survey during Fall 2019. One hundred and ninety BSW and MSW students completed the survey (53% response rate). The majority of students were MSW students (64%), African Americans (90%) and females (88%).

Adverse childhood experiences were measured by the 10 types of Adverse Childhood Experiences questionnaire (Feliti et al., 1998). The questionnaire included the areas of abuse (physical, psychological, and sexual), neglect (physical and emotional), household dysfunction (domestic violence, substance abuse, parental divorce, mental illness, and incarceration). Each type of the ACEs was coded as a binary variable. The prevalence of ACEs in the study was from 0 to 10, which was used to examine the cumulated scores of the ACEs.

Self-care was measured by the 19-item, Likert-type Self-Care Behavior Inventory (Santana & Fouad, 2017) ranging from 1 being never to 5 being always. Perceived stress was measured by the 14-item Likert-type Perceived Stress Scale (Cohen et al., 1983) ranging from 1 being not at all to 5 being nearly every day.

Latent class analysis (LCA) using R was conducted to identify clusters of similar types of individuals from the ACEs criterion items. Using SPSS (v. 26), a series of chi-square tests and analyses of variance were calculated to examine the association of ACEs classes with other variables.

Results: LCA with a 3-class solution resulted in the best model fit (lowest AIC, BIC, adjusted BIC, and significant likelihood ratio tests): Moderate Child Maltreatment and High Divorce (Class 1; 38.7%, n=72), a group of students who had moderate probabilities of exposure to child maltreatment and high probabilities of exposure to parental divorce; Low ACEs (Class 2; 39.2%, n=73), a group of students who had low probabilities of exposure to all the types of ACEs; and High ACEs (Class 3; 22.0%, n=41), a group of students who had high probabilities of exposure to all the types of ACEs, in particular, substance abuse of a family member. All three groups had moderate current stress and self-care behavior.

Conclusions and Implications: The results suggest the importance of understanding the different subgroups of ACEs among social work students. The profiles of ACEs hold implications for self-care with respect to stress management. Support efforts for students could be varied based on the range of the ACEs severity.