Individual, Relational, and Community Protective Factors in the Relation between Adverse Childhood Experiences (ACEs) and Adult Mental Health Symptoms

Background: Although a wealth of research has examined the association between adverse childhood experiences (ACEs) and negative health outcomes in adulthood, researchers have seldom examined the role of protective factors. However, factors that promote positive outcomes and resilience may protect adults from the later impacts of adversity. This study examined the associations between the expanded ACEs (i.e., additional adversities like witnessing community violence, experiencing discrimination) and mental health symptoms, and the role of protective factors within the individual (self-internal control, ethnic identity), across relationships (family resiliency, social support), and within the community (informal social control, social cohesion, and safety).

Methods: A statewide sample of 712 adults was surveyed through a Qualtrics panel; quota sampling constraints were included to ensure a representative sample in terms of socio-demographic characteristics. Adults identified as cisgender female (57.7%) and male (40.7%), transgender or gender non-binary (1.6%), and self-reported race (55% White, 15% African American or Black, 16% Hispanic/Latinx, 9% Asian/Asian American, 5% Other). Adults were ages 18 to 24 (31%), 25 to 40 (29%), 41 to 60 (18%), and 61 and older (23%). Adults were surveyed on nine of the ten original ACEs (the item on sexual abuse was not asked), five extended ACEs, mental health symptoms, and protective factors. Logistic regression was conducted to examine the association between ACEs and clinically significant mental health symptoms. Also, moderation analyses were conducted to examine the role of protective factors.

Results: About 63% of adults experienced at least one ACE, and 29% experienced four or more ACEs. This sample also reported clinically significant symptoms of depression (42%), traumatic stress (45%), and anxiety (27%). Experiencing ACEs increased the odds of adults reporting current clinical levels of depression (Odds Ratio [OR] = 1.36), anxiety (OR = 1.33), and traumatic stress (OR = 1.52). Among adults with higher ACEs, several moderating factors protected them from experiencing as high of mental health symptoms. For example, the interactions between ACEs and social support (B = .30), family resilience (B = .18), and community social cohesion (B = .26) on anxiety were statistically significant. These three protective factors were also associated with depression and traumatic stress.

Conclusions and Implications: This study makes an important contribution to the existing literature as significantly less research has examined the role of the protective factors in the relationship between expanded ACEs and adult mental health symptoms. Findings demonstrated associations between the expanded ACEs and mental health symptoms and identified protective factors that moderate the relationship. In particular, protective factors within relationships and cohesion with the community are important processes to buffer the deleterious impacts of negative childhood experiences. Future research is needed to replicate these findings longitudinally; additionally, research should consider examining community protective factors – informal social control, social cohesion, and safety – through multilevel modeling. However, these results demonstrate that incorporating protective processes into mental health treatments, such as strengthening social relationships and social cohesion, may be beneficial for adults with previous experiences of adversity and trauma.