The Roles of Family Economic Status, Adverse Childhood Experiences and Family Conflict in Adolescent Mental Health

Background: Adverse mental health outcomes among children and youth continue to rise. Links between socioeconomic status with child and youth mental health outcomes are well-documented, yet the complex interplay between family socioeconomic status (FES), social environment, and youth psychopathology remains less understood. The family stress model proposes that economic hardships influence child/youth outcomes by compromising parenting and family interactions. Adverse childhood experiences (ACEs) are disproportionately higher among lower-income families and, thus, may mediate SES and youth psychopathology. Conflictual family environments could potentially exacerbate relationships SES, ACEs, child/youth mental health.

Method: Using 3 waves of data from the longitudinal Adolescent Brain Cognitive Development (ABCD) Study® (n=11,878), a series of conditional process path analyses examined if 1) FES directly influenced youth internalizing and externalizing symptoms, 2), if ACEs mediated this relationship, and 3) if family conflict moderated the direct and indirect relationships. Identical models were run separately based on youth vs caregiver reported data. Independent Variable. FES was computed as a quotient of household income by household size (wave 1). Dependent Variables. Caregiver-reported youth internalizing and externalizing symptoms derived from Child Behavior Checklist Internalizing and Externalizing scale, youth reports derived from the Brief Problem Monitor (BPM) (wave 3). Mediating Variable. Youth and caregiver ACE scores derived from the PhenX Adverse Life Events scale (wave 2). Moderating Variable. Youth and caregiver family conflict scores derived from the Family Conflict Scale (wave 2). Covariates included sex and age (wave 1).

Results. Among the caregiver models, lower FES associated with greater ACEs and internalizing and externalizing symptoms, and higher ACEs were associated with greater internalizing and externalizing symptoms. FES interacted with family conflict to predict ACEs, such that the association between FES and ACEs was stronger at higher levels of conflict. Additionally, FES intensified the relationship between FES and youth internalizing and externalizing symptoms. Family conflict additionally moderated the mediated pathway from FES to ACEs for both internalizing and externalizing symptoms. Youth-rated models showed similar associations, including that lower FES was associated with higher levels of ACEs, which were associated with higher levels of internalizing and externalizing symptoms. However, lower FES only predicted higher levels of externalizing symptoms and not internalizing. Lastly, family conflict intensified the relationship between FES and ACEs, but not between FES and internalizing or externalizing symptoms, nor ACEs and internalizing or externalizing symptoms.

Discussion. Families can be sources of resilience or risk for adolescent mental health outcomes. Ideally, supportive, cohesive families can bolster adolescent mental health by offering youth a source of emotional and social support. Conversely, when adolescents live in families with high levels of conflict, youth mental health can be compromised as evidenced by our findings that lower FES directly and indirectly associated with higher levels of ACEs and internalizing and externalizing symptoms and that relationships were conditioned by conflictual family environments with a number of these associations consistent, regardless of the rater. Because the family environment is a potentially modifiable social factor, resources and interventions aiming to improve family environments may have lasting benefits for youth mental health.