Mitigating the Effect of Childhood Adversity on Mental Health: Resilience As Mediator Among Cambodian American Young Adults

Background and Purpose: Adverse Childhood Experiences (ACEs) are risk factors for poorer adult mental health, and resilience mitigates these effects. The long-term effects of ACEs are less examined among Asian immigrant and refugee populations. Second-generation Cambodian Americans (CAs) grew up in refugee families whose parents survived the trauma of the Khmer Rouge and may have turned to maladaptive behaviors. Consequently, second-generation CAs were exposed to various ACEs. Little is known to what extent they develop resilience as they come out of age and how resilience acts as a protective factor. This study examines 1) the prevalence of childhood adversity among CA young adults measured in 7 ACEs, 2) the effects of cumulative ACEs on mental health, and 3) the mitigating role of resilience in this relationship.

Methods: Survey data were collected from second-generation CA young adults from communities using purposive sampling. Facebook groups, community events, and other real-world CA social networks were employed. The analysis sample (n = 122) was predominantly female (65%), with a mean age of 32.35. Mental health was measured by the Depression, Anxiety, Stress Scale (DASS-21, Cronbach’s α=.95), where higher scores indicate poor current mental health. The 7-item ACE scores were created from the CAs reporting the mother’s behavior during their childhood; suicidal thoughts, drinking, drug use, mental health diagnosis, gambling, physical abuse and emotional abuse. Resilience was measured by the Adult Resilience Measure (Cronbach’s α=.91). Mediation model was analyzed using Hayes’ (2018) PROCESS macro, controlling for the young adults’ age and gender.

Results: Almost 90% of the sample experienced at least one ACE, 52.8% reported three or more, and about 30% reported four or more ACEs. Emotional and physical abuses were the most prevalent ACEs (81.6% and 73.6%), followed by maternal mental health diagnosis and suicidality (31.6% and 46.8%). Analysis showed a significant total effect of ACEs on poor mental health (b=-1.63, 95% CI [-2.78, -.48]). Both two paths, ACEs to resilience and resilience to mental health, were significant (a =-1.63, p<.05 and b=-.98, p<.05). When resilience entered the relationship between ACEs and poor mental health, the indirect effect was significant (ab=1.60, 95% CI [.01,.11]). More childhood adversity was likely to lead to lower resilience, which resulted in poorer mental health outcomes among CAs.

Conclusions and Implications: This study’s findings further prove the inverse relationships between childhood adversities and mental health. The prevalence of ACEs exposure among these young adults was much higher than the general population, where only 6.2% had four or more ACEs (Felitti et al., 1998). Childhood adversity affects resilience among young adults, which is well established as a protective mechanism for good mental health. Given the rising number of refugees, research must include second-generation Americans whose parents were refugees. Social workers and counselors working with refugee populations need to be aware of the sequela of trauma, especially parenting practices. Practitioners working with second-generation young adults with refugee parents should assess ACEs and advise ways to promote resilience and address mental health issues.