Do Global Perceptions of Childhood Happiness Moderate the Effects of Adverse Childhood Experiences?

Background: An emerging literature suggests childhood happiness and related indicators of subjective well-being may confer physical and mental health benefits well into adulthood. Less is known about whether retrospective global appraisals of childhood are associated with health-related outcomes. Moreover, it is uncertain whether happiness protects against the deleterious effects of adverse childhood experiences (ACEs). The current study examines whether childhood happiness moderates the associations between ACEs and adult physical and mental health.

Methods: The current analysis uses two waves of survey data from 1,560 women (M_age= 27.0, 45.8% white) who participated in the Families and Children Thriving Study, a longitudinal investigation of risk and resilience among a sample of racially and ethnically diverse, low-income families receiving perinatal home visiting services in Wisconsin. ACEs, childhood happiness, and physical and mental health outcomes were measured at Wave 1 after families enrolled in services. To test for robustness, analyses were repeated with Wave 2 health and mental health outcomes collected approximately one year after Wave 1. Ten ACEs were measured using the Childhood Experiences Survey; cumulative scores (range 0-10) were dichotomized to differentiate participants with >5 ACEs from those with < 5 ACEs. Childhood happiness was assessed using a Likert-scale item: “I had a happy childhood” (range 1-7). Global physical and mental health were measured using subscales of the Patient-Reported Outcomes Measurement Information System (PROMIS-10).

Bivariate correlations were used to explore associations between study variables. Multivariate ordinary least squares (OLS) regression was used to examine the main effects of ACEs and childhood happiness on health outcomes while controlling for age, race/ethnicity, education, partner cohabitation, and prior mental health treatment (for mental health models). We then added an interaction term (ACEs x childhood happiness) to test whether happiness ratings moderated the relationship between ACEs and health outcomes.

Results: Participants reported 3.4 ACEs on average (SD= 2.6), and nearly one-third (32.7%) reported five or more ACEs. The sample mean for childhood happiness was 4.6 (SD=2.0), and 47.3% of respondents agreed they had a happy childhood. Exposure to five or more ACEs was negatively correlated with childhood happiness (r= -.47), physical health (r= -.20), and mental health (r= -.27). Childhood happiness was positively correlated with health (r= .32) and mental health (r= .39). Moderation analyses revealed that childhood happiness significantly moderated the association between ACEs and physical health (β= -0.16, p= .004) and mental health (β= -0.16, p= .002). Robustness tests with Wave 2 outcomes showed that moderation effects remained significant for health (β= -0.14; p= .04) and marginally significant for mental health (β= -0.13, p= .05).

Conclusion and Implications: Results indicate that associations between ACEs and health-related outcomes were moderated by childhood happiness. Findings suggest the effects of ACEs may be partly dependent on subjective childhood well-being. Further research is needed to understand the mechanisms that connect childhood happiness to indicators of adult well-being. Positive psychology interventions that bolster subjective well-being may be an effective way of enhancing happiness and mitigating the negative effects of ACEs across the life course.