Gender Difference in the Relationship between ACEs, Emotion Regulation, and Depression Among Adolescents: A Moderated Mediation Model

Background and Purpose: Adverse childhood experiences (ACEs) have consistently been linked to depressive symptoms in youth. However, there remains a gap in understanding the psychological mechanisms underlying the association. Understanding these mechanisms is crucial for developing interventions that address the mental health needs of youth affected by ACEs. Existing literature suggests that ACEs can affect youth emotion regulation, and emotion regulation is a key predictor of youth mental health. As such, the current study aims to investigate the mediating role of emotion regulation between ACEs and depression in youth. We hypothesize that cognitive reappraisal and emotional suppression, as two emotion regulation strategies, both mediate the impact of ACEs on youth depression. Additionally, given the documented gender disparities in mental health consequences of trauma, with females being more vulnerable to the impact of trauma, we anticipate that the effects of ACEs on emotion regulation and subsequent depression are more pronounced in females compared to males.

Methods: Survey data collected from 8,704 seventh-grade students in a metropolitan area in Taiwan were analyzed to investigate the connections among ACEs, emotion regulation, and depression. The ACEs questionnaire developed by Felitti and colleagues was used to assess participants’ childhood experiences. Emotion regulation was measured using the Emotion Regulation Questionnaire (ERQ), while depression was assessed using the Depression Scale of the Center for Epidemiologic Studies (CES-D). Gender was included as a moderator in the relationships between ACEs, emotion regulation, and depression.

Statistical analyses were conducted using SPSS v.29 and the PROCESS macro. A mediation model was first developed to explore the mediating role of emotion regulation between ACEs and depression. Subsequently, a moderated mediation model was developed to examine the gender difference in the relationships between ACEs, emotion regulation, and depression.

Results: The findings indicate that both cognitive reappraisal and emotional suppression significantly mediate the relationship between ACEs and depression in youth. ACEs are associated with reduced cognitive reappraisal (b = -.24, p < .001), which subsequently leads to increased youth depression (b = -.12, p < .001). Conversely, ACEs are linked to increased emotional suppression (b = .06, p < .01), which in turn leads to elevated depression levels (b = .11, p < .001). Females exhibit heightened susceptibility to the negative impact of ACEs on emotional suppression (b = .16, p < .01) and its subsequent influence on depression(b = .03, p < .001). The inferential test results demonstrate that the moderated mediation was statistically significant (Index [X→Y] = 0.068; 95% CI [0.014, 0.142]).

Conclusions and Implications: This study is the first to examine gender differences in the relationship between ACEs, emotion regulation, and youth depression. The results highlight the role of emotion regulation in mediating the impact of ACEs on depression for both female and male youth, suggesting that enhancing emotion regulation skills may serve as a strategy to mitigate the adverse impact of ACEs on youth mental health. Intervention programs could focus on bolstering emotion regulation capacities and addressing emotional suppression tendencies among female adolescents with ACEs.