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. Author manuscript; available in PMC: 2024 Feb 5.
Published in final edited form as: J Affect Disord. 2022 Jul 24;314:303–308. doi: 10.1016/j.jad.2022.07.047

Adverse childhood experiences and adolescent mental health: Understanding the roles of gender and teenage risk and protective factors

Jamie M Gajos a,*, Chelsea R Miller b, Lindsay Leban c, Karen L Cropsey b
PMCID: PMC10840483  NIHMSID: NIHMS1958384  PMID: 35896138

Abstract

Adverse Childhood Experiences (ACEs) have been linked to a host of negative outcomes in adolescence. However, research on the impact of ACEs on adolescent mental health has produced mixed results, leaving it unclear how ACEs may relate to depression and anxiety during adolescence. Moreover, this body of work has neglected how gender, risk and protective factors may influence these relationships, despite research demonstrating gender differences in both responses to adversity and in the impact of risk and protective factors on maladaptive outcomes in adolescence. Drawing on a sample of at-risk youth from the Fragile Families and Child Wellbeing Study (N = 2455; age 14–18; 48 % female, 50 % Black, 23 % Hispanic), the current study examines the association between ACEs during early childhood (i.e., ages 1 to 5) and anxious and depressive tendencies reported during adolescence. Models are stratified by gender and incorporate six types of teenage risk and protective factors (peer bullying, delinquent peers, low self-control, parental attachment, collective efficacy, and school connectedness). Results showed support for gender differences in the associations between ACEs and boys’ and girls’ mental health symptoms. Initially, ACEs were associated with an increased risk of both depressive and anxious tendencies in boys, but the total ACEs score was only significantly associated with an increased risk for depressive symptoms in girls. After accounting for teenage protective factors, ACEs were related to a decreased risk of depressive and anxious symptoms among girls only. Findings have important implications for refining intervention and prevention strategies focusing on mitigating the harms of ACEs.

Keywords: Adverse childhood experiences, Adolescent mental health, Gender differences, Adolescent risk and protective factors

1. Introduction

In 1998, Kaiser-CDC published their groundbreaking study linking child maltreatment and household dysfunction to poor health outcomes in adults. This initial study found that almost two-thirds of participants had at least one adverse childhood experience (ACE), and roughly 16 % had greater than four ACEs (Felitti et al., 1998). Given the prevalence of these early traumatic events, research over the last two decades has focused on the negative impacts of ACEs on many facets of behavioral health. However, much of the reporting on ACEs is retrospective, and some have raised concerns about the biases in self-reporting that could affect the validity of the research findings (Hardt and Rutter, 2004). Relatedly, prior studies examining ACEs have largely focused on their impact on adult outcomes, which provides less clarity about the proximal impact of ACEs in earlier stages of development, such as during adolescence. Nonetheless, a growing body of research has examined the salience of ACEs on early developmental outcomes, such as risk-taking behaviors, conduct disorders, substance use, and adverse health outcomes (Choi et al., 2019; Hughes et al., 2017; Masten and Cicchetti, 2010; Schilling et al., 2007). ACEs before the age of three, for instance, are associated with risk-taking behaviors at age five (Choi et al., 2019). Moreover, the risk of exposure to ACEs during early life is not entirely uncommon, as the National Center for Children in Poverty found that 20 % of their research population had been exposed to greater than three ACEs by age six (Evans et al., 2013).

The Fragile Families and Child Wellbeing Study (FFCWS) has been used to study ACEs in children prospectively, with most research focusing on predicting externalizing behaviors and delinquency (James et al., 2021; Masten and Cicchetti, 2010; Morris, 2019). Few studies have utilized the FFCWS to examine mental health outcomes in adolescents (Felitti et al., 1998; Schilling et al., 2007; Schroeder, 2017) and results have varied among those that have examined adolescent mental health. Of the research utilizing the FFCWS, family dysfunction has been shown to increase both depression and anxiety in adolescents, but child maltreatment was associated with increased risk for anxious tendencies only (Wang et al., 2021a). Yet, other research has found support for the link between family dysfunction and adolescent anxiety, but not depression (Font and Berger, 2015; Morris, 2019). These findings are also supported in other samples beyond the FFCWS, such as with data from the National Survey of Children’s Health (Kim, 2021) and the Great Smokey Mountains Study (Gifford et al., 2019). Nonetheless, other research using the FFCWS found support for the association between particular types of ACEs (i.e., material hardship, which includes a measure of food insecurity, acquisition of housing, and the ability to afford utilities) and an increased risk for adolescent depression, but not anxiety (Edmunds and Alcaraz, 2021).

Further, an evolving body of work has demonstrated that the impact of ACEs on youth outcomes may vary by gender (Gajos et al., 2022; Leban and Gibson, 2020; Duke et al., 2010; Schilling et al., 2007). Gender differences may not be surprising, however, given that scholarship has long-documented gender differences in responses to stressful or traumatic events (e.g., Piccinelli and Wilkinson 2000). In general, girls tend to react to stressors with internalizing symptoms, while boys may be more likely to respond with externalizing symptoms (Daughters et al., 2009; Hankin et al., 2007; Rudolph, 2002). However, relatively few studies have explored whether ACEs impact adolescent mental health symptoms differently by gender. ACEs have been linked to a greater increase in anxiety disorders for adult women compared to adult men (Afifi et al., 2008), and boys who experienced greater ACEs were at a heightened risk of exhibiting elevated externalizing symptoms across adolescence compared to girls (Leban, 2021).

Moreover, there is a lack of research on the role of teenage risk and protective factors in the relationship between ACEs and mental health outcomes, as well as whether these relationships are moderated by gender. This is a notable shortcoming, since increasing our understanding of how gender and risk and protective factors operate in the relationship between ACEs and adolescent mental health has important relevance for refining intervention and prevention strategies. Prior work suggests that there may be gender differences in the impact of teenage risk and protective factors, particularly in the school/peer and community domains, for maladaptive outcomes in adolescence (Kroneman et al., 2004; Rosenbaum and Lasley, 1990). Although ACEs have been shown to have detrimental impacts on behavioral and health outcomes, limited research has examined the potential for protective factors to attenuate the impact of ACEs (Moore and Ramirez, 2016), especially on mental health. In what limited studies there are on protective factors, a focus has been on parental engagement showing that father engagement (Wang et al., 2021b) and parental warmth (Wang et al., 2021a) have protective abilities against ACEs in relation to behavioral outcomes in adolescents. Moreover, school connectedness and peer role models could have mitigating effects on ACEs to anxiety and depression (Kim, 2021). With these risk and protective factors having limited exploration, this leaves an opportunity to study their associations with ACEs and mental health outcomes in adolescents.

2. Current study

Research on the impact of ACEs on mental health in adolescence has produced mixed results, leaving it unclear how ACEs may be related to depressive and anxiety symptoms during adolescence. Moreover, this body of work has neglected how gender and adolescent risk and protective factors may influence these relationships, despite scholarship demonstrating gender differences in both responses to adversity and in the impact of risk and protective factors on maladaptive outcomes in adolescence. In light of these limitations, this study examines the association between ACEs during early childhood (i.e., ages 1 to 5) and anxious and depressive tendencies reported during adolescence. These symptom clusters are stratified by gender and incorporate teenage risk factors (i.e., peer bullying, delinquent peers, and adolescent low self-control) and protective factors (parental attachment, collective efficacy, and school connectedness) to explore their potential to attenuate the influence of ACEs on risk for mental health outcomes in a sample of high-risk adolescents from the Fragile Families and Child Wellbeing Study (FFCWS). It is hypothesized that ACEs will be associated with adolescent anxiety and depressive symptoms and that these relationships will remain in the presence of teenage risk factors. However, we hypothesize that teenage mitigating factors will attenuate the relationship between ACEs and teenage depressive and anxiety symptoms. Due to the lack of research examining gender differences in the role of teenage risk and protective factors in the relationship between ACEs and mental health outcomes, we did not formulate specific hypotheses regarding the moderation of gender. However, given the risk for internalizing symptoms in teenage girls (Dyer and Wade, 2012), girls’ (rather than boys’) symptoms of depression and anxiety may be more strongly associated with ACEs and teenage risk and protective factors.

3. Methods

3.1. Data

The FFCWS includes a cohort of approximately 4700 families and is representative of a nationally-based sample of non-marital births in large U.S. cities (i.e., approximately 3600 unwed and 1100 married couples were enrolled at baseline (see (Reichman et al., 2001) for additional study design details). To date, six waves of data have been collected, beginning in 1998–2000, approximately 48 h after birth. The other waves of data were collected via telephone-based interviews with mothers and fathers when the children were ages one (1999–2001), three (2001–2003), five (2003–2006), nine (2007–2010) and fifteen (2014–2017). A subset of primary caregivers (typically the biological mother) also participated in in-home interviews at years three, five, and nine. De-identified data from the FFCWS are publicly available and approval for secondary data analyses was given by the [University of Alabama Institutional Review Board] Institutional Review Board (Protocol 19–11-2993). The analytic sample for the current study is based on the sample of adolescents whose primary caregivers completed the in-home interviews during years three and five (i.e., when the available ACEs measures were assessed in the FFCWS). At the onset of analyses, 2455 adolescents were included in the analytic sample (based on the number of primary caregivers who completed the in-home surveys). The demographics of the adolescents in the sample include: 48 % female, 50 % Black, 23 % Hispanic and ranged in age from 14 to 18 (Mage = 15.4).

3.2. Measures

3.2.1. Adolescent mental health

3.2.1.1. Depression.

Teen depression was self-reported with five items from the Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff, 1977) at year fifteen. Item scores ranged from 0 = strongly disagree to 3 = strongly agree and were summed to create a score for teen depression (range 0–15).

3.2.1.2. Anxiety.

Adolescents’ anxiety was also self-reported at year fifteen with six items from a modified version of the Brief Symptom Inventory 18 (BSI 18) (Derogatis and Savitz, 2000). Items were scored as 0 = strongly disagree to 3 = strongly agree and were summed to create a score of teen anxiety (range 0–18).

3.2.2. Adverse childhood experiences

Seven ACEs were measured from the mother/father core interviews and the in-home surveys during early childhood (ages 1–5). Physical Abuse, Psychological Abuse, and Neglect is measured with subscales from the Parent-Child Conflict Tactics Scale (CTSPC) (Straus et al., 1998); Parental Alcohol and Drug Dependence are assessed with questions derived from the Composite International Diagnostic Interview-Short Form (CIDI-SF) (Kessler et al., 1998); Parental Depression and Anxiety is measured with questions from the CIDI-SF; Parental Intimate Partner Violence (IPV) is based on mothers’ reports of the behaviors of the child’s biological father (either currently married/romantically involved or no longer together) or their current partner; and Parental Criminal Behavior is based on mothers and fathers self-reports of their experiences with the criminal justice system. If primary caregivers and mothers/fathers reported “yes” to any of the items within a given ACE domain (e.g., neglect) across the waves in which that ACE was assessed, adolescents were scored as having been exposed to that ACE. The total ACEs score reflects a cumulative score, ranging between 0 (no exposure to ACEs) and 7 (exposed to all 7 types of ACEs).

3.2.3. Adolescent risk factors

3.2.3.1. Peer bullying.

Adolescents reported on their exposure to peer bullying in the past month with items adapted from the peer bullying assessment from the Panel Study of Income Dynamics Child Development Supplement (PSID-CDS-III) (2010). The four items were averaged into an index of greater exposure to peer bullying (α = 0.69).

3.2.3.2. Delinquent peers.

Adolescents self-reported on their friends’ engagement in delinquent activities during the past year. Eleven items were coded as 1 (i.e., peer(s) engaged in the delinquent act in the past year) or 0 (peer(s) did not engage in the act during the past year) and summed to reflect greater peer participation in delinquency (range 0–11).

3.2.3.3. Low self-control.

Adolescent-reported impulsivity was assessed with six items from an abbreviated form of the Dickman’s impulsivity scale (Dickman, 1990). Items were averaged to create an index of teen impulsivity (α = 0.78).

3.2.4. Adolescent protective factors

3.2.4.1. Parental attachment.

During the year fifteen interview, adolescents reported on their closeness to both their mother and father with items from the Family Functioning section of the National Survey of Children’s Health (2003). The four items were summed to create an index score of parental attachment (α = 0.63).

3.2.4.2. Collective efficacy.

Adolescents reported on levels of informal social control, as well as cohesion and trust in their neighborhoods with items developed by Sampson et al. (1997). The eight items of the scale were averaged into an index representing greater neighborhood collective efficacy (α = 0.75).

3.2.4.3. School connectedness.

Adolescents reported on four items compiled by Jacquelyn Eccles for the Panel Study of Income Dynamics Child Development Supplement (PSID-CDS-III) (2010) intended to measure levels of inclusiveness, closeness, happiness, and safety felt in their school environments. The items were averaged into an index representing greater school connectedness (α = 0.73).

3.2.4.4. Demographics.

Gender (0 = female, 1 = male), age (Mage = 15.4, SD = 0.66), and self-reported race/ethnicity (0 = non-Hispanic White, 1 = non-White) were included as covariates. Primary caregiver-reported annual household income (0 = under $5000 to 8 = greater than $60,000), primary caregivers’ highest level of education (0 = less than high school to 3 = college or graduate), and primary caregivers’ current marital status (0 = not married, 1 = married) were also reported at year fifteen.

3.3. Statistical analyses

The study was conducted in a series of steps. First, negative binomial regressions were used to predict Incident Risk Ratios (IRR) for the associations between teen depressive and anxiety symptoms, the total ACEs score, and the remaining study variables for the full sample (n = 1645). Next, a series of stepwise regression analyses were conducted to estimate the association between ACEs and teen depressive and anxiety symptoms once accounting for covariates and teenage risk and protective factors. All of the negative binomial stepwise regression models are reported separately by gender. First, the association between the total ACEs score and teen depressive and anxiety symptoms are reported. Second, the study demographics are entered into the model. Third, the teenage risk factors are included in the model, followed by the inclusion of the teenage protective factors in the final model.

4. Results

The relationship between adolescent mental health outcomes and the total ACEs score, covariates, and teenage risk and protective factors for the full sample are reported in Table 1. The total ACEs scores were not significantly associated with teenage depressive nor anxiety symptoms once all study variables were included in the model. However, household income (IRR = 0.98, p < 0.01) and parental education (IRR = 0.97, p < 0.05) were associated with less risk for depressive symptoms in the full sample. Moreover, males and non-White adolescents were at less risk for depression and anxiety symptoms than females and White adolescents, respectively. In addition, each of the teen risk factors were significantly related to an increased risk for depression and anxiety symptoms, whereas the teenage protective factors were associated with less risk for depression and anxiety symptoms.

Table 1.

Association between mental health and ACEs among full sample.

Depression Anxiety
IRR (95 % CI) IRR (95 % CI)
Total ACEs 1.00 (0.97, 1.02) 0.99 (0.98, 1.01)
Income 0.98** (0.97, 1.00) 1.00 (0.99, 1.01)
Parent education 0.97* (0.94, 1.00) 0.98 (0.96, 1.00)
Parent married 0.95 (0.89, 1.02) 1.00 (0.95, 1.05)
Age 0.98 (0.94, 1.03) 1.01 (0.97, 1.05)
Gender 0.89** (0.84, 0.94) 0.93** (0.98, 0.98)
Race/ethnicity 0.90** (0.83, 0.97) 0.83** (0.79, 0.88)
Peer bullying 1.26** (1.19, 1.33) 1.21** (1.16, 1.26)
Delinquent peers 1.03** (1.02, 1.04) 1.01** (1.00, 1.02)
Low self-control 1.29** (1.24, 1.36) 1.53** (1.48, 1.59)
Parental attachment 0.77** (0.75, 0.81) 0.87** (0.84, 0.90)
Collective efficacy 0.93** (0.89, 0.98) 0.90** (0.87, 0.94)
School connectedness 0.73** (0.69, 0.76) 0.91** (0.87, 0.94)
n = 1645 n = 1645
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Note: IRR = incident risk ratio; gender (0 = female, 1 = male), race/ethnicity (0 = non-Hispanic White, 1 = non-White), and parent married (0 = not married, 1 = married)

**

p ≤ 0.01

*

p ≤ 0.05

significant findings are presented in bold.

The stepwise regression models for predicting adolescent depressive symptoms for girls and boys are presented in Tables 2 and 3, respectively. Table 2, Model 1 shows that the total ACEs score is significantly associated with an increased risk of girls’ depressive symptoms (IRR = 1.04, p < 0.01). ACEs remain significantly associated with an increased risk of depressive symptoms in girls once demographics were added to Model 2 (IRR = 1.03, p < 0.05). However, once the teen risk factors were entered in Model 3, ACEs were no longer significantly related to an increased risk of depressive symptoms in girls. Model 4 reveals that all of the teenage risk and protective factors were significantly related to an increased and decreased (respectively) risk of depression, while ACEs became significantly related to less risk for depression in girls (IRR = 0.97, p < 0.05) once these variables were included in the final model. Similar patterns emerged for boys’ depressive symptoms in Table 3. The total ACEs score was significantly related to an increased risk of depressive symptoms for boys (IRR = 1.09, p < 0.01) in Model 1 and remained significantly related to an increased risk of depressive symptoms across Models 2 and 3. However, once the teenage risk and protective factors were included in Model 4, the total ACEs score was no longer significantly associated with an increased risk of depressive symptoms in boys.

Table 2.

Association between girls’ depression, ACEs, and teen risk and protective factors.

Model 1 Model 2 Model 3 Model 4
IRR (95 % CI) IRR (95 % CI) IRR (95 % CI) IRR (95 % CI)
Total ACEs 1.04** (1.01, 1.07) 1.03* (1.00, 1.06) 1.00 (0.97, 1.03) 0.97* (0.94, 1.00)
Income – 0.97** (0.95, 0.98) 0.99 (0.98, 1.01) 0.99 (0.97, 1.01)
Parent education – 0.96* (0.92, 1.00) 0.96* (0.92, 1.00) 0.97 (0.93, 1.01)
Parent married – 0.82** (0.75, 0.90) 0.88** (0.81, 0.97) 0.93 (0.85, 1.02)
Age – 0.95 (0.89, 1.01) 0.93* (0.87, 0.99) 0.91** (0.85, 0.97)
Race/ethnicity – 0.89* (0.80, 0.99) 0.89* (0.81, 0.99) 0.86** (0.77, 0.95)
Peer bullying – – 1.53** (1.41, 1.65) 1.31** (1.20, 1.42)
Delinquent peers – – 1.06** (1.04, 1.07) 1.03** (1.02, 1.05)
Low self-control – – 1.37** (1.29, 1.45) 1.27** (1.20, 1.34)
Parental attachment – – – 0.75** (0.71, 0.79)
Collective efficacy – – – 0.93* (0.87, 0.99)
School connectedness – – – 0.74** (0.70, 0.79)
n = 1039 n = 817 n = 801 n = 798
Open in a new tab

Note: IRR = incident risk ratio; race/ethnicity (0 = non-Hispanic White, 1 = non-White) and parent married (0 = not married, 1 = married)

**

p ≤ 0.01

*

p ≤ 0.05

significant findings are presented in bold.

Table 3.

Association between boys’ depression, ACEs, and teen risk and protective factors.

Model 1 Model 2 Model 3 Model 4
IRR (95 % CI) IRR (95 % CI) IRR (95 % CI) IRR (95 % CI)
Total ACEs 1.09** (1.06, 1.12) 1.07** (1.04, 1.11) 1.04** (1.01, 1.08) 1.02 (0.99, 1.06)
Income – 0.97** (0.95, 0.98) 0.96** (0.94, 0.98) 0.98* (0.96, 1.00)
Parent education – 0.94** (0.90, 0.98) 0.95* (0.91, 1.00) 0.97 (0.92, 1.01)
Parent married – 0.91 (0.83, 1.00) 0.93 (0.85, 1.02) 0.98 (0.89, 1.08)
Age – 1.07* (1.01, 1.13) 1.09** (1.03, 1.16) 1.06 (0.100, 1.13)
Race/ethnicity – 1.02 (0.91, 1.15) 0.98 (0.87, 1.10) 0.96 (0.85, 1.08)
Peer bullying – – 1.41** (1.31, 1.51) 1.25** (1.16, 1.34)
Delinquent peers – – 1.04** (1.02, 1.06) 1.03** (1.01, 1.05)
Low self-control – – 1.39** (1.31, 1.49) 1.35** (1.26, 1.44)
Parental attachment – – – 0.81** (0.76, 0.86)
Collective efficacy – – – 0.93* (0.86, 0.99)
School connectedness – – – 0.71** (0.66, 0.76)
n = 1090 n = 869 n = 852 n = 847
Open in a new tab

Note: IRR = incident risk ratio; race/ethnicity (0 = non-Hispanic White, 1 = non-White) and parent married (0 = not married, 1 = married)

**

p ≤ 0.01

*

p ≤ 0.05

significant findings are presented in bold.

The stepwise regression results for girls’ and boys’ anxiety symptoms are presented in Tables 4 and 5, respectively. In Table 4, Model 1 shows that the total ACEs score was not significantly associated with an increased risk for girls’ anxiety symptoms. Higher levels of parental education remained significantly related to less risk of anxiety in girls across Models 2, 3, and 4. Moreover, non-White girls displayed less risk of anxiety symptoms across all four Models. Similar to the findings for girls’ depressive symptoms, once the teenage risk and protective factors were entered into Model 4, the total ACEs score became significantly associated with less risk for anxiety in girls (IRR = 0.96, p < 0.01). In contrast, the results for boys suggest that the total ACEs score was significantly related to an increased risk for anxiety symptoms across Models 1, 2, and 3. However, once the teenage protective factors were added to Model 4, the total ACEs score was no longer significantly related to boys’ anxiety.

Table 4.

Association between girls’ anxiety, ACEs, and teen risk and protective factors.

Model 1 Model 2 Model 3 Model 4
IRR (95 % CI) IRR (95 % CI) IRR (95 % CI) IRR (95 % CI)
Total ACEs 1.02 (1.00, 1.04) 1.02 (0.99, 1.04) 0.99 (0.96, 1.01) 0.96** (0.94, 0.99)
Income – 0.99 (0.97, 1.00) 1.01 (0.99, 1.02) 1.01 (0.99, 1.02)
Parent education – 0.93** (0.90, 0.96) 0.94** (0.91, 0.98) 0.94** (0.91, 0.98)
Parent married – 0.90** (0.83, 0.96) 0.96 (0.90, 1.03) 0.99 (0.92, 1.06)
Age – 0.97 (0.92, 1.02) 0.97 (0.92, 1.02) 0.96 (0.91, 1.01)
Race/ethnicity – 0.85** (0.79, 0.92) 0.82** (0.75, 0.89) 0.79** (0.72, 0.85)
Peer bullying – – 1.39** (1.30, 1.48) 1.31** (1.22, 1.40)
Delinquent peers – – 1.02** (1.01, 1.04) 1.01* (1.00, 1.03)
Low self-control – – 1.57** (1.50, 1.65) 1.51** (1.44, 1.58)
Parental attachment – – – 0.86** (0.82, 0.90)
Collective efficacy – – – 0.88** (0.84, 0.93)
School connectedness – – – 0.91** (0.86, 0.96)
n = 1039 n = 817 n = 801 n = 798
Open in a new tab

Note: IRR = incident risk ratio; race/ethnicity (0 = non-Hispanic White, 1 = non-White) and parent married (0 = not married, 1 = married)

**

p ≤ 0.01

*

p ≤ 0.05

significant findings are presented in bold.

Table 5.

Association between boys’ anxiety, ACEs, and teen risk and protective factors.

Model 1 Model 2 Model 3 Model 4
IRR (95 % CI) IRR (95 % CI) IRR (95 % CI) IRR (95 % CI)
Total ACEs 1.07** (1.04, 1.09) 1.06** (1.04, 1.09) 1.03* (1.01, 1.06) 1.02 (1.00, 1.04)
Income – 0.99* (0.97, 1.00) 0.98* (0.97, 1.00) 0.99 (0.98, 1.01)
Parent education – 1.00 (0.96, 1.03) 1.01 (0.98, 1.05) 1.01 (0.98, 1.05)
Parent married – 0.96 (0.90, 1.03) 0.99 (0.92, 1.06) 1.01 (0.94, 1.08)
Age – 1.02 (0.97, 1.07) 1.06* (1.01, 1.11) 1.04 (0.99, 1.10)
Race/ethnicity – 0.94 (0.86, 1.02) 0.91* (0.84, 0.99) 0.90* (0.83, 0.98)
Peer bullying – – 1.22** (1.15, 1.29) 1.15** (1.09, 1.23)
Delinquent peers – – 1.02** (1.01, 1.03) 1.01* (1.00, 1.03)
Low self-control – – 1.59** (1.52, 1.67) 1.58** (1.50, 1.66)
Parental attachment – – – 0.87** (0.83, 0.91)
Collective efficacy – – – 0.92** (0.87, 0.97)
School connectedness – – – 0.92** (0.86, 0.97)
n = 1090 n = 869 n = 852 n = 847
Open in a new tab

Note: IRR = incident risk ratio; race/ethnicity (0 = non-Hispanic White, 1 = non-White) and parent married (0 = not married, 1 = married)

**

p ≤ 0.01

*

p ≤ 0.05

significant findings are presented in bold.

5. Discussion

Examining the association between adolescent mental health outcomes and early ACEs, as noted previously, is an understudied topic with varied results. Much of the ACEs literature has focused on mental and behavioral health outcomes reported in adulthood, confirming the link between ACEs and poor mental health outcomes later in life (Evans et al., 2013; Felitti et al., 1998; Hughes et al., 2017). A follow-up to Kaiser’s initial ACE study found that for those who had experienced five or more ACEs, their risk of experiencing depression in adulthood was increased 5 times for women and 2.4 times for men (Chapman et al., 2004). It is interesting then, that a compounding number of ACEs was not associated with adolescent depressive or anxious symptoms within the full analytic sample. However, teenage risk factors (i.e., peer bullying, delinquent peers, and adolescent low self-control) increased the likelihood of depressive and anxious tendencies. Teenage protective factors, moreover, (i.e., parental attachment, collective efficacy, and school connectedness) reduced the risk for depressive and anxious symptoms in the full sample. These findings suggest that proximal risk and protective factors are salient for teenage depressive and anxiety symptoms, above and beyond any influences that early ACEs may have on the development of depressive and anxiety tendencies during adolescence.

The results also found support for gender differences in the associations between ACEs and boys’ and girls’ mental health. In the baseline models, ACEs were associated with an increased risk of depressive symptoms and anxious tendencies in boys, but the total ACEs score was only significantly associated with an increased risk for depressive symptoms in girls. Surprisingly, once accounting for teenage risk and protective factors among girls, the cumulative exposure to ACEs was related to a decreased risk of experiencing depressive and anxious symptoms. These findings could suggest that girls with a history of ACEs may have obtained greater access to resources to cope with abuse (compared to boys with ACEs). Indeed, prior evidence suggests that girls may cope to stressors with internalizing symptoms, whereas boys may be more likely to cope with externalizing symptoms (Daughters et al., 2009; Hankin et al., 2007; Rudolph, 2002). Thus, this knowledge may have informed how parents, schools, and/or communities respond to girls with ACEs, thereby devoting attention toward teaching strategies to combat mental health risk factors early in life.

The current study findings also highlight the importance of teenage risk and protective factors for adolescent mental health outcomes. Erikson’s psychosocial development posits that stable home environments are necessary for children to successfully progress through early developmental stages (Orenstein and Lewis, 2020). However, children transition from needing family nurturing to a focus on companionship during middle childhood and adolescence; therefore, relationships outside of the home environment are beginning to take a more important role in development (Harris, 1995; Hayward, 2003; Lourenço, 2016; Orenstein and Lewis, 2020). For instance, in both boys and girls, peer bullying seemed to confer the highest risk of depressive symptoms. Peer bullying was also strongly linked to the risk of anxiety symptoms in both genders. For adolescents, social anxiety, which stems from fears around acceptance from peers, is the most common form of anxiety in this age group (Beesdo et al., 2009). Therefore, these peer relational challenges are more strongly correlated to the anxious symptoms than ACEs experienced in early childhood. Nonetheless, adolescent low self-control was associated with the greatest risk for anxiety symptoms in both girls and boys, which suggest that emotion regulation—especially within the context of peer relationships—would be beneficial for reducing anxiety in high-risk adolescent populations.

The results should be interpreted within the context of the study’s limitations. First, it should be noted that when comparing these results to findings garnered from populations of adults, studies using adolescent populations seem to only select for several characteristics of disease processes, such a low mood in depression, but do not obtain the information required for a clinical diagnosis of either anxiety or depression. Therefore, the inability to obtain a clinical diagnosis in the study population is a limitation. Second, the omission of data on sexual abuse may have influenced the current study findings. Girls are significantly more likely to experience sexual trauma than boys (Assink et al., 2019); thus, unavailable data on sexual abuse as an ACE in the current study could be skewing the results and not painting a full picture of early ACEs in girls and their mental health risks.

Overall, the current study suggests that protective factors during adolescence can modify negative experiences from early childhood in relation to mental health outcomes. However, it appears adolescent risk with relation to peers is significantly detrimental to mental health outcomes in adolescents. This could be due to bias in reporting, where primary caregivers were reporting on ACEs in early childhood and teens were self-reporting on their current peer, school, and community relationships perhaps more accurately. Nonetheless, the findings have implications for the creation of better interventions, especially early at the peer level, to mitigate mental health risks. These results also suggest that fostering school connectedness might be a prudent topic to focus early interventions and that such interventions would be beneficially for both girls and boys. Finally, from this study it is apparent more research is warranted on the developmental timing of ACEs to identify sensitive periods with which to create early interventions to mitigate negative mental health impacts.

Supplementary Material

Supplemental tables

Acknowledgments

Funding for the Fragile Families and Child Wellbeing Study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health under award numbers R01HD036916, R01HD039135, and R01HD040421, as well as a consortium of private foundations. Jamie M. Gajos received funding from the National Institute on Drug Abuse (K01 DA054262). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

CRediT authorship contribution statement

Jamie M. Gajos conceptualized the manuscript idea, ran the data analyses, and wrote the manuscript. Chelsea R. Miller and Lindsay Leban also assisted with conceptualizing the manuscript idea and writing the manuscript. Karen L. Cropsey helped conceptualize the manuscript idea and provided edits and feedback on the manuscript.

Declaration of competing interest

None.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi.org/10.1016/j.jad.2022.07.047.

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