The Relationship Between Childhood Trauma and Mental Health in Indian Undergraduate Students: A Cross-sectional Study

Abstract

Background:

Childhood trauma encompassing abuse, neglect, and household dysfunction is known to have enduring consequences on mental health, increasing susceptibility to depression, anxiety, and PTSD (post-traumatic stress disorder) across the lifespan. Despite the rising focus on mental health in higher education, research on the prevalence and impact of childhood trauma within Indian undergraduate populations remains limited. This study examines the prevalence of childhood trauma and its association with mental health outcomes in undergraduates, framed within a lifespan developmental perspective.

Methods:

We conducted a cross-sectional study involving 410 undergraduate students (74.6% female; mean age = 20.57 years). Participants completed validated instruments: The Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI-21), PTSD Checklist for DSM-5 (PCL-5), and the Generalized Anxiety Disorder 7-Item Scale (GAD-7). Descriptive statistics, Pearson’s correlations, and multiple linear regression analyses were employed to assess the relationships between childhood trauma subtypes and mental health outcomes.

Results:

Emotional abuse (r = 0.507, p < .01) and physical abuse (r = 0.517, p < .05) demonstrated the strongest associations with depression, anxiety, and PTSD symptoms. Emotional neglect significantly predicted depressive symptoms (β = 0.231, p = .002). Female students reported substantially higher PTSD scores compared to males (p < .05), reflecting gendered differences in trauma responses. Although minimization/denial of trauma showed negative correlations with mental health symptoms, these associations were not statistically significant, suggesting a possible role of avoidance-based coping.

Conclusions:

This study reveals a robust relationship between childhood trauma and mental health challenges among undergraduates, with emotional abuse, physical abuse, and emotional neglect emerging as key predictors of psychological distress. The findings highlight the urgent need for trauma-informed, gender-sensitive mental health interventions within academic institutions. Early screening and culturally tailored support services could play a pivotal role in mitigating the long-term impacts of adverse childhood experiences during the critical life phase of emerging adulthood.

Key Messages:

• We evaluated childhood trauma and mental health symptoms among Indian undergraduate students.

• Emotional and physical abuse strongly predicted depression, anxiety, and PTSD, while emotional neglect was linked to depressive symptoms. Female students showed higher PTSD symptoms than males.

• Childhood trauma has a significant association with the health of undergraduates into adulthood. Emotional abuse and neglect require targeted mental health interventions.

Childhood trauma, encompassing experiences such as physical, emotional, or sexual abuse, neglect, and household dysfunction (e.g., domestic violence, substance abuse, or parental mental illness), has been widely recognized as a critical factor influencing an individual’s psychological and emotional development. Research consistently demonstrates that adverse childhood experiences (ACEs) have profound and enduring effects on mental health, often persisting into adulthood.^1,2 These experiences can disrupt emotional regulation, cognitive functioning, and social skills, thereby elevating the risk of depression, anxiety, post-traumatic stress disorder (PTSD), and substance abuse.^3,4

Conceptualizing trauma through a lifespan approach provides a comprehensive understanding of its pervasive impact across developmental stages. ⁵ Early-life adversities can initiate maladaptive psychological trajectories that influence mental health not just in childhood or adolescence but well into adulthood.^6,7 The period of emerging adulthood (roughly between 18 and 25 years), which overlaps with the college years, is particularly sensitive, as individuals navigate identity formation, autonomy, and academic pressures. This stage can either consolidate resilience or exacerbate latent vulnerabilities stemming from childhood trauma.^8,9

For undergraduate students, the lingering effects of childhood trauma may intensify the academic, social, and emotional challenges that characterize this developmental phase. Such adversities may compromise academic performance, interpersonal relationships, and overall psychological well-being. ¹⁰ Despite the growing recognition of mental health issues in higher education, there is limited research examining the prevalence and psychological impact of childhood trauma specifically among university students in India. This gap is particularly notable given the cultural and contextual factors unique to the Indian socio-educational landscape, which may shape both the experience of trauma and its mental health outcomes. ¹¹

This study aims to make a unique contribution by focusing on the Indian undergraduate population, an under-researched group in the global discourse on childhood trauma and mental health. While studies from Western contexts have established robust associations between ACEs and later psychopathology,^12,13 evidence from India remains sparse, especially within academic institutions where competitive environments and socio-cultural expectations often compound stress levels. ¹⁴

Understanding the relationship between childhood trauma and mental health outcomes in undergraduate students is crucial for several reasons. First, it can help identify individuals at risk who may benefit from early intervention and tailored support. Second, it can inform the development of trauma-informed mental health services that address the specific needs of students with a history of trauma. Third, it contributes to a broader understanding of how early adverse experiences influence long-term psychological functioning, especially during critical life transitions. ¹⁵

By situating this inquiry within a lifespan developmental framework, this study underscores the importance of addressing unresolved trauma during emerging adulthood. In this period, interventions can alter life trajectories for the better. Such an approach not only enriches academic understanding but also has practical implications for student mental health services and policy-making within higher education settings.

This cross-sectional study addresses these research gaps by investigating the prevalence of childhood trauma among undergraduate students in India and examining its association with key mental health outcomes, including depression, anxiety, PTSD, and other psychological challenges. Specifically, it explores how different types of trauma (e.g., abuse, neglect, household dysfunction) correlate with mental health symptomatology in this demographic. By doing so, this research seeks to provide evidence-based insights that can guide the development of effective, trauma-informed interventions and support systems in academic environments.

Hypothesis

Undergraduate students with a history of childhood trauma, particularly emotional abuse, physical abuse, and neglect, will exhibit significantly higher levels of depression, anxiety, and PTSD symptoms compared to those without such experiences. Furthermore, emotional abuse is expected to emerge as the most potent predictor of psychological distress among the trauma subtypes.

Aims

To investigate the relationship between childhood trauma and mental health outcomes among Indian undergraduate students, and to identify which specific types of traumas most strongly predict psychological distress. By employing a lifespan developmental perspective, the study aims to elucidate how early adverse experiences continue to shape mental health trajectories during the critical period of emerging adulthood.

Objectives

1. To assess the prevalence and patterns of various forms of childhood trauma (e.g., emotional abuse, physical abuse, neglect, household dysfunction) among undergraduate students in India.

2. To examine the associations between childhood trauma and mental health symptoms, specifically depression, anxiety, and PTSD, and to identify which trauma subtypes serve as the strongest predictors of these outcomes.

3. To conceptualize and interpret the psychological impact of childhood trauma within a lifespan framework, providing a rationale for focusing on adolescence and early adulthood as sensitive periods for the manifestation of mental health challenges.

Methods

This study employed a cross-sectional design to assess the prevalence of childhood trauma and its associations with mental health outcomes among undergraduate students in India. By focusing on this population, the study aimed to fill a critical research gap concerning the long-term psychological effects of early adversity in emerging adulthood, a sensitive developmental phase. Data were collected between July 2024 and December 2024 through a structured, self-reported questionnaire comprising validated instruments to evaluate childhood trauma and current mental health status. This approach provided a comprehensive yet practical method to capture retrospective trauma exposure alongside current symptoms of depression, anxiety, and PTSD within an academic setting.

Participants and Recruitment

Undergraduate students aged between 18 and 25 years, enrolled at a selected Indian university, were eligible for inclusion. The age range was chosen to align with the developmental period of emerging adulthood, which is marked by psychological transitions sensitive to the impacts of earlier trauma. Students were approached in classrooms, common areas, and via institutional communication platforms. Before data collection, rapport-building sessions were held with student groups to explain the study’s purpose, reassure them about confidentiality, and address any concerns, recognizing the sensitivity of the subject matter.

Exclusion criteria included, (a) Individuals not enrolled as undergraduates (e.g., postgraduate students, faculty, staff), (b) Participants outside the age range of 18–25 years, (c) Those with severe mental health conditions, such as diagnosed psychotic disorders or significant cognitive impairments, might compromise their ability to provide informed consent or complete the questionnaire accurately, and (d) Individuals are unable to comprehend the survey due to language barriers.

These exclusions were applied carefully to ensure ethical participation while maintaining the representativeness of the sample. The rationale for excluding individuals with severe mental health conditions was to avoid exacerbating existing conditions and to ensure the reliability of self-reported data, in line with ethical standards.

Measures

Childhood Trauma

The Childhood Trauma Questionnaire-Short Form (CTQ-SF) is a 28-item retrospective self-report instrument designed to assess five domains of childhood trauma: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect.16 It has demonstrated strong psychometric properties, with high internal consistency (Cronbach’s α > 0.85) and good construct validity. Studies among Indian adolescents and young adults have confirmed its reliability and cultural acceptability in non-Western contexts. ⁴

Depression

The Beck Depression Inventory-II (BDI-II) is a 21-item scale that evaluates the severity of depressive symptoms over the past two weeks.17 It is one of the most widely used tools in clinical and research settings, with excellent internal consistency (Cronbach’s α = 0.91) and sensitivity to changes in depressive severity. Although initially developed in Western populations, it has been validated in Indian samples and is considered both linguistically and culturally acceptable. ¹⁸

Anxiety

The Generalized Anxiety Disorder 7-Item Scale (GAD-7) assesses anxiety symptoms experienced in the past two weeks. ¹⁹ It is a brief, reliable instrument with good internal consistency (α = 0.89) and has been validated against diagnostic interviews. The GAD-7 has shown strong applicability in academic and general populations in India. ²⁰

Post-traumatic Stress Disorder

The PTSD Checklist for DSM-5 (PCL-5) is a 20-item measure designed to assess PTSD symptoms in line with DSM-5 criteria.21 It evaluates four symptom clusters: intrusion, avoidance, negative alterations in mood/cognition, and hyperarousal. The tool has demonstrated high internal consistency (α = 0.94) and strong convergent validity (r = 0.82 with clinician ratings). While it is typically used in the context of recent traumatic events, we retained the standard 1-month reference period for consistency with validation studies. Its utility in young adult populations, including Indian samples, has been supported by prior research (Forkus SR et al., 2023). ²²

Demographic Data

A structured form collected data on age, gender, socioeconomic status (classified via the Modified Kuppuswamy Scale), place of residence (urban/rural), and other relevant background variables. ²³

Procedure

Participants completed the paper-based questionnaire in private classroom settings, ensuring minimal distractions and preserving confidentiality. To protect participant privacy, (a) Responses were anonymized using unique codes, (b) Data were stored securely with restricted access to the research team, and (c) Participants were informed about the voluntary nature of the study, their right to withdraw at any time, and the availability of counseling services in case of distress.

Sample Size

A target sample size of approximately 400 was established based on power calculations to detect moderate effect sizes (power ≥ 80%, α = 0.05), considering the expected trauma prevalence (30–60%) in similar populations. ¹¹ This ensured adequate representation across gender, socioeconomic strata, and types of residence.

Statistical Analysis

Descriptive statistics summarized participant characteristics and prevalence rates of trauma and mental health symptoms. Pearson’s correlation coefficients were used to assess the relationships between CTQ subscales and mental health outcomes (BDI-II, GAD-7, PCL-5). Group comparisons were conducted using independent t-tests and one-way ANOVA, with Tukey’s HSD post-hoc tests where appropriate. Multiple linear regression models identified predictors of depression, anxiety, and PTSD, controlling for demographic variables. Assumptions of normality, linearity, and multicollinearity were checked before analysis. All analyses were conducted using SPSS Version 27.0.13. ²⁴

Ethical Considerations

Ethical clearance was obtained from the Institutional Ethics Committee. Written informed consent was obtained from all participants, who were briefed on the study’s objectives, confidentiality measures, and potential risks. Referral pathways were established with the institution’s counseling services to support participants who reported significant psychological distress. Confidentiality was strictly maintained through the use of anonymization and secure data storage.

Results

A total of 450 undergraduate students were initially approached for participation. All students were screened based on the predefined inclusion and exclusion criteria. Of these, 25 students were excluded because they were outside the specified age range (18–25 years). An additional 15 students declined participation or did not provide informed consent, citing time constraints or personal disinterest. The final sample comprised 410 students who provided written informed consent and completed the questionnaire in full, including the CTQ, BDI-II, GAD-7, and PCL-5. The overall participation rate was 96.5%.

This study examined the relationship between childhood trauma, demographic factors, and mental health outcomes—specifically depression, anxiety, and PTSD—among undergraduate students. The final sample included 410 participants (74.6% female, 25.3% male), with a mean age of 20.57 years (SD = 1.89). Participants represented diverse socioeconomic backgrounds, as classified by the Modified Kuppuswamy Scale: 48.3% upper-middle SES, 28.3% upper SES, 13.2% lower-middle SES, and 10.2% lower SES. Regarding residency, 61.9% were from urban areas, 27.8% from semi-urban areas, and 10.2% of rural regions. Family structures included 82.4% nuclear and 17.6% joint families.

Urban residency correlated with higher emotional abuse (r = 0.18, p = .02); no SES differences emerged.

Table 1 summarizes the descriptive statistics for childhood trauma subtypes and mental health outcomes.

Table 1.

Descriptive Statistics for Childhood Trauma and Mental Health Outcomes.

Childhood Trauma	Mean (SD)
Physical abuse	7.85 (3.83)
Emotional abuse	12.80 (3.42)
Sexual abuse	7.31 (3.87)
Physical neglect	9.74 (3.85)
Emotional neglect	12.06 (4.10)
Minimization/denial	0.70 (1.04)
Mental Health	Mean ( SD )
BDI-II (depression)	15.10 (11.97)
GAD-7 (anxiety)	7.78 (5.37)
PCL-5 (PTSD)	29.72 (18.56)

SD: Standard deviation; BDI-II: Beck Depression Inventory-II; GAD-7: Generalized Anxiety Disorder 7-item scale; PCL-5: PTSD Checklist for DSM-5.

Table 2 presents the Pearson correlation coefficients (r) between childhood trauma subscales and mental health outcomes.

Table 2.

Correlation Matrix for Childhood Trauma and Mental Health Outcomes.

Variable	BDI-II (Depression)	GAD-7 (Anxiety)	PCL-5 (PTSD)
Physical abuse	0.517**	0.207*	0.349**
Emotional abuse	0.507**	0.488**	0.624**
Sexual abuse	0.438*	0.210*	0.301*
Physical neglect	0.328**	0.310*	0.339**
Emotional neglect	0.292**	0.298**	0.249**
Minimization/denial	-0.293	-0.426	-0.382

Values represent Pearson’s correlation coefficients (r).

BDI-II: Beck Depression Inventory-II; GAD-7: Generalized Anxiety Disorder 7-item scale; PCL-5: PTSD Checklist for DSM-5.

*p < .05; **p < .01.

Emotional abuse exhibited the strongest positive correlations with anxiety and PTSD symptoms, while both emotional abuse and physical abuse were strongly associated with depression. Sexual abuse and physical neglect showed moderate but significant correlations with all mental health outcomes, whereas emotional neglect showed weaker yet statistically significant correlations. Minimization/Denial was negatively correlated with mental health symptoms, though these correlations did not reach statistical significance, as noted in Table 2.

Group comparisons for mental health outcomes across gender are depicted in Figure 1 and Table 3.

Figure 1. Mental Health Outcomes by Sex.

BDI-II: Beck Depression Inventory-II; GAD-7: Generalized Anxiety Disorder 7-item scale; PCL-5: PTSD Checklist for DSM-5.

Table 3.

Group Comparisons for Mental Health Outcomes.

Outcome	Male (Mean ± SD)	Female (Mean ± SD)	t-value	p Value
BDI-II (depression)	14.08 ± 12.08	15.46 ± 11.95	-0.72	.47
GAD-7 (anxiety)	6.67 ± 5.21	8.16 ± 5.39	-1.74	.08
PCL-5 (PTSD)	25.31 ± 17.34	31.22 ± 18.79	-2.00	.05

BDI-II: Beck Depression Inventory-II; GAD-7: Generalized Anxiety Disorder 7-item scale; PCL-5: PTSD Checklist for DSM-5; SD: Standard deviation; t-value: T

Test statistic from the t test; p value: Probability value.

Females scored significantly higher than males in PTSD symptoms (PCL-5; p = .05), while differences in depression and anxiety scores were not statistically significant.

Table 4 displays the results of the multiple linear regression analysis predicting depression (BDI-II scores).

Table 4.

Multiple Linear Regression Predicting Depression (BDI-II).

Predictor	β (Standardized)	t-value	p Value
Physical abuse	0.273	3.431	.001
Emotional abuse	0.296	4.291	<.001
Sexual abuse	0.131	1.824	.070
Physical neglect	–0.063	–0.803	.423
Emotional neglect	0.231	3.091	.002
Minimization/denial	0.020	0.288	.774
Sex (female)	0.068	1.194	.234
SES (lower)	–0.084	–1.254	.211
Age	0.018	0.309	.757

BDI-II: Beck Depression Inventory-II; SES: Socioeconomic status; β: Standardized beta coefficient; t-value: Test statistic; p value: Probability value.

The regression model explained 41.7% of the variance in depression scores (R² = 0.417). Emotional abuse (β = 0.296, p < .001), emotional neglect (β = 0.231, p = .002), and physical abuse (β = 0.273, p = .001) emerged as significant predictors of depression. Sexual abuse, physical neglect, minimization/denial, sex, SES, and age were not significant predictors in this model.

Figures 2 and 3 illustrate the relationships between emotional abuse, emotional neglect, and depression levels.

Figure 2. Emotional Abuse Versus Depression (BDI-II).

BDI-II: Beck Depression Inventory-II.

Figure 3. Emotional Neglect Versus Depression (BDI-II).

BDI-II: Beck Depression Inventory-II.

These figures visually demonstrate that higher levels of emotional abuse are strongly associated with elevated depressive symptoms, reinforcing its role as the most significant trauma predictor of depression in this sample. Similarly, emotional neglect is positively associated with depression scores, although its impact is comparatively weaker.

Discussion

This study underscores the profound and lasting impact of childhood trauma on mental health outcomes among undergraduate students, particularly within the Indian academic context. This population remains underrepresented in trauma research. Consistent with existing literature, emotional abuse, physical abuse, and emotional neglect emerged as significant predictors of depression, anxiety, and PTSD symptoms. These findings reinforce the role of ACEs in shaping mental health trajectories well into emerging adulthood, a developmental period marked by heightened psychological vulnerability and life transitions.

Comparison with Prior Research

The robust association between emotional abuse and mental health outcomes observed in this study mirrors previous findings. For example, Infurna et al. (2016) reported that emotional abuse was a key predictor of depression and anxiety among young adults, with similar effect sizes to those identified here. ²⁵ The observed link between physical abuse and PTSD aligns with the longitudinal research by Widom et al. (2007), which demonstrated that childhood physical abuse elevates the risk of developing PTSD in adulthood. ²⁶

Significantly, the current study expands this evidence by focusing on undergraduate students navigating the unique academic, social, and personal challenges of college life. Our findings suggest that the psychological imprint of childhood trauma remains salient during this critical stage, potentially interfering with academic success, interpersonal relationships, and emotional well-being.

Additionally, emotional neglect was found to be a significant predictor of depression, consistent with the work of Hildyard and Wolfe (2002), who highlighted the association between neglect and depressive symptoms in youth. ²⁷ The enduring impact of emotional neglect on self-worth and emotional regulation may account for its persistent influence during the college years, when identity formation and autonomy are central developmental tasks.

Interestingly, while minimization/denial of trauma was negatively correlated with mental health symptoms, these correlations were not statistically significant. This pattern suggests that avoidance or denial may offer short-term psychological protection. However, as prior research on coping mechanisms indicates, such strategies may not be sustainable and could predispose individuals to future psychological distress. ²⁸ This highlights the clinical importance of identifying and addressing maladaptive coping mechanisms in trauma-informed interventions.

Gender Differences

Consistent with a well-established body of research, female students in this study reported significantly higher PTSD symptoms than males, though differences in depression and anxiety were not statistically significant.^29,30 The higher PTSD burden among women may reflect gendered responses to trauma, where females are more prone to internalizing disorders. This reinforces the need for gender-responsive mental health strategies in university settings, recognizing that women may require tailored support for trauma-related symptoms.

Implications for Practice and Policy

These findings have several implications for mental health practice within academic institutions:

Trauma Screening and Early Intervention

The clear associations between childhood trauma and mental health symptoms warrant the inclusion of ACE screening in university health services. However, given the ethical and legal complexities surrounding trauma disclosure— including the risk of re-traumatization and mandatory reporting—screening should only be implemented when appropriate support services are in place.

Trauma-informed Care

Interventions should prioritize not only the more apparent forms of trauma, such as physical or sexual abuse, but also the pervasive effects of emotional abuse and neglect, which are often overlooked. Trauma-informed approaches that prioritize safety, trust, and empowerment can foster supportive environments that promote healing. ³¹

Coping Strategies and Therapeutic Support

The association between minimization/denial and lower symptom reporting, albeit non-significant, suggests that some students may underreport distress due to avoidance. Interventions such as cognitive-behavioral therapy (CBT) and mindfulness-based programs can equip students with adaptive coping skills, enhancing emotional regulation and resilience.^32,33

Unique Contribution and Lifespan Perspective

By conceptualizing this research within a lifespan framework, the study contributes to understanding how early adversity continues to influence mental health during the sensitive phase of emerging adulthood. While many studies have examined ACEs in childhood or mid-life, this research uniquely situates undergraduate students within a developmental continuum, emphasizing the ongoing need for targeted mental health interventions during the transition to adulthood.

Limitations and Future Recommendations

While this study offers important insights into the relationship between childhood trauma and mental health outcomes among Indian undergraduate students, certain limitations should be acknowledged. The cross-sectional design constrains the ability to establish causal relationships between childhood trauma and subsequent mental health outcomes. Longitudinal studies are essential to trace the developmental trajectory of trauma’s impact on mental health, academic performance, and functional outcomes across the lifespan. Such studies would help determine whether specific trauma effects intensify or diminish over time and whether particular life transitions, such as the move to adulthood, exacerbate vulnerabilities. The study relied on self-reported measures for both childhood trauma and mental health symptoms. Given the sensitive and potentially stigmatizing nature of these experiences, social desirability bias and recall inaccuracies may have influenced participant responses. Future research should consider supplementing self-report tools with clinical interviews, behavioral assessments, or physiological biomarkers to obtain a more comprehensive and objective evaluation of trauma exposure and its psychological effects. All mental health instruments used in this study were screening tools and may have limited capacity to assess long-term or historical symptomatology. For instance, the BDI-II measures symptoms over the past two weeks and may not adequately capture earlier or chronic depressive symptoms. Similarly, the PCL-5 is typically administered with reference to a recent stressor within the past month; in this study, the standard timeframe was retained to maintain psychometric integrity. However, this may have underrepresented persistent or delayed PTSD symptoms not tied to recent triggers. While these tools are validated and widely used, future research may benefit from incorporating diagnostic interviews or alternative instruments, such as the PHQ-9,34 that are tailored to broader symptom timelines. The sample was predominantly female, reflecting a gender imbalance that may limit the generalizability of the findings to male students or non-binary individuals. Future studies should aim for a more gender-balanced sample to fully capture gender-specific patterns in trauma exposure and mental health outcomes. Although the study was conducted within an Indian undergraduate population—a strength in addressing a research gap—future research should explore the role of socio-cultural factors, such as family dynamics, cultural stigma, and community support, in modulating the relationship between childhood trauma and mental health. This culturally informed approach can enhance the relevance and applicability of findings to diverse populations.

Conclusions

This study adds to the expanding body of evidence on the enduring impact of childhood trauma on mental health, particularly within the under-researched context of Indian undergraduate students. By delineating the specific types of trauma—especially emotional abuse, physical abuse, and emotional neglect—that are most strongly associated with depression, anxiety, and PTSD, the findings offer a foundation for designing targeted, trauma-informed interventions in academic settings. Importantly, the study situates these findings within a lifespan developmental perspective, emphasizing that unresolved childhood trauma continues to shape psychological well-being during the critical phase of emerging adulthood. Early identification of at-risk students, coupled with gender-sensitive approaches and the promotion of adaptive coping strategies, should form the cornerstone of mental health services within higher education institutions. Going forward, universities and policymakers must integrate comprehensive, trauma-informed mental health services that not only address overt trauma but also the often-overlooked impacts of emotional neglect and maltreatment. Such efforts are crucial for fostering resilience, supporting academic success, and safeguarding the long-term psychological well-being of young adults as they navigate the transition to adulthood.