Moderators in the relationship between cumulative adverse childhood experiences and anxiety/depression among U.S. adolescents
Open Access
- Author:
- Kim, Isak
- Graduate Program:
- Counselor Education
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 02, 2021
- Committee Members:
- Soo-yong Byun, Outside Unit & Field Member
Richard Hazler, Chair & Dissertation Advisor
Jolynn Carney, Major Field Member
Deirdre O'sullivan, Major Field Member
Jolynn Carney, Program Head/Chair - Keywords:
- adverse childhood experiences
adolescent
anxiety
depression
protective factors
sex - Abstract:
- Guided by the social-ecological risk and protective factors framework, the purpose of this study was to examine the moderating variables from the family and community systems in the associations between cumulative Adverse Childhood Experiences (ACEs) and anxiety/depression among U.S. adolescents. More specifically, this study first aimed to identify the relationships between cumulative ACEs and anxiety/depression among adolescents, and further examined the moderating roles of family resilience, parental aggravation, community activities, and neighborhood support, after controlling for sociodemographic characteristics, such as age, race/ethnicity, and highest parental education level. The researcher also investigated how sex impacts interactions of cumulative ACEs and moderators. The study sample was drawn from the National Survey of Children’s Health 2018-2019 (NSCH 2018-2019), a nationally representative cross-sectional archival data collected by parents or caregivers of children/adolescents. Among a total of 59,963 respondents in the survey (ages 0-17), the sample was limited to 12-17 aged adolescents, resulting in the final analytic sample for this study was 23,242 after addressing missing values. Two different sets of hierarchical binary logistic regression models were separately implemented for anxiety and depression in order to identify distinctive impacts of predictive and moderating variables on those mental health conditions. For ad-hoc analyses, additional hierarchical binary logistic regression models were conducted for anxiety and depression by sex. Descriptive findings from Chi-square tests, independent t-tests, and bivariate correlation analyses suggested statistically significant relationships between research variables. Results of hierarchical binary logistic regression models demonstrated that predictive variables in the models presented similarities and differences across anxiety and depression in terms of their statistical significance. Both sets of models revealed that cumulative ACEs were significantly associated with outcome variables (OR = 1.40 for anxiety; OR = 1.53 for depression). Among moderating variables, including family resilience, parental aggravation, community activities, and neighborhood support, parental aggravation and community activities significantly moderated the relationship between ACEs and both outcome variables, anxiety and depression. Three-way interactions, among ACEs, family resilience, and sex and ACEs, parental aggravation, and sex, were significant in the model predicting anxiety. In contrast, no three-way interaction term was statistically significant in the model for depression. Implications for practice, counselor training, and future investigation are discussed.