Childhood adversity and mental health among Chinese young adults: The protective role of resilience

Abstract

Aim:The aims of this study were to examine the prevalence of adverse childhood experiences (ACEs) among health science students in China; associations between the number of ACE exposures and severity of depressive and anxiety symptoms; and the extent to which resilience moderates the effect of ACEs on mental health outcomes.Design: This descriptive, cross-sectional study was conducted May-August 2020.Methods: Five hundred and sixty-six health science students (18-38 years) from China completed online surveys measuring ACEs using the Simplified Chinese version of the ACE-International Questionnaire, depressive and anxiety symptoms and resilience. Descriptive statistical analysis, ANOVA with Tukey HSD post hoc tests and multiple regression analysis were performed using SPSS 27.Results: 88.5% of participants reported at least one ACE; 42.6% reported four or more ACEs. Higher number of ACEs was associated with more symptoms of depression and anxiety. Four or more ACEs were associated with significantly worse mental health outcomes than those with no ACEs and those with one to three ACEs. Greater resilience significantly attenuated the effects of ACEs on mental health symptoms.Conclusions: ACEs are highly prevalent among Chinese health science students but their impact on mental health can be buffered by higher levels of resilience.Impact: Screening for ACEs and strength-based, trauma-informed interventions on fostering resilience is needed to promote mental health among Chinese young adults.

Interventions in Chinese Undergraduate Students’ Mental Health: Systematic Review

“…Interventions in the mental health of Chinese undergraduate students studying in China have only recently attracted scholarly attention, as evidenced by the fact that all 49 included studies [ 2 , 12 , 26 , 48 - 93 ] were published between 2020 and 2022, including 11 (22%) published in 2020, 33 (67%) published in 2021, and 2 (4%) published in 2022. This indicates the worsening mental health condition of this particular population in recent years, especially in the context of the repeated resurgences of the COVID-19 pandemic, which increased the stress of college students and exposed them to new frustrating stressors that caused various mental health concerns [ 2 ].…”

“…This indicates the worsening mental health condition of this particular population in recent years, especially in the context of the repeated resurgences of the COVID-19 pandemic, which increased the stress of college students and exposed them to new frustrating stressors that caused various mental health concerns [ 2 ]. Given college students’ high stress and anxiety levels during the COVID-19 pandemic [ 88 ], 35 (71%) of the 49 studies [ 2 , 12 , 48 , 49 , 52 - 58 , 61 - 64 , 67 - 69 , 72 - 77 , 81 - 89 , 91 , 92 ] investigated the COVID-19–induced mental health concerns of Chinese undergraduate students and proposed specific interventions in response to the severity of the psychological impact of COVID-19 [ 87 ].…”

“…The interventions proposed in the included studies can be divided into two broad categories: social support and coping strategies. Social support was provided by government authorities [ 49 , 52 - 54 , 61 , 62 , 68 , 72 , 84 , 86 - 88 ]; university authorities [ 12 , 48 , 50 , 51 , 53 - 55 , 57 - 59 , 62 , 64 , 65 , 67 , 69 , 91 , 93 ]; students’ affairs counselors and teachers [ 54 , 75 , 83 - 85 , 87 , 93 ]; family members [ 52 , 54 , 57 , 83 , 94 ]; health care authorities and professionals [ 52 , 63 , 66 , 75 , 77 - 79 , 87 ]; researchers [ 70 , 85 ]; and media-, internet-, and smartphone-based interventions [ 26 , 53 , 55 , 56 , 60 , 71 , 73 , 75 , 77 , 80 , 81 ]. Positive coping strategies were adopted by undergraduate students themselves [ 52 , 82 , 83 , 85 , 86 ,…”

“…Previous studies proposed university authorities to make the following interventions in undergraduate students’ mental health concerns, including (1) developing a caring culture and ambience, which backs up undergraduate students to make life adjustments, promoting cultural and sports activities, facilitating the expansion of social networks, strengthening mental health education and counseling (eg, hotlines providing timely help for those in urgent need), early detection and effectively managing mental health concerns [ 12 ]; (2) screening for adverse childhood experiences and providing strength-based, trauma-informed interventions on fostering resilience [ 48 ]; (3) screening for anxiety disorders [ 50 , 57 ]; (4) screening and managing of emotional eating [ 51 ]; (5) organizing health education activities, and encouraging undergraduate students to arrange their time reasonably and find a proper approach to alleviate stress [ 53 ]; (6) encouraging timely, effective communication between family members [ 54 ]; (7) conducting interventions using cognitive behavioral approaches and screening for and addressing excessive social networking service use [ 55 ]; (8) developing psychological help-seeking interventions, strengthening the dissemination of mental health knowledge, and improving the level of mental health perception to improve help-seeking attitudes and increase the probability of seeking psychological help [ 57 ]; (9) being aware of undergraduate students’ coping strategies, organizing programs such as an online experience-sharing competition, encouraging students by offering rewards or financial aids, and supplying necessary food and health care materials [ 58 ]; (10) implementing various interventions such as sleep hygiene, mobile phone and internet use hygiene, mental health education courses, and professional psychological counseling [ 59 , 62 , 64 , 67 , 91 ]; (11) providing positive mental imagery training [ 65 ]; (12) offering relevant online mental health courses [ 67 ]; (13) adopting a web-based positive psychology intervention [ 69 ]; (14) establishing an early warning system for mental health concerns, guiding students to correctly understand their mental health status and individual differences in mental tolerance while encouraging them to seek help if necessary, developing targeted mental health education programs, and creating a new guidance mode to improve the communication between students and counselors [ 91 ]; and (15) promoting stress-coping strategies [ 93 ].…”

Examining Childhood Adversities in Chinese Health Science Students Using the Simplified Chinese Version of the Adverse Childhood Experiences-International Questionnaire (SC-ACE-IQ)

“…It is important to note that although statistically significant, the correlations between SC-ACE-IQ and depression and anxiety score were both modest in our sample. This suggests that the other variables, such as those measuring individual sources of strength and resilience, would also be important to measure as these may buffer the effects of ACEs on health science students’ mental health (Yu et al, 2021 ).…”