Deconstructing pathways to resilience: A systematic review of associations between psychosocial mechanisms and transdiagnostic adult mental health outcomes in the context of adverse childhood experiences

Abstract

Adverse childhood experiences (ACEs) are identified with increased risk of adult mental health difficulties and negative impacts on well‐being. However, there is a need to go beyond simple associations and identify candidate mechanisms underpinning the ACEs–mental health relationship. Further methodological heterogeneity points to issues around the operationalization of ACEs and the importance of modelling data using robust research designs. The aim of the current review was to synthesize studies that utilized formal mediation and/or moderation analyses to explore psychological and social variables on the pathway between clearly defined ACEs (as measured by the ACE questionnaire and Childhood Trauma Questionnaire [CTQ]) and common mental health outcomes (depressive, anxiety and post‐traumatic stress disorder [PTSD] symptoms) across community samples aged over 18. A total of 31 papers were retrieved for critical appraisal. The majority of the studies explored factors mediating/moderating the link between child adversity and depression and less on anxiety and trauma. Most mechanisms were tested in only single studies, limiting the consistency of evidence. Evidence indicated that the mechanisms underlying associations between ACEs and adult mental health are likely to reflect multiple intervening variables. Further, there are substantial methodological limitations in the extant literature including the proliferation of causal inferences from cross‐sectional designs and both measurement and conceptual issues in operationalizing adversity. Consistent transdiagnostic mechanisms relevant to common mental health problems were identified, including perceived social support, emotion regulation and negative cognitive appraisals/beliefs. Further research using longitudinal design is required to delineate the potential contribution of the identified mechanisms.

Relationships Among Adverse and Benevolent Childhood Experiences, Emotion Dysregulation, and Psychopathology Symptoms

“…Miu and colleagues' (2022) meta-analysis found supporting evidence for an indirect effect of emotion regulation on the relationship between childhood adversity and a wide range of psychopathology symptoms. This is consistent with other research, suggesting emotion regulation may be a transdiagnostic mediator (i.e., a variable that accounts for the relationship between a risk factor and a range of disorders) on the pathway from childhood adversity to a range of disorders (Hoppen & Chalder, 2018;Panagou & MacBeth, 2022). Research examining mediators of the relationship of positive childhood experiences with outcomes has started to emerge; however, none has examined emotion regulation as a potential mediator, and most has focused on positive outcomes such as well-being (Shaw et al, 2022) and resilience (Kocatürk & Çiçek, 2021).…”

Childhood trauma and anger in adults with and without depressive and anxiety disorders

“…The substantial impact of CT is reflected by its association with the high prevalence of depressive and anxiety disorders in adulthood, including increased comorbidity and chronicity 5 . Although there are multiple potential mechanisms for psychopathology in the context of CT, emotion regulation arises as a key mechanism 6 . Poor emotion regulation can be a consequence of parents lacking sensitiveness and responsiveness to their children's emotional states or poor parental self‐regulation, learning children to be very attentive and ready to brace themselves for a possible emotional outburst of a parent 7 .…”

“…5 Although there are multiple potential mechanisms for psychopathology in the context of CT, emotion regulation arises as a key mechanism. 6 Poor emotion regulation can be a consequence of parents lacking sensitiveness and responsiveness to their children's emotional states or poor parental self-regulation, learning children to be very attentive and ready to brace themselves for a possible emotional outburst of a parent. 7 This heightened sense of awareness of the emotional state of a parent can lead to a faster perception of threat in later life and to a defense system more "ready" to respond lowering the threshold to experience anger.…”

Adverse Childhood Experiences and Health in Rural Areas of Riyadh Province in Saudi Arabia: A Cross-Sectional Study

“…Adverse childhood experiences (ACEs) and their consequences are a worldwide problem [ 1 ]. ACEs are a major public health issue that affects all people, with long-term effects on general health as well as negative health, social, and financial consequences [ 2 , 3 ].…”