The Association of Adverse Childhood Experiences and Resilience With Health Outcomes in Adolescents: An Observational Study

Abstract

The relationship between Adverse childhood experiences (ACEs), resilience, and health outcomes has not been as thoroughly studied in adolescents. Adolescents completed the ACEs Questionnaire and a validated resilience measure (Child Youth Resilience Measure, or CYRM). Poor health outcome was having 1 or more: obesity, hypertension, and/or depression. 34.5% of teens had a poor health outcome, 38.6% had ACE scores of 4 or more, and resilience ranged from 45 to 84 (mean = 74.6). By univariate and bivariate analysis, ACEs (OR = 1.11, 95% CI = 1.03-1.19, P = .0039; OR = 1.08, 95% CI = 1.0-1.16, P = .045) and resilience (OR = 0.95, 95% CI = 0.92-0.98, P = .0016; OR = 0.96, 95% CI = 0.93-0.99, P = .016) were significantly associated with poor health outcome. Resilience relationship subscale was significantly associated with reduced health risk (OR = 0.85, 95%CI = 0.75-0.95, P = .005). ACEs are associated with poor health outcomes in adolescents, resilience is inversely related, and the caregiver relationship may be the driving force.

Resilience and mental health in children and adolescents: an update of the recent literature and future directions

“…Nine cross-sectional studies and one longitudinal study examined resilience and psychopathology in the context of adverse childhood experiences (ACE) and negative life events [ 18 ▪ , 19 , 20 ▪ , 21 ▪ , 22 ▪ , 23 , 24 , 25 , 26 ▪ , 27 ]. Overall, these studies show that higher levels of resilience are associated with mental health.…”

“…Five studies demonstrated the importance of investigating different components of resilience – for example, individual, relationship with a caregiver and educational support – in relation to ACEs and mental health in children and adolescents [ 18 ▪ , 19 , 20 ▪ , 23 , 24 ]. A retrospective file review in 176 children referred to a Child Abuse Service [ 18 ▪ ] found that protective factors (individual items: personal skills, peer support and social skills; caregiver: physical and psychological caregiving; and context: educational support) moderated the association between adversity and trauma-related distress.…”

“…Notably, children who were exposed to higher levels of adversity had fewer protective factors. Another study in 450 youth who had experienced trauma and came to a preventive care visit, observed an inverse relationship of resilience and trauma [ 19 ] and found lower levels of resilience, in particular, relationship with caregiver, to be associated with poor health outcomes (obesity, hypertension or depression). In the National Survey of Children's Health [ 20 ▪ ] in 40 302 children, absence of child emotional resilience and lack of family problem-solving skills and hopefulness in the family, were significantly associated with depression.…”

Adolescents’ academic achievement, mental health, and adverse behaviors: Understanding the role of resilience and adverse childhood experiences

“…Most of these studies found consistent evidence that resilience acts as a buffer between ACEs and psychological distress (Beutel et al, 2017), depression (Poole et al, 2017; Young-Wolff et al, 2019; Youssef et al, 2017), mood swings (Poole et al, 2017), and substance abuse (Wingo et al, 2014). Previous studies also found that higher levels of resilience predict less depression in adolescence (Freeny et al, 2021; Meng et al, 2018), and lower negative health outcomes (Hall et al, 2021). Adolescents with a history of multiple ACEs were more likely to be less resilient (Ding et al, 2017).…”

“…These findings are consistent with previous studies which found that adolescents with higher ACEs scores had higher negative health risks, and higher resilience scores were associated with a lower risk of negative health outcomes (suicide, sadness, and/or depression anxiety). For example, Hall's study found that ACEs and resilience were inversely related (Hall et al, 2021). A meta-analysis of outcome reporting (≥ 1 ACEs vs. no ACEs) found that persons with a history of ACEs were 63% less likely to demonstrate high resilience compared to those with no history of ACEs (Morgan et al, 2022).…”