Childhood Adversity and Psychiatric Diagnoses: The Role of Protective Factors Restricted; Files Only

Abstract

Introduction: An abundance of research has established that adverse childhood experiences (ACEs) confer risk for psychiatric diagnoses, and that protective factors may moderate this association. Research exploring the effect of different types of protective factors in the relationship between ACEs and internalizing disorders (e.g., depression, anxiety) is more limited. The purpose of the present study was to 1.) investigate the relationship between ACEs and risk for diagnosis of a depressive, or anxiety disorder, suicidality, and substance use difficulties, 2.) examine whether protective factors moderate this relationship, and 3.) determine whether internal personal facets and external environmental facets differentially impact these associations.

Methods: 688 participants aged 12-30 (M= 18.17; SD=4.05) identified as youth at clinical high risk (CHR) for serious mental illness were assessed using a child adversity interview, protective factors assessment (SAVRY), and diagnostic assessment (SCID- 5). Logistic regression analyses were performed to determine whether ACEs predicted a lifetime or current diagnosis of a depressive, or anxiety disorder, history of self-harm or suicide attempts, and substance use difficulties. Moderation regression analyses were then conducted to assess whether these associations were weaker in the presence of protective factors.

Results & Conclusions: Higher levels of cumulative ACEs predicted diagnosis of a current depressive disorder (β= .12(1.13), p=.04), history of self-harm or suicide attempts (β= .34(1.40), p<.001), and substance use difficulties (β= .14(1.15), p=.04). Childhood sexual abuse (β= .77(2.15), p=.001), emotional neglect (β= .38(1.46), p=.05), and psychological abuse (β= .42(1.52), p=.04), specifically predicted a history of self- harm or suicide attempts. Sexual abuse (β= .58(1.79), p=.02), and emotional neglect (β= .52(1.69), p=.006), were also associated with diagnosis of a current depressive disorder. Only witnessing violence in the home during childhood uniquely predicted lifetime substance use difficulties (β= .70(2.01), p=.002). There was no association between ACEs and diagnosis of anxiety disorder, across adversity subtypes, and no moderation effect of protective factors in the relationship between ACEs and psychiatric outcomes. These findings add nuance to a growing literature linking adverse childhood experiences to subsequent psychopathology, and highlights the importance of continued investigation into the mechanisms that may buffer this relationship. 

Table of Contents

Introduction................................................................................1

Methods......................................................................................6

Results........................................................................................9

Discussion..................................................................................12

Table 1. ACEs and Protective Factors.............................................17

Table 2. Sample Characteristics....................................................18

Table 3. Associations Between ACEs and Clinical Outcomes............20

References..................................................................................22 

About this Honors Thesis

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School	Emory College
Department	Psychology
Subfield / Discipline	Clinical Psychology
Degree	B.A.
Submission	Honors Thesis
Language	English
Research Field	Psychology, Developmental Psychology, Clinical
Keyword	self-harm protective factors anxiety disorder adverse childhood experiences substance use difficulties depressive disorder suicide
Committee Chair / Thesis Advisor	Allison M. LoPilato, Emory University Elaine F. Walker, Emory University
Committee Members	Rachel Hershenberg, Emory University Patricia Brennan , Emory University

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