Introduction

Adverse childhood experiences (ACEs) have been shown to negatively affect mental and physical health, but less is known about the effect of positive childhood experiences (PCEs). In the U.S., 61.5% of adults and 48% of children have been exposed to ACEs, with greater than one-third having multiple exposures. ACEs have been linked with adult mental health problems such as depression and with diminished relational health, assessed by reports of insufficient social and emotional support. While there is substantial literature on the lifelong effects of adversity, resilience, and interventions associated with improved child and adult health outcomes, assessing the prevalence of PCEs at the population level using standardized measures has been less well studied. PCEs include parent-child attachment, positive parenting (e.g., warmth, responsiveness, support), family health, and positive peer relationships at school and in the community. Studies are needed to understand the impact of whether retrospectively reported PCEs co-occur with ACEs and how PCEs interact with ACEs to better inform the social determinants of healthy development and physical and mental well-being.

 

The Study

This study was designed to evaluate associations between adult-reported PCEs and (1) adult depression and/or poor mental health and (2) adult- reported social and emotional support (ARSES) across four ACE exposure levels. Data was obtained from the 2015 cross-sectional Wisconsin Behavioral Risk Factor Survey, a random telephone survey of Wisconsin adults aged 18 years and older ( n=6188). The PCE score was determined by asking respondents to report how often or how much they endorsed 7 interpersonal experiences as a child: (1) felt able to talk about difficult feelings, (2) felt their family stood by them during difficult times, (3) enjoyed participating in community traditions, (4) felt a sense of belonging in high school, (5) felt supported by friends, (6) had at least 2 non-parent adults who took an interest in them, and (7) felt safe and protected by an adult in their home. Depression/poor mental health was defined as having a lifetime history of a depression diagnosis and/or 14 or more poor mental health days in the past month. ACEs were defined by the CDC standardized survey and included 11 items such as physical or emotional abuse or neglect, sexual abuse and household dysfunction (e.g., parental substance abuse, incarceration, divorce). The 4 levels of ACEs were based on cumulative scores of 0, 1, 2-3, or 4-8 ACEs. ARSES were based on a standardized single question, " How often do you get the social and emotional support you need?" with a choice of 5 answers ranging from always to never.

 

Results

Results of this study showed the odds of depression/poor mental health status were 72% lower for adults reporting 6 to 7 vs. 0 to 2 PCEs and 50% lower for 3 to 5 vs. 0 to 2 PCEs. Associations were similar for ACEs with fewer ACEs associated with reduced depression/poor mental health. The odds that adults reported "always" on the ARSES variable were 3.5 times greater with 6 to 7 PCEs vs. 0 to 2 PCEs. PCEs associations with depression/poor mental health remained stable across each ACEs level when controlling for ARSES. This study shows that PCEs have a dose-response relationship with depression/poor mental health and ARSES after accounting for exposure to ACEs. Working to promote PCEs for children may reduce the risk of depression/poor mental health and promote healthy adult relationships. Assessment of both PCEs and ACEs may better focus interventions to promote child and adult well-being.

 

Limitations

Because this study was cross-sectional, it did not confirm a causal association between PCEs and outcomes. The PCEs in this study focused on interpersonal experiences rather than other types of positive experiences (e.g., engagement with nature, spirituality/religion, personal accomplishments, participation in activities). It was not possible in this study to examine bias in depressed adults in their reports of PCEs although studies show an absence of bias in the reporting of ACEs.