The Moderating Effect of Resilience on the Relationship between Adverse Childhood Experiences (ACEs) and Quality of Physical and Mental Health among Adult Sexual and Gender Minorities

Impact of adverse childhood experiences on risk for internalizing psychiatric disorders in youth at clinical high-risk for psychosis

INTRODUCTION

Research has established that adverse childhood experiences (ACEs) confer risk for psychiatric diagnoses, and that protective factors moderate this association. Investigation into the effect of protective factors in the relationship between ACEs and internalizing disorders (e.g., depression, anxiety) is limited in high-risk groups. The present study investigated the relationship between ACEs and risk for internalizing disorders in youth at clinical high risk for psychosis (CHR-P) and tests the hypothesis that protective factors moderate this relationship.

METHODS

688 participants aged 12-30 (M = 18; SD = 4.05) meeting criteria for CHR-P were administered measures of child adversity, protective factors (SAVRY), and diagnostic assessment (SCID- 5). Logistic regression tested whether ACEs predicted internalizing disorders. Moderation regression analyses determined whether these associations were weaker in the presence of protective factors.

RESULTS & CONCLUSIONS

Higher levels of ACEs predicted history of depressive disorder (β = 0.26(1.30), p < .001), self-harm/suicide attempts (β = 0.34(1.40), p < .001), and substance use (β = 0.14(1.15), p = .04). Childhood sexual abuse (β = 0.77(2.15), p = .001), emotional neglect (β = 0.38(1.46), p = .05), and psychological abuse (β = 0.42(1.52), p = .04), predicted self- harm/suicide attempts. Sexual abuse (β = 1.00 (2.72), p = .001), and emotional neglect (β = 0.53(1.71), p = .011), were also linked to depressive disorder. There was no association between ACEs and anxiety disorder, and no moderation effect of protective factors in the relationship between ACEs and psychiatric outcomes. These findings add nuance to a growing literature linking ACEs to psychopathology and highlight the importance of investigation into the mechanisms that may buffer this relationship.

Adverse Childhood Experiences and Health Outcomes Among Sexual and Gender Minorities: A Systematic Review

Current research indicates a strong association between adverse childhood experiences (ACEs) and adverse health outcomes. Participants in frequently cited ACE research are predominantly heterosexual and cis gendered; the extent to which ACEs affect health outcomes among sexual and gender minorities (SGMs) is unclear. This systematic review examined the frequency of, and relationship between, ACEs and negative health outcomes among SGM. CINAHL, MEDLINE, PsycARTICLES, PsycINFO, Scopus, and PubMed databases were searched with no date restriction. After eliminating duplicates, titles and abstracts were reviewed resulting in 22 articles to be critiqued using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. A total of 22 studies met final inclusion criteria. The frequency of reporting at least one ACE among SGMs ranged from 51.4 to 91.6%, while the frequency of reporting four or more ACEs ranged from 18.1 to 60.7%. SGMs reported a higher frequency of ACEs than non-SGM. ACEs were associated with poorer mental and physical health outcomes, as well as increased risky behavior among SGMs. SGMs report a high frequency of ACEs, but current studies did not include data regarding ongoing stigma and adversities that may further contribute to their negative health outcomes. Further research is needed to fully understand the impact of adversities experienced due to the sexual and/or gender orientation of this minority group.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-023-00576-4.

Perceived school bullying and psychotic-like experiences in sexual minority adolescents: the mediating and moderating roles of resilience

AIMS

This two-wave, longitudinal study aimed to examine the potential moderating and mediating effects of resilience on the association between perceived school bullying and psychotic-like experiences among Chinese sexual minority adolescents.

METHODS

A total of 4192 senior high students were included and 984 (23.5%) of them were identified as a sexual minority (mean age = 16.68 years, SD = 0.71). Participants completed two online surveys during April 21 to May 12, 2021 and December 17 to 26, 2021, respectively, as well as completed self-report measures of sample characteristics, perceived school bullying, resilience, and psychotic-like experiences (including two dimensions: delusional experiences and hallucinatory experiences).

RESULTS

Perceived school bullying and resilience were associated with psychotic-like experiences in sexual minority adolescents. Resilience mediated the relationship between perceived school bullying and subsequent psychotic-like experiences (b = 0.03, 95% CI = 0.01 ~ 0.04)/ delusional experiences (b = 0.03, 95% CI = 0.01 ~ 0.04)/ hallucinatory experiences (b = 0.02, 95% CI = 0.01 ~ 0.03). Additionally, resilience only moderated the associations of perceived school bullying with hallucinatory experiences (b = -0.06, 95% CI = -0.12 ~ -0.01).

CONCLUSIONS

These findings indicated that resilience plays a crucial role in mediating or moderating the relationship between perceived school bullying and psychotic-like experiences. Assessing and reducing school bullying, as well as promoting resilience, may have important clinical implications for reducing the risk of psychotic-like experiences in sexual minority adolescents.

Analysing the effect of resilience and perceived social environment on university students' intention to start sustainable ventures

The literature mostly has addressed the determinants of entrepreneurial intention in general and social entrepreneurship, without focusing specifically on sustainable entrepreneurial intention despite it has become highly relevant in addressing environmental degradation and social challenges. This study aims to contributes to the understanding of psychological and social factors that influence sustainable business, evaluating the effect of resilience, subjective norms, and perceived social support on sustainable entrepreneurial intention. We analysed the online survey responses of 433 students from Chile and Ecuador enrolled in business and engineering programs using Partial Least Squares Structural Equation Models (PLS-SEM), moreover, a multi-group analysis (MGA) has been conducted to assess gender differences. The findings have supported the positive effect of psychological resilience and subjective norms on perceived social support, besides, an important effect of social support on sustainable entrepreneurial intention was found. These results offer new evidence regarding the significance of the social environment, support networks, and resilience of university students in fostering the establishment of sustainable businesses with a focus on social well-being and environmental protection in Latin America. This is particularly pertinent as the countries in this region are grappling with social and environmental challenges that could be addressed through sustainable entrepreneurship.

Psychometric Properties of the Brief Resilience Scale Among Alternative Sexuality Community Members

Assessing resilience among alternative sexuality (alt-sex; e.g., kink, polyamory) community members is imperative as alt-sex individuals often face discrimination and possess intersecting marginalized identities. The Brief Resilience Scale (BRS) has extensive psychometric support; however, prior research indicates both a one- and two-factor (i.e., succumbing and resilience) structure. Further, the psychometric properties of the BRS have not been examined among alt-sex community members. As such, the current study examined the BRS factor structure among alt-sex individuals and measurement invariance across demographic groups (i.e., sexual orientation, gender identity, and sexual assault history). Confirmatory factor analyses and multi-groups invariance analyses were conducted. The two-factor BRS model demonstrated better fit to the data. Model fit did not differ by sexual orientation or gender identity. Measurement invariance was observed by lifetime sexual assault history, with higher factor loadings on succumbing items among alt-sex community members with a lifetime history of sexual assault. Our findings support use of the BRS to measure resilience among alt-sex individuals. Succumbing, or weakened resilience, is a salient factor for alt-sex community members who are sexual assault survivors, warranting further attention.

Health Disparities Among Sexual and Gender Minorities With Adverse Childhood Experiences: Insights From the 2021 Behavioral Risk Factor Surveillance System Data

Objectives. To identify the prevalence of adverse childhood experiences (ACEs) among sexual or gender minorities (SGMs) and examine the impact of ACEs on their health. Methods. We analyzed 2021 Behavioral Risk Factor Surveillance System (BRFSS) data. Respondents from Arkansas, Iowa, Mississippi, Nevada, and Wisconsin completed modules on 10 individual ACEs, sexual orientation and gender identity, and health. Results. Among the 38 483 eligible respondents, 2329 (6.1%) identified as an SGM. SGMs reported higher ACE prevalence than did their non-SGM counterparts. ACEs partially attenuated relationships between SGMs and a higher risk for depression, cardiovascular disease, chronic kidney disease, electronic nicotine delivery system use, and cannabis use. Conclusions. Evaluating and better understanding the ACE and health outcome relationship among SGMs should be prioritized. Targeted interventions are needed to mitigate the impact of ACE-associated sequelae in this population. (Am J Public Health. 2023;113(12):1343-1351. https://doi.org/10.2105/AJPH.2023.307420).

Measuring the prevalence and impact of adverse childhood experiences in the lives of LGBTQ individuals: A much-needed expansion

BACKGROUND

Numerous studies indicate that LGBTQ people have extensive experiences with adverse childhood experiences (ACEs), more so than their heterosexual and cisgender counterparts. Research also shows that LGBTQ youth endure traumatic experiences with victimization, including bullying, harassment, and violence, based on their non-hetero-cis-normative genders and/or sexual identities. Yet, most ACE measurement strategies fail to: (1) explicitly link the risk of ACE exposure to the discrimination and stigmatization of LGBTQ people, and (2) account for the breadth of potential ACE exposure in LGBTQ populations.

OBJECTIVE

In the current article, we develop and present a more comprehensive ACE measurement strategy for understanding the cumulative and deleterious impacts of ACEs in the lives of LGBTQ individuals.

METHODS

Here, we offer three expansions to the current ACE framework: (1) the inclusion of an LGBTQ-specific ACE in addition to the standard ACE measures, (2) the addition of LGBTQ qualifiers for current ACE items (when applicable), and (3) the expansion of ACE measures to capture the unique ACE experiences of LGBTQ individuals in family life, schools, and faith communities.

CONCLUSIONS

The implementation of a more comprehensive ACE measurement strategy will assist scholars and policymakers in better understanding the impacts of ACEs in the lives of LGBTQ individuals. In all, ACE measurement strategies that capture the breath of exposure of ACEs in the lives of LGBTQ individuals will assist in ACE screening, public health policy, and clinical intervention efforts.

Substance Use Outcomes For Sexual and Gender Minority Adults With a History of Adverse Childhood Experiences: A Scoping Review

Purpose

The impacts of Adverse Childhood Experiences (ACEs) on behavioral, mental, and physical health have been extensively investigated. As such, it is paramount to synthesize their quantified effects, especially within vulnerable populations. The goal of this scoping review was to collect, summarize, and synthesize existing research on ACEs and substance use (SU) in adult sexual and gender minority (SGM) populations.

Methods

WebofScience, APA PsychInfo, LGBTQ+ Life (EBSCO), Google Scholar, and PubMed electronic databases were searched. We included reports published between 2014 and 2022 that assessed SU outcomes, ACEs in adult (18+) SGM populations, in the United States (US). We excluded those in which SU was not an outcome, measured community-based abuse or neglect, or investigated adulthood trauma. Data were extracted using the Matrix Method and categorized across three SU outcomes.

Results

Twenty reports were included in the review. Nineteen employed a cross-sectional design and 80% focused on a single SGM group (transgender women, bisexual Latino men, etc.). Nine of 11 manuscripts found SU frequency and quantity were higher among ACE exposed participants. Three of four studies found ACE exposure to correlate with substance use problems and substance misuse. Four of five studies found ACE exposure to be correlated with substance use disorders.

Conclusions

Longitudinal research is needed to comprehend the impact of ACE on SU within the diverse subgroups of SGM adults. Investigators should prioritize the use of standard operationalizations of ACE and SU to improve comparability across studies and include diverse samples from the SGM community.

Low resilience in severe obesity: marker of adverse childhood experiences and current psychological disorders

PURPOSE

Psychological disorders, early-age psychological traumas and eating disorders may contribute to the development of severe obesity in vulnerable individuals. Resilience may serve a protective role against binge eating disorder or depression. The current study aimed to investigate the relationship between adverse childhood experiences (ACE), resilience, and current psychological disorders. It also examined whether resilience plays a protective role in this pathway in a cohort of patients seeking bariatric surgery.

METHODS

Two hundred patients (153 women, 47 men) with severe obesity scheduled for bariatric surgery at the CHRU Nancy were included between September 2016 and April 2017. Participants completed the Resilience Scale for Adults (RSA) questionnaire and underwent a structured interview on ACE and current psychological disorders.

RESULTS

Mean total RSA score was 5.16 ± 0.87. The most frequent ACE were emotional neglect (90.5%) and emotional abuse (61%); 96% reported at least one ACE; 67% presented at least one current psychological disorder, the most frequent being anxiety (36%) and BED (35%). The number of psychological disorders, cumulative ACE and age explained 19.5% of the variance in total RSA score (p < 0.0001; adjusted R² = 0.19). The association of cumulative ACE and number of psychological disorders was mediated by resilience.

CONCLUSION

Our findings suggest that resilience is a relevant component of the psychosocial phenotype of severe obesity in bariatric surgery candidates. Resilience seems to play a partly mediation role in the relationship between ACE and psychological disorders. Low resilience becomes a marker that underscores the necessity to examine in greater depth ACE and psychological disorders.

LEVEL OF EVIDENCE

Level III, cohort analytic study.

Moderating Effect of Community and Individual Resilience on Structural Stigma and Suicidal Ideation among Sexual and Gender Minority Adults in the United States

BACKGROUND

Structural stigma in the form of discriminatory laws and policies impacts the mental health of sexual and gender minorities, especially with regard to suicidality. However, this relationship could be moderated by resilience. The past two years has brought anti-SGM legislation, particularly transgender sports bans, at the state level in the United States into focus. This study aims to understand if the relationship between familiarity with transgender sports bans (proposed or enacted) and suicidality was moderated by individual or community resilience.

METHODS

This was a cross-sectional study of survey data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and multivariate moderation analyses were used.

RESULTS

In the univariate analyses and the final model, community resilience moderated the relationship between structural stigma and suicidality (p = 0.0002); however, individual resilience did not (p = 0.0664).

CONCLUSION

Interventions to bolster community resilience may attenuate the negative mental health impacts of structural stigma and are warranted, along with concerted efforts to minimize structural stigma in the form of discriminatory laws and policies targeting people who are SGM.

Omar ZT, Segun E, Evbayekha EO, Abolurin A, Egberuare EO, Ezegbe HC, Adegbosin A, Adedeji AG, Angaye EG, Izundu IC, Oyelade BO. Impact of Adverse Childhood Experiences on Resilience and School Success in Individuals With Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

Adolescents with emotional and behavioral disorders face known academic challenges and poor life outcomes. It was imperative to explore and find if the new diagnostic criterion for diagnosing autism profoundly affects educational outcomes and resilience in individuals diagnosed with co-occurring autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). The literature is robust on the impact of adverse childhood experiences (ACEs) on educational outcomes and resilience in adolescents with no history of disability. Still, there remains a dearth of literature explaining, with no ambiguity, the complex relationships between ACEs and resilience, school engagement, and success in individuals with co-occurring ASD and ADHD. This study reviews the existing scholarships on the topic. The significance of this review is that it informs healthcare providers, rehabilitation counselors, and educators about the need for early identification of individuals with ASD and ADHD with a background in ACEs. This will enable interventions early enough to ensure they are more resilient and can obtain improved success in school-related and outside-school activities and eventually improved quality of life.

The Relationship Between Adverse Childhood Experiences and Utilization of Different HIV Testing Strategies Among Young Men Who Have Sex with Men in Texas

Adverse childhood experiences (ACEs) are a well-documented HIV-risk factor, but less is known about the relationship between ACEs and different HIV testing strategies. This study used data from an LGBTQ + community health assessment, that was part of a multi-staged community-based participatory research project in San Antonio, Texas. Overall, 464 young men who have sex with men (YMSM; < 36-years-old) completed an online, cross-sectional survey that included questions about ACEs and HIV testing behavior. An association between increased ACEs exposure and the odds of clinic-based testing and HIVST HIV significantly decreased relative to never testing for HIV. Additionally, greater ACEs exposure was significantly associated with increased odds of reporting community-based testing (AOR = 1.09, 95% CI = 1.00, 1.20) and significantly reduced odds of HIV self-testing (AOR = 0.72, 95% CI = 0.63, 0.82) compared to clinic-based testing. Cumulative ACEs exposure is important in understanding HIV testing behaviors in YMSM and should be considered when developing HIV testing programs.

It gets better with age: Resilience, stigma, and mental health among lesbian, gay, bisexual, transgender and queer persons from Poland

Lesbian, gay, bisexual, transgender, and queer populations are disproportionately affected by chronic stress associated with stigma which contributes to health adversities including depression. Negative impact of stigma on health can be alleviated by factors such as resilience. Little is known however on how exposure to stigma, protective factors and mental health change with age among gender and sexually diverse persons. Our study aimed at investigating this issue. Our sample consisted of (i) 245 sexually diverse cisgender women, (ii) 175 sexually diverse cisgender men, and (iii) 98 transgender and gender diverse persons. We collected data through a web-based survey. Linear regression models were performed to investigate the interactions of age and each group of participants for resilience, stigma exposure, and mental health indicators (depression and self-esteem). We hypothesized that resilience and mental health indicators will be positively associated with age in all distinguished groups despite the continued exposure to minority stress. The analysis yielded no significant relationships between stigma exposure and age among study participants. However, we observed significant interaction effects of distinguished groups of participants and age in case of self-esteem, depression, and resilience. Self-esteem and resilience were related positively, and depression was negatively associated with age in all study groups. Additionally, we observed that sexually diverse cisgender men demonstrated significantly increased resilience, reduced depression and higher self-esteem compared to other groups. Although the exposure to stigma did not decrease with age, resilience and self-esteem increased, suggesting that LGBTQ persons manage to thrive despite adversities.

Coping Style and Resilience Mediate the Effect of Childhood Maltreatment on Mental Health Symptomology

Background: A well-known distal risk factor for mental health symptomology is childhood maltreatment. Previous research revealed that several mediators, such as coping style and resilience, might be connected to the psychological mechanism of childhood maltreatment on mental health symptomology. Objective: The purpose of this study was to assess how coping style and resilience affect the relationship between childhood maltreatment and mental health symptomology of college students. Methods: With the method of cross-sectional survey, 740 college students from China (Gansu Province) completed the Childhood Trauma Questionnaire (CTQ), the Simplified Coping Style Questionnaire (SCSQ), the Connor–Davidson Resilience Scale (CD-RISC), and the Symptom Checklist 90 (SCL-90). Structural equation modeling (SEM) was used to reveal the link between childhood maltreatment, coping style, resilience, and mental health symptomology. Results: The results showe that childhood maltreatment was significantly positively correlated with mental health symptomology and significantly negatively correlated with coping style and resilience. Coping style was significantly negatively correlated with mental health symptomology and significantly positively correlated with resilience. Resilience was significantly negatively correlated with mental health symptomology. Coping style and resilience played a partially mediating role in the relationship between childhood maltreatment and college students’ mental health symptomology. Through a chain of intermediary effects on coping style and resilience, childhood maltreatment not only had a direct impact on mental health symptomology but also had an indirect impact. Conclusion: Childhood maltreatment could affect college students’ mental health symptomology through the chain mediating effect of coping style and resilience. Therefore, it is an effective way to reduce the influence of childhood maltreatment on mental health symptomology through some intervention measures to cultivate positive coping style and improve resilience.

The Adverse Childhood Experiences - International Questionnaire (ACE-IQ) in community samples around the world: A systematic review (part I)

BACKGROUND

The Adverse Childhood Experiences International Questionnaire (ACE-IQ) collects additional data (e.g., witness community violence/terrorism) than the previous version. Despite ACE-IQ is widely used and validated in several languages, no reviews focus on this measure.

OBJECTIVE

The main goals are to: 1) synthesize the ACE-IQ prevalence rates and average means among community samples, both for total ACE and single dimensions (e.g., intrafamily abuse, bullying); 2) discuss these data in light of the characteristics of studies and samples; 3) identify main research lines of the field.

PARTICIPANTS AND SETTING

The search for studies using the ACE-IQ with community participants was conducted on seven academic databases, including retrieval of grey literature. The screening process led to include 63 documents.

METHODS

A systematic review following the PRISMA guidelines was performed.

RESULTS

1) On average, 75% of community respondents experienced ACEs, with a mean of three, primarily emotional abuse and bullying. 2) Males experienced more ACEs, but they were underrepresented, as well as children and adolescents. Most studies were conducted in Asia or Africa, and different geographical areas showed different pathways of prevalence in subdimensions. 3) Most research focused on prevalence and relationships between ACE-IQ scores and respondents' mental and physical health, suicide and parenting, focusing on intrafamily ACEs more than on those outside the household.

CONCLUSIONS

Several issues emerged in terms of lack of reporting prevalence or means, lack of studies in Europe, America and Oceania, and no attention to collective/community/peer violence, plus a lack of consensus toward the dimensions of the ACE-IQ.

Development and psychometric properties of the sexual and gender minority adverse childhood experiences (SGM-ACEs): Effect on sexual and gender minority adult mental health

BACKGROUND

Research has consistently shown a relationship between adverse childhood experiences (ACEs) and poor mental health outcomes, and recent research shows that sexual and gender minority (SGM) individuals are at increased risk for ACEs. Moreover, SGM individuals may experience unique ACEs. Increased risk for exposure to traditional and SGM-specific ACEs are related to heterosexism.

OBJECTIVE

The purpose of this paper is two-fold. First, establish the need for an SGM specific ACEs framework that accounts for exposure to heterosexism. Second, assess the psychometric properties of the SGM-ACEs scale.

PARTICIPANTS AND SETTING

Data were collected using a multifaceted sampling strategy. In total, 1725 self-identified SGM Texans completed an online survey about ACEs, SGM-ACEs, mental health diagnoses, and demographic characteristics.

RESULTS

The most commonly reported SGM-ACEs were seeing or hearing of other SGM being physical harmed (71.2%), being bullied in school for being SGM (67.9%), and hearing religious leaders say homophobic, biphobic, or transphobic things (60.8%). The EFA showed that 7-items loaded onto a single factor and the CFA indicated a good model fit, with items showing a significant factor loading higher than 0.60. SGM-ACE showed adequate to good psychometric properties and predicted depression (AOR = 1.49, CI = 1.20, 1.86), anxiety (AOR = 1.61, CI = 1.25, 2.00), and PTSD (AOR = 1.97, CI = 1.47, 2.66), when controlling for ACEs and demographic factors.

CONCLUSIONS

The 7-item SGM-ACEs measure is a psychometrically sound and unidimensional measure that can be quickly used to assess common adverse childhood experiences related to heterosexism.