Adverse childhood experiences and resilience among adult women: A population-based study

Abstract

Background: Adverse childhood experiences (ACEs) have consistently been associated with elevated risk of multiple adverse health outcomes, yet their contribution to coping ability and psychiatric resilience in adulthood is unclear.

Methods: Cross-sectional data were derived from the ongoing Stress-And-Gene-Analysis cohort, representing 30% of the Icelandic nationwide female population, 18-69 years. Participants in the current study were 26,198 women with data on 13 ACEs measured with the ACE-International Questionnaire. Self-reported coping ability was measured with the Connor-Davidson Resilience Scale and psychiatric resilience was operationalized as absence of psychiatric morbidity. Generalized linear regression assuming normal or Poisson distribution were used to assess the associations of ACEs with coping ability and psychiatric resilience controlling for multiple confounders.

Results: Number of ACEs was inversely associated with adult resilience in a dose-dependent manner; every 1SD unit increase in ACE scores was associated with both lower levels of coping ability (β = -0.14; 95% CI-0.15,-0.13) and lower psychiatric resilience (β = -0.28; 95% CI-0.29,-0.27) in adulthood. Compared to women with 0 ACEs, women with ≥5 ACEs had 36% lower prevalence of high coping ability (PR = 0.64, 95% CI 0.59,0.70) and 58% lower prevalence of high psychiatric resilience (PR = 0.42; 95% CI 0.39,0.45). Specific ACEs including emotional neglect, bullying, sexual abuse and mental illness of household member were consistently associated with reduced adult resilience. We observed only slightly attenuated associations after controlling for adult socioeconomic factors and social support in adulthood.

Conclusions: Cumulative ACE exposure is associated with lower adult resilience among women, independent of adult socioeconomic factors and social support, indicating that adult resilience may be largely determined in childhood.

Funding: This work was supported by the European Research Council (Consolidator grant; UAV, grant number 726413), and the Icelandic Center for Research (Grant of excellence; UAV, grant number 163362-051). HBD was supported by a doctoral grant from the University of Iceland Research Fund.

Keywords: SAGA; adverse childhood experiences; child maltreatment; coping ability; epidemiology; global health; human; resilience; women's health.

Conflict of interest statement

HD, TA, ET, KF, FF, GT, HR, QY, KC, BK, TH, DL, HS, JJ, AH, UV No competing interests declared

© 2022, Daníelsdóttir et al.

Figures

Figure 1.. Associations between different types of ACEs and perceived coping ability (A) and psychiatric resilience (B) (β and 95% CI).

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs. *Coefficients are standardized.

Figure 2.. Prevalence Ratios (with 95% CI) of high perceived coping ability (A) and high psychiatric resilience (B) in relation to individual ACEs.

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs.

Appendix 1—figure 1.. Sociodemographic characteristics of SAGA participants vs. the general female population of Iceland (see further: https://www.afallasaga.is/nidurstodur).

Appendix 1—figure 2.. Flow-chart of the analytic sample.

Appendix 1—figure 3.. Proposed causal model with alternative pathways of how ACEs could influence resilience in adulthood.

Note: Boxes in green indicate potential confounders of the association between ACEs and adult resilience, whereas boxes in red indicate potential mediators of the association.

Appendix 1—figure 4.. Flow-chart of the analytic sample (complete case analysis).

Appendix 1—figure 5.. Associations between different types of ACEs and perceived coping ability (A) and psychiatric resilience (B) (β and 95% CI).

Models were corrected for age, childhood deprivation, education level, civil status, employment status and income. *Coefficients are standardized.

Appendix 1—figure 6.. Prevalence Ratios (with 95% CI) of high perceived coping ability (A) and high psychiatric resilience (B) in relation to individual ACEs.

Models were corrected for age, childhood deprivation, education level, civil status, employment status and income.

Appendix 1—figure 7.. Associations between different types of ACEs and perceived coping ability (A) and psychiatric resilience (B) (β and 95% CI), complete case analyses (n = 19,637).

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs. *Coefficients are standardized.

Appendix 1—figure 8.. Prevalence Ratios (with 95% CI) of high perceived coping ability (A) and high psychiatric resilience (B) in relation to individual ACEs, complete case analyses (n = 19,637).

Models were corrected for age, childhood deprivation, educational level, civil status, employment status, income and mutually adjusted for other ACEs.