Category: Health Psychology / Behavioral Medicine - Adult
Keywords: Resilience | Emotion Regulation | Primary Care
Presentation Type: Symposium
Adverse childhood experiences (ACEs), such as childhood abuse, neglect, and household dysfunction, have been identified as risk factors for adult depression and anxiety. However, not all individuals who experience ACEs go on to develop depression or anxiety. There has been inadequate examination of the extent to which resilience (the ability to demonstrate stable levels of functioning despite adversity) and emotional dysregulation (the inability to calm one's affective and physiological state effectively when difficult emotions are triggered) may influence the association between ACEs and symptoms of anxiety or depression among individuals with a history of ACEs.
In an initial study designed to address the associations between ACEs, depression, and resilience, 4006 adult participants were recruited from primary care clinics in Calgary, Canada. Participants completed self-report questionnaires including: the Adverse Childhood Experiences Questionnaire, a retrospective measure of childhood adversity; the Patient Health Questionnaire-9, a measure of the presence and severity of the major symptoms of depression; and the Connor-Davidson Resilience Scale, a measure of psychological resilience. Results from regression analyses indicated that, while controlling for a range of demographic variables, both ACEs and resilience independently predicted symptoms of depression, F(9, 3040) = 184.81, R2 = 0.354. Further, resilience moderated the association between ACEs and depression, F(10, 3039) = 174.36, p < 0.001, R2 = 0.365. Specifically, the association between ACEs and depression was stronger among individuals with low resilience than those with high resilience.
A subsequent analysis of data obtained from the same 4,006 adult primary care patients evaluated whether emotional dysregulation and resilience, independently or in combination, influence the association between ACEs and symptoms of anxiety in adults who report significant exposure to childhood trauma. In addition to the ACE Questionnaire and the Connor-Davidson Resilience Scale, participants were asked to complete the Generalized Anxiety Disorder-7 item scale (GAD-7) (Spitzer et al., 2006), a unidimensional self-report measure designed to assess the presence and severity of the seven symptoms of generalized anxiety disorder (GAD) as outlined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) (Spitzer et al., 1999; APA, 2013). The GAD-7 has also been identified as an effective screening tool for other common anxiety disorders, such as panic disorder, social anxiety disorder, and posttraumatic stress disorder (Kroenke et al., 2007). Participants also completed the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), a 36-item, self-report questionnaire designed to assess multiple aspects of emotion dysregulation. A moderated mediation analysis showed that emotion dysregulation mediated the association between ACEs and anxiety symptoms, and that this mediation was further moderated by psychological resilience. Specifically, the mediation model was stronger among individuals with low levels of psychological resilience than among those with high levels of psychological resilience.
Taken together, these findings have implications for the conceptualization of ACEs, emotion dysregulation, and psychological resilience in etiological models of depression and anxiety. Further, these results have the potential to inform the development of treatments aimed to prevent or reduce symptoms of depression and anxiety among primary care patients with a history of childhood adversity.
University of Calgary
Friday, November 17
12:00 PM – 1:30 PM
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