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Do Positive Childhood Experiences Promote Positive Adult Mental Health?

Many people know about adverse childhood experiences (ACEs), and understand they can have a negative impact on adult mental health, but that begs a question: if ACEs can lead to negative mental health outcomes during adulthood, can positive childhood experiences (PCEs) lead to positive mental health outcomes during adulthood?

A study published in the Journal of the American Medical Association (JAMA) called “Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels” addresses this question.

Here’s how the research team frames their inquiry:

Are positive childhood experiences (PCEs) associated with adult depression and/or poor mental health (D/PMH) and adult-reported social and emotional support (ARSES) independent from adverse childhood experiences (ACEs)?

We can clarify that research question, because the language is jargon heavy. What they ask is whether PCEs mitigate the effect of ACEs on adult mental health, and whether PCEs are associated with levels of available social and emotional support during adulthood.

We’ll discuss the results of the study below. First, however, we’ll define the key terms in the study – PCEs and ACEs – and report on both the prevalence of PCEs and ACEs in the U.S. We’ll also discuss the negative consequences of ACEs that make an examination of the impact of PCEs on adult mental health a critical component of our understanding of childhood experiences on long-term mental health outcomes.

What Are Adverse Childhood Experiences?

Almost 30 years ago, The Centers for Disease Control (CDC) and Kaiser Permanente Health 1998 initiated a study on the impact of childhood emotional/psychological trauma on adult health. Known as ACE Study, this research resulted in a new paradigm: trauma-informed care, which is now a core component of mental health treatment in the U.S. and around the world.

The ACE study is ongoing today. Researchers initially identified 9 ACEs that impact adult physical and mental health, and have identified additional ACEs in the interim. The research team conducting the study we introduce above assessed ACEs using criteria from CDC publications, including:

  1. Physical abuse
  2. Physical neglect
  3. Emotional abuse
  4. Emotional neglect
  5. Sexual abuse
  6. Substance use disorder/substance misuse in home
  7. Parental incarceration
  8. Divorce
  9. Food insecurity
  10. Housing instability
  11. Experiencing discrimination

The CDC advises grouping the effect of ACEs by the number a person experiences. A long-term study on twins with and without ACEs assessed the impact of the number of ACEs on the presence of mental health disorders as adults. They found escalating numbers of ACEs were associated with mental health problems as adults:

  • None: 6.4% reported MH disorder
  • 1: 10.2% reported MH disorder
    • 65% increased risk of any MH disorder
  • 2: 10.2% reported MH disorder
    • 147% increased risk of any MH disorder
  • 3 or more: 24.6% reported MH disorder
    • 357% increased risk of any MH disorder
Each additional ACE correlates with a 53% increased risk of any MH disorder

Now let’s look at the prevalence of ACEs reported by adults in the U.S.:

  • 1 or more: 64%
  • 1 only: 23.1%
  • 2-3: 23.5%
  • 4+: 17.3%

Having for or more ACEs was higher among:

  • Females: 19.2%
  • American Indigenous/Alaksa Native (AI/AN): 32.4%
  • Multiracial people: 31.5%
  • Income under $15,000/year: 24.1%
  • Less than high school education: 20.5%

Additional research shows that experiencing four or more ACEs further increases risk of adult mental health problems and/or risky behavior:

  • Depression: 360% increased risk
  • Suicide: 1200% increased risk
  • Alcohol use disorder (ADU): 700% increased risk
  • Illicit drug use 450% increased risk
  • Early sexual activity: 660% increased risk
On average, people reporting 6 or more ACEs died almost 20 years earlier than people reporting no ACEs.

That information allows a straightforward interpretation: presence of ACEs significantly increases risk of serious mental health problems during adulthood. That’s why research into protective effect PCEs may have on adult mental health is essential.

What are Positive Childhood Experiences?

Here’s how the CDC defines PCEs:

“Positive childhood experiences (PCEs), children’s experiences of safe, stable, and nurturing relationships and environments, promote healthy child development and adult mental and relational health and buffer against negative impacts of adverse childhood experiences.”

We should note that PCEs are more than good things that happen when people are young. Going to a fair and winning the big stuffed animal is a positive experience, possibly connected to the presence of nurturing adults, but PCEs are stable factors in the life of a child, rather than one-off events.

For instance, winning a state championship team of any sort – football, chess, debate – is a positive experience, but being on the team, forming connects with peers, and having a coach and assistant coaches invested in your success are what count as PCEs, not winning the title itself.

Child development experts identify ten relationship and general PCEs.

Ten Most Common PCEs

  1. Unconditional love from a parent/adult who makes child feel safe and protected
  2. Having a best friend/sense of belonging in school/felt supported by friends
  3. Volunteering in the community/engagement in community traditions
  4. Feeling like part of a specific social group
  5. Having support from an at least two adult outside of the family
  6. Living in a safe/clean home with enough food to eat
  7. Educational opportunities and resources
  8. Hobbies and extracurricular activities
  9. Consistent exercise/physical activity
  10. Consistent routines/fair rules at home

The Center on Child Wellbeing and Trauma describes the positive impact of PCEs.

How PCEs Affect Youth

PCEs can:

  • Improve and protect long-term physical and mental health
  • Help youth develop meaningful relationships and strong, healthy connections
  • Improve self-esteem/self-image
  • Promote feelings of belonging
  • Build skills to cope with stress in healthy ways

The CDC reports the following prevalence of PCEs among adults in the U.S., meaning that as adults they reported the number of PCEs they experienced during childhood:

  • 0-2: 12.2%
  • 3-5: 34.7%
  • 6-7: 53.2%

In the study we discuss in this article, researchers used a 7-item list to gauge the level and impact of PCEs. They asked respondents if they:

  1. Could talk to family about emotions or challenges
  2. Felt they had an adult at home who kept them safe and protected
  3. Believed their family supported them through difficulties
  4. Participated/enjoyed community traditions
  5. Experienced belonging in high school years
  6. Had a supportive friend and peer network
  7. Felt supported by at least two adults other than parents

Let’s take a look at what they found.

The Impact of PCEs on Adult Mental Health

The top-line results of the study are clear:

Adults with more PCEs had lower likelihood of developing depression and/or poor mental health, and reported a higher level of adult reported social and emotional support (ARSES), which remained consistent after accounting for the presence of ACEs.

In other words, the researchers identified a dose-response relationship between PCEs and ARSES in both the absence and presence of ACEs. That’s important information that can help parents, providers, educators and policymakers protect youth mental health.

Now for the details.

Mental Health and PCEs, Without ACEs

  • Adults with 0-2 PCEs:
    • 2% reported experiencing depression or poor mental health
  • Adults with 3-5 PCEs:
    • 1% reported experiencing depression or poor mental health
  • Adults with 6-7 PCEs:
    • 6% reported 48.2% reported experiencing depression or poor mental health
The likelihood of developing depression and/or poor mental health was 50% lower for people with 3-5 PCEs compared to 0-2 PCEs, and 72% lower for people with 6-7 PCEs.

Next, the effect of ACEs on the impact of PCEs.

Mental Health and PCEs, With ACEs

  • The impact of PCEs on depression and poor mental health remained stable for adults reporting 1, 2-3, or 4-8 ACEs.
  • Adults who reported they always had appropriate social and emotional support were 3.8 times greater for adults who reported more PCEs:
    • 0-2 PCEs: 48.2%
    • 6-7 PCEs: 12.6%
  • The impact of PCEs on depression and poor mental health were consistent across all levels of reported ACEs after accounting for the presence of adult-reported social and emotional support (ARSES).

Aside from the top-line results we mention at the beginning of this section, there’s surprising information in that last bullet point: PCEs were associated with depression and poor mental health regardless of the presence of ARSES. The more PCEs a person reported, the less likely they were to develop depression or report poor mental health, and the fewer PCEs a person reported, the more likely they were to develop depression or report poor mental health, whether they reported always having appropriate social and emotional support as adults or not.

How This Research Helps Us Help Youth, Teens, and Young Adults

We need to reiterate that last point: positive childhood experiences have a significant and durable impact on adult mental health in the absence of consistent social and emotional support during adulthood and across all levels of exposure to ACEs early in life.

That speaks to the power of genuine human connection, which is something we prioritize. In fact, our approach is to lead with connection and compassion in all cases, with all patients of all ages. When we look at what experts consider positive childhood experiences, we see that they almost all revolve around enriching relationships with parents, friends, schools, adults other than parents, and the community.

Those that don’t revolve around connection are associated with essentials: a safe home, plenty of food, educational resources, adequate/activity exercise, and fair rules at home.

Here’s how the study authors advise anyone involved in improving the lives of children and promoting long-term positive mental health:

“The proactive promotion of PCEs for children may reduce risk for adult depression and poor mental health and promote adult relational health. Assessment of PCEs and ACEs may better target needs and interventions and enable a focus on building strengths to promote well-being. Findings support prioritizing possibilities to foster safe, stable nurturing relationships for children.”

We’ll close by refraining and reframing a point we made earlier. These results mean more than a happy childhood means fewer mental health problems as an adult. What they mean is that when we work to prioritize safe, stable, nurturing environments for children, characterized by connection and the support of both friends, family, and adults, the likelihood a child will develop depression or poor mental health decrease significantly.

We understand that since we see it every day: we create those environments for our child, teen, and young adult patients because we know those are the conditions in which they thrive. And now the research tells us that those conditions not only promote short-term thriving, but also long-term positive mental health.

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