Deconstructing pathways to resilience: a systematic review of associations between psychosocial mechanisms and adult mental health outcomes in the context of ACEs; and, Trajectories of risk and resilience: the role of empathy and perceived social support in the context of early adversity
Item statusRestricted Access
Embargo end date31/07/2022
Background: Adverse childhood experiences (ACEs) are well-known to have enduring and serious consequences, while evidence overwhelmingly suggests that they constitute a risk factor for poor physical and mental health outcomes across life span. Although the consequences of early adversity are documented, less is known about the mechanisms linking child adversity to adult psychopathology. Emerging research has identified numerous potential psychosocial mechanisms, giving insights into the way childhood adversity affects individuals’ wellbeing. Objective: The aim of the systematic review was to identify and synthesize studies that utilised formal mediation and/or moderation analyses to explore psychological and social variables on the pathway between clearly defined ACEs (as measured by the ACE questionnaire and the Childhood Trauma Questionnaire) and common mental health outcomes (depressive, anxiety, PTSD symptoms) across community samples aged over 18. The empirical project aimed to contribute to the literature on child adversity and adult outcomes, via modelling the effects of empathy and perceived social support (PSS) on mental health outcomes in the context of childhood adversity. The sample was recruited from a mixed clinical and non-clinical population. Results: The systematic review search yielded 31 complete texts which were retrieved for critical appraisal. The majority of the studies explored factors mediating/moderating the relationship between child adversity and depression. A smaller number of studies focused on anxiety and PTSD/trauma. The evidence from the review indicated that the child adversity-psychopathology association is likely to be attributable to multiple intervening variables. However, the majority of mechanisms were tested in single studies, limiting the consistency of evidence. Transdiagnostic mechanisms relevant to depression, anxiety and trauma to be considered included perceived social support, emotion regulation and negative core beliefs. A key issue in the current literature on ACEs is the lack of consistency in the operationalization of adversity. Research findings of the empirical project revealed statistically significant indirect effects of ACEs on adult mental health through affective empathy and PSS. Emotional neglect was the only type of adversity that was significantly correlated with both dimensions of empathy. Findings revealed that affective and cognitive empathy differentially mediated the pathway between emotional neglect and adult mental health. Conclusion: Taken together, despite the significant work in progress related to the exploration of underlying mechanisms on the path between child adversity and psychopathology, further research using longitudinal designs is requited to delineate their potential contribution. It is also important that consensus criteria are agreed upon the way adversity and trauma are conceptualised. Further, the empirical project highlighted the role of affective empathy and PSS as transdiagnostic mechanisms influencing the pathway between early adversity and adult mental health. In addition, it stresses the importance of taking these into account when designing interventions, aiming to promote well-being amongst individuals who experienced childhood adversity.