Jalal Uddin1, Najwa Alharbi2, Helal Uddin3, Md Belal Hossain4, Serra S Hatipoğlu5, D Leann Long6, April P Carson7. 1. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233, United States. Electronic address: jalal@uab.edu. 2. Department of Social Work, Umm Al-Qura University, Saudi Arabia. Electronic address: nhoharbi@uqu.edu.sa. 3. Department of Sociology, East West University, Dhaka, Bangladesh. Electronic address: helal@ewubd.edu. 4. Department of Sociology, Oklahoma State University, Stillwater, Oklahoma. Electronic address: belal.hossain@okstate.edu. 5. Department of Sociology, University of Alabama at Birmingham, Birmingham, AL 35233, United States. Electronic address: sserra@uab.edu. 6. Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35233, United States. Electronic address: leannl@uab.edu. 7. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35233, United States. Electronic address: apcarson@uab.edu.
Abstract
INTRODUCTION: Exposure to adverse childhood experience (ACE) has harmful consequences for children's health and well-being. However, it is less clear how different social processes may amplify or mitigate the effects of ACE on children's mental health. We examined how parenting stress mediates and family resilience moderates the associations of ACE with children's mental health and attention-deficit/hyperactivity disorder (ADHD) outcomes. METHODS: This secondary data analysis included 44,684 children aged 6-17 years from the 2016-17 National Survey of Children's Health (NSCH). Logistic regression with survey weights was used to account for the complex survey design and obtain odds ratios (OR) and 95% CI adjusted for sociodemographics. RESULTS: Overall, 7.3% of children had any mental health condition and 10.4% had ADHD. A higher ACE score (per 1-unit increase) was associated with a higher prevalence of any mental health condition (OR = 1.33, 95% CI: 1.27-1.40) and ADHD (OR = 1.21; 95% CI: 1.15-1.27) after adjustment for sociodemographics. Parenting stress mediated 57% of the total effect of ACE on any mental health condition and 60% of the total effect of ACE on ADHD diagnosis. The effect of ACE on mental health and ADHD outcomes was stronger among children with low levels of family resilience and connection index (FRCI) than among those with higher levels of FRCI. CONCLUSIONS: Parenting stress may be a potential mechanism through which ACE impacts a child's mental health and behavioral outcomes. Family resilience can lessen the impact of ACE on children's mental health and behavioral disorders.
INTRODUCTION: Exposure to adverse childhood experience (ACE) has harmful consequences for children's health and well-being. However, it is less clear how different social processes may amplify or mitigate the effects of ACE on children's mental health. We examined how parenting stress mediates and family resilience moderates the associations of ACE with children's mental health and attention-deficit/hyperactivity disorder (ADHD) outcomes. METHODS: This secondary data analysis included 44,684 children aged 6-17 years from the 2016-17 National Survey of Children's Health (NSCH). Logistic regression with survey weights was used to account for the complex survey design and obtain odds ratios (OR) and 95% CI adjusted for sociodemographics. RESULTS: Overall, 7.3% of children had any mental health condition and 10.4% had ADHD. A higher ACE score (per 1-unit increase) was associated with a higher prevalence of any mental health condition (OR = 1.33, 95% CI: 1.27-1.40) and ADHD (OR = 1.21; 95% CI: 1.15-1.27) after adjustment for sociodemographics. Parenting stress mediated 57% of the total effect of ACE on any mental health condition and 60% of the total effect of ACE on ADHD diagnosis. The effect of ACE on mental health and ADHD outcomes was stronger among children with low levels of family resilience and connection index (FRCI) than among those with higher levels of FRCI. CONCLUSIONS: Parenting stress may be a potential mechanism through which ACE impacts a child's mental health and behavioral outcomes. Family resilience can lessen the impact of ACE on children's mental health and behavioral disorders.
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