According to the Center for Disease Control and Prevention [1], adverse childhood experiences (ACEs) including physical, sexual, emotional abuse, and neglect have a significant adverse effect on adult well-being and lifelong health. In a survey across 25 states, nearly 61% of adults reported experiencing at least one ACE, one in six reported experiencing more than three ACEs. Moreover, traumatic events experienced during childhood—such as experiencing or witnessing violence at home or in the community, substance misuse, parental separation, and parental incarceration or mental illness—may have permanent, adverse effects on health and well-being [2].
In addition, ACEs may increase the risk for acquiring a variety of chronic diseases and leading causes of death such as heart disease, cancer, diabetes, and suicide, as well as maternal and child health problems, sexually transmitted infections, and teen pregnancy. There are also associations of social determinants of health related to ACEs such as frequently moving, living in an underserved or racially segregated community, and experiencing food insecurity that all accumulate as prolonged or “toxic stress” exposures. As a result, chronic stress during childhood can harm brain development during a critical period that lead to poor adult psychosocial, stress, decision-making, learning, and attentional outcomes [2]
Many studies have illustrated the risk associated with ACEs. One study reported that among those who had ACEs there were higher chances of risky behaviors such as drug abuse and suicide attempts and depressive symptoms [3]. In a meta-analysis, health outcomes were assessed among individuals after ACEs compared to those with none and found negative health effects [4]. There were moderate to strong associations between ACEs and poor self-rated health, heart disease, mental illness, sexual risk-taking, violence, drug use, and problematic alcohol use.
However, the risks associated with ACEs are considered preventable. It was suggested that creating stable, safe, and sustainable relationships and environments for children and their families could prevent the impact of ACEs and help children to reach their full potential and maximum health [2]. For instance, promoting accountability for the well-being of all children, enhancing positive parenting through safe and effective discipline, encouraging help-seeking, and increasing connectedness can protect against adversity and violence and help to build resiliency and prevent ACEs [5, 6]. There is less understanding of the factors that could moderate ACEs’ impact on health during adulthood and additional research is warranted.
Social Support
Social support has been studied in the context of health and psychological well-being. It is defined as the perception that one has support available from others, is cared for, and is a part of a supportive social network though it can be perceived as either positive or negative. The most commonly reported forms of positive social support (PSS) are instrumental—tangible and practical material support; informational—useful information, advice, and suggestions; emotional—expressions of empathy, trust, care and love; and appraisal—useful communication for self-evaluation rather than solving a problem [7–9]. On the other hand, Lincoln [10] points out that negative social support (NSS) has been characterized in a variety of different ways including— but not limited to—negative interaction, criticism, distress, resentment, discouraging feeling, and interfering in one’s affairs. In that regard, using qualitative methods along with confirmatory factor analyses, Newsom, Rook, Nishishiba, Sorkin and Mahan [11] developed extensive measurements to capture NSS. They provide four equivalent domains to the PSS: denial or neglect, failure to provide assistance, unwelcome advice or meddling, and insensitive or unsympathetic behavior.
PSS works as a protective factor for many health issues and risky behaviors found to be associated with ACEs, yet knowledge on how social support would counter them is still limited. Von Cheong, Sinnott, Dahly and Kearney [12] reported that the odds of depressive symptoms were three times higher among those who had ACEs and low social support, while they were very low among those who had ACEs and reported moderate to strong social support. Social support is also a protective factor for suicide attempts [13]. It is also worth mentioning that social support was assessed during alcohol and smoking cessation programs and is associated with the likelihood of abstinence [14, 15]. PSS is associated with fewer risky behaviors [16], increased healthful behaviors (sleep patterns, exercising, and healthy eating patterns) [17], physical health [18], and life satisfaction [19].
Further, NSS is associated with psychological distress and poor well-being. Newsom, Rook, Nishishiba, Sorkin and Mahan [11] reported that well-being was indirectly affected by different domains of NSS—failure to provide help, unsympathetic behavior, and rejection or neglect and that unsympathetic behaviors directly and significantly influence distress. Likewise, Hirsch and Barton [20] report that NSS is positively associated with suicidal behaviors and intentions among college students. However, NSS has not acquired as much attention as PSS and they have not been included in extensive research as one construct and NSS has been inconsistently defined (e,g., negative network interactions, network upset, social undermining) [10].
Moderating Role of Positive and Negative Social Support
PSS may potentially buffer the effect of both physical and psychological maltreatment during childhood. In that regard, perceived social support was assessed as a potential moderator among women survivors of intimate partner violence. Beeble, Bybee, Sullivan and Adams [21] reported no significant moderating effect of social support on the association between physical abuse and quality of life. However, it is worth mentiong that they reported a significant decline in the quality of life when women experience a low level of social support and psychological abuse. Likewise, Racine, Madigan, Plamondon, Hetherington, McDonald and Tough [22] report emotional or informational and instrumental support significantly reduce the association between maternal ACEs and prenatal risk. However, these results were found only among females and the PSS effect was solely assessed. Newsom, Rook, Nishishiba, Sorkin and Mahan [11] state that negative exchanges such as being unsympathetic or failing to provide help were associated with distress. Thus, it would be important to investigate whether both positive and NSS work together to change the impact of ACEs on mental health.
Oshio, Umeda and Kawakami [23] report social support did not moderate the effect of ACEs on subjective well-being. In their study, however, ACEs and social support measurements might not be comprehensive enough to fully capture the magnitude of either ACEs or social support. ACEs were measured only via parental maltreatment and bullying in school. In this regard, Felitti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss and Marks [3] mention that childhood abuse may also occur in different and important forms such as spousal violence, criminal activity, and drug abuse in the household so a broader assessment would be important. Whereas, PSS and NSS were assessed by examining emotional support, helpful guidance; instrumental support; and, negative support assessed as irritation [11]. Although the involvement of partners, family members, and neighbors was considered in all the questions asked by Oshio, Umeda and Kawakami [23], the size of the network along with other important negative and positive constructs were omitted. Hence, considering the complete social support construct would enable us to better comprehend the role of social support as a protective factor after ACEs.
As less has been studied in relation to NSS and ACEs this will be an important addition to the literature. Further, including both PSS and NSS after ACEs will add to this literature. Finally, in this study, we examined a sample from the United States and Canada and a large sample of both Whites and Blacks. This is an effort to further our understanding of whether PSS and NSS work together to potentially buffer or exacerbate the association of ACEs with mental health and life satisfaction.
The following hypotheses were tested:
-
ACEs will be negatively associated with life satisfaction and with mental health.
-
PSS will moderate the association of ACEs with mental health and life satisfaction.
-
NSS will moderate the association of ACEs with mental health and life satisfaction.