Associations of threat and deprivation-related childhood exposures with children's ' s mental health and flourishing: The moderating role of family resilience

Introduction: The association of adverse childhood experience (ACE) with physical and mental well-being is predominantly examined using a cumulative ACE score. However, less is known how different dimensions of adversity (e.g., threat and deprivation) may uniquely predict children's mental health and development. We examined (i) whether two aspects of ACE - threat and deprivation - are differently associated with children's anxiety, depression, and flourishing and (ii) whether family resilience and connection index (FRCI) moderates these associations. Methods: We analyzed data from the National Survey of Children's Health (2017-20). The analytic sample consisted of 81,626 children (6-17 years). Logistic regression with survey weights was used to obtain odds ratios (OR) and 95 % confidence intervals (CI) adjusting for sociodemographic factors. Results: The experience of threat-only ACE and deprivation-only ACE showed differential associations with anxiety, depression, and child flourishing. For example, children who experienced threat-only ACE had a 4.2-fold higher odds of depression (OR=4.2; 95 % CI: 3.37-5.24), and those who experienced deprivation-only ACE had a 2.4-fold (OR=2.4; 95% CI: 1.98-2.92) higher odds of depression compared to those exposed to neither threat nor deprivation experience. Experiencing both a threat and deprivation showed larger than an additive association with all outcomes. Further, interaction models suggest that the associations of threat and deprivation-type ACE with all outcomes significantly differed by the levels of FRCI. Conclusions: Threat and deprivation dimensions of adversity were differentially associated with mental health and flourishing outcomes in childhood. Family resilience appears to be protective against the negative effect of threat and deprivation dimensions of ACE on children's mental health and developmental outcomes.