Impact of adverse childhood experiences on risk for internalizing psychiatric disorders in youth at clinical high-risk for psychosis

Introduction: Research has established that adverse childhood experiences (ACEs) confer risk for psychiatric diagnoses, and that protective factors moderate this association. Investigation into the effect of protective factors in the relationship between ACEs and internalizing disorders (e.g., depression, anxiety) is limited in high-risk groups. The present study investigated the relationship between ACEs and risk for internalizing disorders in youth at clinical high risk for psychosis (CHR-P) and tests the hypothesis that protective factors moderate this relationship. Methods: 688 participants aged 12-30 (M = 18; SD = 4.05) meeting criteria for CHR-P were administered measures of child adversity, protective factors (SAVRY), and diagnostic assessment (SCID- 5). Logistic regression tested whether ACEs predicted internalizing disorders. Moderation regression analyses determined whether these associations were weaker in the presence of protective factors. Results & Conclusions: Higher levels of ACEs predicted history of depressive disorder ((3 = 0.26(1.30), p < .001), self-harm/suicide attempts ((3 = 0.34(1.40), p < .001), and substance use ((3 = 0.14(1.15), p = .04). Childhood sexual abuse ((3 = 0.77(2.15), p = .001), emotional neglect ((3 = 0.38(1.46), p = .05), and psychological abuse ((3 = 0.42(1.52), p = .04), predicted self- harm/suicide attempts. Sexual abuse ((3 = 1.00 (2.72), p = .001), and emotional neglect ((3 = 0.53(1.71), p = .011), were also linked to depressive disorder. There was no association between ACEs and anxiety disorder, and no moderation effect of protective factors in the relationship between ACEs and psychiatric outcomes. These findings add nuance to a growing literature linking ACEs to psychopathology and highlight the importance of investigation into the mechanisms that may buffer this relationship.