Childhood Adversities and Adult Mental Health: Conceptualizing and Measuring Heterogeneity in Adversity Experience

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2022

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The life course perspective has long theorized that childhood is a sensitive period for mental, physical, and emotional development, meaning that negative experiences during childhood can have long-lasting impacts on health and wellbeing. Thus, adverse childhood experiences (ACEs), such as parental alcoholism, sexual abuse, and physical neglect, during this sensitive period of the life course may elicit poor mental health both in childhood and as children age into adulthood. Although research on the long term impact of childhood adversity is growing, this research has been somewhat limited in the measurement of childhood adversity, focusing on dichotomous measures (occurred/ did not occur) or the summation of such dichotomous measures. In doing so, this research fails to capture heterogeneity in adversity experience, such as the severity, duration, and context of childhood adversities as well as how specific types of adversities may co-occur, consequently underestimating the impact of negative experiences for those at greatest risk of poor mental health. In this dissertation, I explore how these sources of distinction pattern mental health trajectories, with consequences for mental health disparities across the life course. In broadening the definition of childhood adversity beyond the simple occurrence of negative events, this dissertation provides an analytic blueprint for future research assessing childhood adversity, contributing to stress, life course, and mental health studies. In Chapter 2, I focus on a single adverse experience, parental mental health problems in childhood, to showcase how differences in severity, duration, and context of an adversity correspond to different mental health patterns across adulthood. Using six waves of data from the Panel Study of Income Dynamics (PSID; 2007-2017) and applying growth curve methods I find that more severe and longer exposures to parental mental health problems in childhood correspond to even greater distress in adulthood. The gender of the parent afflicted does not predict differences in adult mental health, but those individuals exposed to both maternal and paternal poor mental health in childhood have the greatest distress in adulthood. Chapters 3 and 4 focus on two other sources of heterogeneity in childhood adversity experience: the number and type of childhood adverse events. These chapters employ latent class analysis (LCA) to capture latent subtypes who are similar in their responses to a set of indicators, essentially estimating adversity classes that capture both the number and type of adversities that co-occur. These classes are then used to predict mental health trajectories across the life course. Before assessing latent classes of childhood adversity, Chapter 3 sets the groundwork for the analytic strategy of predicting outcome trajectories by latent classes. To date, there are several methods for including a distal outcome in latent class models, with no clear analytic strategy for when the outcome of interest is a growth model. Therefore, in Chapter 3, I employ a simulation study assessing the performance of five different methods under 27 different data conditions. Results from this study suggest that a maximum-likelihood (ML) approach best captures the true parameter estimates while maintaining substantive clarity. Chapter 4 uses the identified method in Chapter 3 (ML approach) to assess how latent classes of childhood adversity relate to trajectories of mental health using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health, Wave I-IV). Findings suggest that in addition to a class represented by low adversity experience, there are two classes with greater experiences of adversity. One adversity class, characterized by household dysfunction, has greater depressive symptoms than the low adversity class in early life, and this gap is maintained into mid-adulthood. The other adversity class, characterized by maltreatment, has both greater depressive symptoms than the low adversity class in early life and becomes increasingly more depressed than this group across the life course. Overall, this dissertation contributes both methodologically and substantively to the study of childhood adversity and life course mental health. Childhood adversity has the ability to shape one’s mental health outcomes for many years after childhood, but this relationship is conditional on the lived experiences of adversity. These findings underscore the importance of severity, duration, context, type, and number of adverse events for patterning which children are at greatest risk for mental health problems in adulthood. Future work should consider these elements in favor over an over-simplified measure that may obscure the life course impact of these negative experiences.

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Kamis, Christina (2022). Childhood Adversities and Adult Mental Health: Conceptualizing and Measuring Heterogeneity in Adversity Experience. Dissertation, Duke University. Retrieved from https://hdl.handle.net/10161/25150.

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