Examining the Differing Effects of Economic Hardship and Poor Maternal Wellbeing on Cumulative Exposure to Adverse Childhood Experiences
Extensive research supports a strong and cumulative relationship between adverse childhood experiences (ACEs) and risky adult behaviors, mental health disorders, diseases, and health status. Additional factors, such as poor maternal wellbeing and economic hardship, compound the detrimental health and wellbeing implications associated with childhood exposure to ACEs. However, limited research has explored the differentiating effects of economic hardship and maternal wellbeing on a child’s cumulative ACE exposure. This study examined the differing effects of poor maternal wellbeing and economic hardship on a child’s exposure to ACEs. This study used a random sub-sample (n = 4000) from the 2011 to 2012 National Survey on Children’s Health (NSCH), a nationally representative cross-sectional study of children (N = 95,677) between birth and 17 years old. Confirmatory factor analysis results revealed greater economic hardship had a significant direct effect on a child’s ACE exposure and poorer maternal wellbeing. Poor maternal wellbeing had a significant mediation-like effect on the relationship between economic hardship and a child’s cumulative ACE exposure. Practice and policy implications include early ACE assessments tailored to identify children and families experiencing adversity across multiple domains.
KeywordsEconomic hardship Maternal wellbeing Adverse childhood experiences (ACEs)
Compliance with Ethical Standards
Conflict of Interest
The corresponding author declares no conflict of interest.
Ethical Standards and Informed Consent
For this type of study, secondary data analysis, formal consent is not required. In the original study, the National Survey on Children’s Health (NSCH) 2011–2012, informed consent was obtained from all individual participants included in the study.
- Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C. H., Perry, B. D., … Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186.Google Scholar
- Bramlett, M. D., & Radel, L. F. (2014). Adverse family experiences among children in nonparental care, 2011–2012. (Report No. 74). Hyattsville, MD: National Center for Health Statistics.Google Scholar
- Brown, T. A. (2014). Confirmatory factor analysis for applied research. New York, NY: The Guilford Publications.Google Scholar
- Bynum, L., Griffin, T., Riding, D. L., Wynkoop, K. S., Anda, R. F., Edwards, V. J., … Croft, J. B. (2010). Adverse childhood experiences reported by adults-five states, 2009. Morbidity and Mortality Weekly Report, 59(49), 1609–1613.Google Scholar
- Child and Adolescent Health Measurement Initiative (CAHMI). (2012). 2011/12 National Survey of Children’s health (2012), sampling and survey administration. Data resource center, supported by cooperative agreement 1-U59-MC06980–01 from the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved from www.childhealthdata.org.
- Child and Adolescent Health Measurement Initiative (CAHMI). (2013). 2011-2012 NSCH: Child Health Indicator and Subgroups SAS Codebook, Version 1.0 [data file and code book]. Data resource Center for Child and Adolescent Health. Retrieved from http://www.childhealthdata.org.
- Cicchetti, D., Toth, S. L., & Maughan, A. (2000). An ecological-transactional model of child maltreatment. In A. J. Sameroff, M. Lewis, & S. M. Miller (Eds.), Handbook of Developmental Psychopathology (pp. 689–722). New York, NY: Springer US.Google Scholar
- Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., … Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771–784. https://doi.org/10.1016/j.chiabu.2004.01.008
- Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the adverse childhood experiences study. American Journal of Psychiatry, 160(8), 1453–1460.CrossRefGoogle Scholar
- Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.Google Scholar
- Finkelhor, D., Turner, H., Hamby, S. L., & Ormrod, R. (2011). Polyvictimization: children’s exposure to multiple types of violence, crime, and abuse. OJJDP Juvenile Justice Bulletin - NCJ235504 (pgs. 1-12). Washington, DC: US Government Printing Office.Google Scholar
- Hayes, A. F. (2017). Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York, NY: Guilford Publications.Google Scholar
- Kerker, B. D., Zhang, J., Nadeem, E., Stein, R. E. K., Hurlburt, M. S., Heneghan, A., … Horwitz, S. M. (2015). Adverse childhood experiences and mental health, chronic medical conditions, and development in young children. Academic Pediatrics, 15, 510–517.Google Scholar
- Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). New York: Guilford Press.Google Scholar
- Liming, K. W., & Grube, W. A. (2018). Wellbeing outcomes for children exposed to multiple adverse experiences in early childhood: a systematic review. Child and Adolescent Social Work Journal, 32, 1–19. https://doi.org/10.1007/s10560-018-0532-x.
- Little, T. D. (2013). Longitudinal structural equation modeling. New York, NY: Guilford Press.Google Scholar
- Little, T. D., Card, N. A., Bovaird, J. A., Preacher, K. J., & Crandall, C. S. (2007). Structural equation modeling of mediation and moderation with contextual factors. In T. D. Little, J. A. Bovaird, & N. A. Card (Eds.), Modeling contextual effects in longitudinal studies (pp. 207–230). Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers.Google Scholar
- Liu, Y., Croft, J. B., Chapman, D. P., Perry, G. S., Greenlund, K. J., Zhao, G., & Edwards, V. J. (2013). Relationship between adverse childhood experiences and unemployment among adults from five US states. Social Psychiatry and Psychiatric Epidemiology, 48(3), 357–369. https://doi.org/10.1007/s00127-012-0554-1.CrossRefGoogle Scholar
- Murphy, N. A., Christian, B., Caplin, D. A., & Young, P. C. (2007). The health of caregivers for children with disabilities: Caregiver perspectives. Child: Care, Health and Development, 33, 180–187.Google Scholar
- Spence, S. H., Najman, J. M., Bor, W., O’callaghan, M. J., & Williams, G. M. (2002). Maternal anxiety and depression, poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence. Journal of Child Psychology and Psychiatry, 43, 457–469.CrossRefGoogle Scholar