Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Nathan Hale

Committee Members

Kate Beatty, Megan Quinn


ACEs are traumatic life events occurring during childhood that can have negative effects. Common mental disorders that are diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety and depression. The associations between ACEs and such problems in children have not been significantly examined. There are protective factors that can help reduce the effects of exposure to ACEs that have not been fully explored.

The purpose of this research study was to examine: 1) the prevalence of mental health outcomes in children; 2) the associations between ACEs, resilience and mental health outcomes; and 3) the role of resiliency as a moderating variable between ACEs and mental health outcomes. A secondary data analysis utilizing data from the 2018 National Survey of Children’s Health (NSCH) was used to examine the proposed aims. The study population consisted of children between the ages of 3 and 17. Chi-square analyses were utilized, and logistic regression models were constructed.

Weighted prevalence estimates were calculated. 8.6%, 6.9%, 8.0% and 3.7% currently had ADHD, behavioral disorders, anxiety and depression. The prevalence of each disorder was higher for older age, Whites, public insurance, single parent homes or homes without parents, caregivers with mental health problems and non-users of medical home. Children exposed to 4 or more ACEs had greater odds of ADHD (adjusted odds ratio [aOR]= 2.03; 95% confidence interval [CI], 1.52-2.72), behavioral disorders (aOR: 2.47; CI: 1.81-3.37), anxiety (aOR: 2.66; CI: 2.00-3.53) and the strongest relationship was seen with depression (aOR: 4.53; CI: 3.13-6.54). Individual resilience, family resilience and community resilience were associated with decreased odds of mental health outcomes and the strongest relationship was seen with individual resilience. There were significant interactions between exposure to ACEs and child resilience for ADHD (aOR: 0.14; CI: 0.08-0.23), current behavioral disorders (aOR: 0.10; CI: 0.06-0.16), anxiety and (aOR: 0.21; CI: 0.13-0.35) depression (aOR: 0.24; CI: 0.13-0.43) as well as significant interactions between ACE exposure and community resilience for depression (aOR: 0.25; CI: 0.10-0.61).

The findings of this research have implications for the improvement of mental health diagnosis, promotion of resilient measures and future research.

Document Type

Dissertation - embargo


Copyright by the authors.