Adverse childhood experiences and mental health: the mediating role of perceived social support and coping strategies

BMC Psychiatry. 2025 Aug 28;25(1):836. doi: 10.1186/s12888-025-07262-9.

ABSTRACT

BACKGROUND: Adverse childhood experiences (ACEs) are significant risk factors for poor mental health in adolescence. However, the mechanisms linking ACEs to depression, anxiety, and stress remain underexplored in low-resource settings like Bangladesh. To examine the associations between ACEs and mental health and investigate the mediating effects of perceived social support and coping strategies among adolescents.

METHODS: A cross-sectional survey was conducted among 1139 high-school graduates in Bangladesh. Self-administered questionnaires assessed ACEs, perceived social support, coping strategies, and symptoms of depression, anxiety, and stress. Structural equation modeling evaluated direct and indirect pathways and logistic regression identified risk factors associated with depression, anxiety, and stress.

RESULTS: ACEs were positively associated with elevated stress (β = 0.459, p< 0.001) and negatively associated with family (β = -0.339), friend (β =-0.239), and support from other significant persons (e.g. a close friend or mentor) (β = -0.199), as well as active (β = -0.345) and emotional coping (β = -0.221; all p< 0.001). Family support fully mediated the associations between ACEs and both depression (β = 0.042, p = 0.002) and anxiety (β = 0.063, p < 0.001), and partially mediated the association with stress (β = 0.217, p< 0.001). Active coping similarly fully mediated the ACE-depression (β = 0.017, p = 0.007) and ACE-anxiety (β = 0.025, p = 0.003) associations, while partially mediating the ACE-stress link (β = 0.125, p < 0.001). Friend support and emotion-focused coping showed smaller but significant partial mediation effects for anxiety (β = 0.020, p = 0.041; β = 0.013, p = 0.013, respectively) and stress (β = 0.027, p= 0.021 for emotion-focused coping), while their indirect effects on depression were not statistically significant. Females had higher odds of all mental health problems. Psychological abuse was associated with worse mental health outcomes, and sexual abuse significantly increased stress risk.

CONCLUSION: Social support and active coping strategies buffer the effect of ACEs on mental health. Interventions should prioritize enhancing family support and promoting active coping, among adolescents.

PMID:40877821 | DOI:10.1186/s12888-025-07262-9