A Cross-National Examination of Adverse Childhood Experiences and Depression in Young Adults: The Mediating Roles of Emotion Regulation, Distress Tolerance, and Rumination

Adverse childhood experiences have been linked to poor mental health outcomes, including depression, yet the underlying mechanisms remain unclear. The present study aimed to investigate how adverse childhood experiences are related to depressive symptoms among college students, focusing on emotion regulation, distress tolerance, and rumination as potential mediating pathways. Our analytic sample consisted of 4,337 participants (67.2% female) from six countries—United States, Canada, Spain, England, Argentina, and South Africa—who completed questionnaires assessing their adverse childhood experiences, depressive symptoms, use of emotion regulation strategies, distress tolerance, and ruminative thinking. We used a comprehensive mediation model in Mplus 8.3 (Muthén & Muthén, 1998–2017) to test for significant pathways. Within our model, greater adverse childhood experiences were significantly associated with greater depressive symptoms through several mediators: greater use of expressive suppression (an emotion regulation strategy), lower distress tolerance, and increased ruminative thinking across three facets (problem-focused, repetitive, and anticipatory thoughts). Model invariance analyses suggested that these findings were consistent across countries and sex at birth. The results highlight the importance of targeting emotion regulation, distress tolerance, and rumination in interventions aimed at reducing depression, particularly among individuals with a history of childhood adversity. Furthermore, the findings suggest that interventions targeting these mechanisms may be broadly applicable across global populations. Future research should employ longitudinal designs to further clarify the directionality of these associations and examine them across more diverse populations, including various age groups and cultural backgrounds. Keywords: adverse childhood experiences, depression, emotion regulation, distress tolerance, rumination