The Moderating Role of Social and Emotional Support in the Association Between Adverse Childhood Experiences and Adult Mental Health Across Racial Groups: the Need for Investing in Social Capital

BACKGROUND: The sustained impact of Adverse Childhood Experiences (ACE) on mental health outcomes in adulthood is well documented in the literature. ACE survivors may be especially vulnerable to poor mental health outcomes if they have limited or no social support. This study examined the moderating role of social support on the association of ACEs and mental health across different racial groups. METHODS: Data were obtained from the 2022 Behavioral Risk Factor Surveillance System (n = 14,327). The nine ACE questions about traumatic events in childhood were used to create ACE scores. Chi-square tests were used for bivariate comparisons. Both stratified and unstratified adjusted multivariable logistic regression models were fitted to assess the association between ACEs and poor mental health using social support as a moderator. RESULTS: Across racial and ethnic groups, higher ACE scores were associated with greater odds of poor mental health after adjustment for covariates, and this association varied by social support. Among White and Hispanic adults without social support, reporting four or more ACEs was associated with significantly higher odds of poor mental health compared with reporting no ACEs (White: AOR = 3.45, 95% CI: 2.22 to 5.35; Hispanic: AOR = 2.64, 95% CI: 1.05 to 6.64). When social support was present, four or more ACEs remained significantly associated with poor mental health across all racial and ethnic groups, including White (AOR = 2.57, 95% CI: 2.20 to 3.00), Black (AOR = 2.81, 95% CI: 1.42 to 5.54), Hispanic (AOR = 3.70, 95% CI: 2.36 to 5.80), and other racial groups (AOR = 2.90, 95% CI: 1.54 to 5.42). CONCLUSION: This study calls for developing culturally responsive, ACE-informed mental health promotion strategies that strengthen social capital and reduce disparities in psychological well-being.