Individual and Interactive Effects of Adverse Childhood Experiences and Household Income on Adolescent Depression and Anxiety Symptoms

Cumulative Adverse Childhood Experiences (ACEs) and low household income are associated with adolescent depression and anxiety, but it is unclear whether distinct ACE subdomains - maltreatment (e.g., abuse) versus parent challenges (e.g., parental mental illness) - when experienced in distinct developmental periods exert a unique influence on adolescent mental health, or how ACEs and economic disadvantage operate together to influence outcomes. Thus, we aimed to (1) examine associations between baseline household income, early childhood ACEs (ages 0-5; sub-indexed as Maltreatment vs. Parent Challenges) and adolescent depression and anxiety symptoms (age 15), and (2) investigate whether household income moderates the associations between ACE sub-indices and each mental health outcome. We used serial linear regressions and data from the United States-based, longitudinal, racially/ethnically and socioeconomically diverse Future of Families and Child Wellbeing Study (n = 2523; 51% female; 51% non-Hispanic Black; 36% in poverty at birth). The Parent Challenges sub-index (but not the Maltreatment sub-index) was associated with depression and anxiety symptoms. Low household income was associated with depression symptoms. Income moderated the association between the Parent Challenges sub-index and anxiety symptoms; youth from the lowest and highest income strata were at greatest risk. Strategies are urgently needed for ACE prevention and to support parents of very young children (or expectant parents) who are experiencing behavioral health challenges, interpersonal violence, criminalized behavior, and/or poverty to promote healthy child development and adolescent mental health. Health professionals are well-positioned to advocate for supportive policies, promote trauma-informed environments, and identify/address significant parental challenges early in development.