Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children

Highlights

• Resilience played a protective role in the relationship between childhood trauma and depression.

• Resilience partially mediated the effect of childhood trauma on depression.

• Resilience also moderated the association of childhood trauma with depression.

Abstract

Background

Childhood trauma has been regarded as a risk factor for adolescent depression. Resilience has been found to be a protective factor for adolescent mental health. However, it is not clear about the role of resilience in the relationship between childhood trauma and depression.

Methods

School attending adolescents (n=6406) aged 9–17 years were drawn from five primary schools, three middle schools and two high schools in Wuhan city of China in 2015. The participants were invited to complete self-report questionnaires, including demographics, childhood trauma, resilience and depressive symptoms.

Results

Resilience played a partially mediating role in the relationship between childhood trauma and depressive symptoms. Resilience also moderated the association of childhood trauma with depressive symptoms.

Limitation

The limitations of this study include cross-sectional study and self- reported instruments.

Conclusions

We conclude that resilience may play an important role in the relationship between childhood trauma and depressive symptoms. Our results suggest that enhancing resilience may provide new possibilities for prevention and intervention of depression in adolescents.

Introduction

Depression is an important public issue. It is estimated that 350 million people worldwide are affected by depression (Xia and Yao, 2015). The prevalence of depression in the United States based on the parent report of a diagnosis among children aged 4–17 years in 2006 was 3.0% (Perou et al., 2013). The overall prevalence of DSM-IV disorders (Diagnostic and Statistical Manual of Mental Disorders) in Northeast China among 6–17 years old children and adolescents in 2008 was 9.49% and depression 1.32% (Yang et al., 2014). Depression in adolescents is a risk factor for multiple negative outcomes. It not only increases the risk of major depression, anxiety disorder and illicit substance abuse/dependence in later life (McLeod et al., 2016), but also is related to increased risk of PTSD (Posttraumatic Stress Disorder) response to adult trauma (Breslau et al., 2014) and suicide attempt (Korczak and Goldstein, 2009).

Many studies revealed that childhood trauma increased the risk for depression (Agorastos et al., 2014, Shanahan et al., 2011), and emotional abuse and neglect showed a stronger association with depression compared with other kinds of trauma (Infurna et al., 2016). Consistent with Post's stress sensitization theory (Post, 1992), which the first episode of depression might heighten sensitivity to proximal stress, childhood adversity might lower an individual's threshold of stress needed to trigger depression responses (La Rocque et al., 2014). Meanwhile, previous research indicated that the experience of early adversity sometimes reduced sensitivity to later stress, so-called “steeling” effect (Rutter, 2006).

While, many victims of childhood trauma showed little or no psychological long-term damage despite of their history of adversity (Schulz et al., 2014). Resilience might play an important role among them. Resilience is regarded as a dynamic course in which individuals exhibited effective adaptation even with previous history of adversity or trauma, containing two structures: exposure to adversity and positive adaptation (Lutha and Cicchetti, 2000). Researchers view resilience as a defense mechanism, which can drive a person to grow in the face of adversity (Davydov et al., 2010). Accordingly, resilience is thought to be a protective factor in the relationship between childhood trauma and depression. Prior researches have revealed that resilience was negatively related to depression (Edwards et al., 2014) and childhood trauma (Schulz et al., 2014, Arslan, 2016).

Several studies have examined the moderating effect of resilience in the relationship between childhood trauma and depression. Wingo et al. (2010) demonstrated that resilience moderated depressive symptom severity in African Americans with a history of exposure to childhood abuse or other traumas. Schulz et al. (2014) reported that childhood maltreatment was positively associated with MDD (Major Depressive Disorder) in later life while resilience buffered the detrimental effect of childhood maltreatment in a community based Caucasian sample. The similar protective effect of resilience was also found in studies assessing depressive symptoms in university students, emerging adults transitioning out of child welfare, postpartum women and HIV-positive and at-risk women following childhood trauma (Campbell-Sills et al., 2006, Goldstein et al., 2013, Dale et al., 2015, Sexton et al., 2015). To our knowledge, there is only one study that assessed the mediating effect of resilience on depressive symptoms following childhood trauma. A cross-sectional study of 937 adolescents in Turkey found that resilience played a mediating role in relationships between psychological abuse in adolescence and emotional and behavioral problems (Arslan, 2016). These studies provide valuable information to understand the role of resilience in the relationship between childhood trauma and depression. However, most of the studies focus on adult psychology, and studies concerning the effects of resilience on depression in adolescence with exposure of childhood trauma are still lacking.

So we conducted a cross-sectional study to understand the role of resilience in the relationship between childhood trauma and depressive symptoms in Chinese adolescents. We hypothesized that resilience mediated the relationship between childhood trauma and depressive symptoms, and also moderated the association of childhood trauma with depressive symptoms.