Relationship between adverse early experiences, stressors, psychosocial resources and wellbeing

Child Abuse & Neglect 38 (2014) 65–75

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Child Abuse & Neglect

Relationship between adverse early experiences, stressors, psychosocial resources and wellbeing Sharon Mc Elroy a,b,c,∗ , David Hevey a a Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Aras An Phairsaigh, College Green, Dublin 2, Ireland b Family and Psychosocial Services, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK c St Patrick’s University Hospital, James Street, Dublin 8, Ireland

a r t i c l e

i n f o

Article history: Received 10 June 2013 Received in revised form 23 July 2013 Accepted 29 July 2013 Available online 6 September 2013

Keywords: Adverse child experiences Abuse Wellbeing Stress Psychosocial resources

a b s t r a c t The study examined a diathesis stress model of the relationship between adverse child experiences (ACEs), stressors and psychosocial resources to explore their relationship with wellbeing. A cross sectional study was conducted across two mental health and addiction treatment centers. 176 individuals were interviewed using a demographics form, SCIDDSM-IV(First, Spitzer, Gibbon, &Williams, 2002), Child Trauma Questionnaire (Bernstein & Fink, 1998), NEO-Five Factor Inventory (Costa & McCrae, 1992), Trait Emotional Intelligence Questionnaire (Petrides, 2009), The Coping, Inventory for Stressful Situations (CISS) (Endler & Parker, 1990), Recent Life Events Questionnaire (Department of Health, 1985) and perceived social support from family, friends and religion. Multiple, regressions and correlations were used to analyze the data. All early experiences, except physical, abuse and death of a parent in childhood, were significantly correlated with increased number of, stressors and lower wellbeing scores. This is possibly because of sample specific issues. Number of stressors partially mediated the relationship between ACEs and wellbeing. Increased number of ACEs was related to higher neuroticism and emotion-focused coping and lower conscientiousness, agreeableness, trait emotional intelligence and task coping scores. These resources were significantly related to increased stressors and lower wellbeing. Distraction and emotion coping significantly moderated the relationship between number of stressors and wellbeing. These findings support the diathesis stress model and indicate that there are significant relationships between ACEs, psychosocial, resources, stressors and wellbeing. Recommendations to improve wellbeing are discussed. © 2013 Elsevier Ltd. All rights reserved.

A higher frequency of adverse child experiences (ACEs) is associated with increased subsequent rates of mental health difficulties and substance dependence (Lee & Kim, 2011; Springer, Sheridan, Kuo, & Carnes, 2007). Examples of ACEs include emotional, physical, and sexual abuse; neglect; being bullied; and death of a parent. Individuals who have experienced a greater number of ACEs are more likely to report illicit drug use and substance dependence and have increased risk of attempted suicide (Dube et al., 2003). Children who experience a range of ACEs are more symptomatic later in life than children who experience repeated episodes of same kind of victimization (Finkelhor, Ormrod, & Turner, 2007). This paper examines a diathesis stress model, which postulates that early ACEs produce vulnerability as they generate a stable difficulty in dealing with later stresses (Slavik & Croake, 2006). Experiencing many ACEs, without adequate support, exceeds a child’s ability to form adequate psychosocial resources to deal with the ACEs resulting in increased stressors and decreased ability to manage stressors when they occur (Slavik & Croake, 2006). The diathesis stress model postulates that as

∗ Corresponding author. 0145-2134/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.chiabu.2013.07.017

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the degree or number of diatheses increases, the required severity of a stressor necessary to reduce well-being decreases (Mc Keever & Huff, 2003). This model is supported by research highlighting that children who experience high levels of ACEs are more at risk of increased stressors in later life (Middlebrooks & Audage, 2008) and ongoing victimization (Widom, Czaja, & Dutton, 2008). The psychological consequences of ACEs may also serve as precipitants for re-victimization (Cuevas, Finkelhor, Clifford, Ormrod, & Turner, 2010). Post-traumatic symptoms such as dissociation and numbing may prevent victims from being aware of danger cues and exercising appropriate judgment (Chu, 1992). This may explain why the individual is less able to manage later stressors and why the severity of stressors required to reduce well-being or precipitate psychopathology is decreased over time. Impact of early experiences on psychosocial resources It is postulated that early internal working models of attachment or caring experiences (Ainsworth, 1969; Bowlby, 1973) organize and influence subsequent personality development and interpersonal relations throughout the life cycle (Blatt & Blass, 1990). Linehan (1993) suggested that experiences of an invalidating environment during childhood contributes to emotional dysregulation by failing to teach the child to label and modulate arousal, to tolerate distress, or to trust their emotional responses and this reduces coping ability. Furthermore, the cognitive reactivity diathesis-stress perspective (Beck, 1967; Segal, 1988; Williams, Watts, MacLeod, & Mathews, 1997) suggests early childhood experiences shape schemas that guide appraisal of self, others, and the world, which in turn may influence psychosocial resources. All these theories suggest that ACEs influence psychosocial resources. Such resources include personality traits, coping styles and trait emotional intelligence (TEI). TEI refers to a constellation of behavioral dispositions and self-perceptions concerning one’s ability to recognize, process, and utilize emotion-laden information (Petrides & Furnham, 2001). Relationship between ACEs, psychosocial resources and well-being The relationship between ACEs and personality traits is important as personality traits are robust predictors of important outcomes such as psychological well-being (Wihelm, Wedgwood, Parker, Geerligs, & Hadzi-Pavlovis, 2010) and life satisfaction (Gannon & Ranzijn, 2005). Some studies suggest that individuals who experience many ACEs are more likely to develop personality disorders (PDs) in adulthood (e.g., Afifi et al., 2011; Widom, Czaja, & Paris, 2009), yet other studies have found that many children who experience abuse do not develop PD later in life (Clarkin & Sanderson, 2000). As ACEs may affect personality in subtle ways, studying personality traits may be more useful than measuring diagnostic PDs. Research has shown a relationship between ACEs and personality traits. A relationship between ACEs and high neuroticism and openness to experiences was found in a nationally representative sample in a study conducted in the United States (Allen & Lauterbach, 2007). Modest correlations were reported between neuroticism scores in adults and their recall of intrusive parenting (Reti et al., 2002) and lack of religious upbringing (Willemsen & Boomsma, 2007). Lower openness and extraversion scores were found in women who had been sexually abused by a parent (Talbot, Duberstein, King, Cox, & Giles, 2000). Research has focused predominantly on the relationship between neuroticism, extraversion, and well-being rather than the other big five traits. Findings on relationship between extraversion and well-being have been mixed (e.g., Kendler, Gatz, Gardner, & Pederse, 2006; Lönnqvist et al., 2009), whereas high neuroticism is generally linked to lower well-being. Despite theories suggesting that ACEs contribute to emotional dysregulation, to date little research has examined the relationship between ACEs and TEI or the relationship between TEI and well-being (Hertel, Schutz, & Lammers, 2009). Low TEI individuals are hypothesized to be at higher risk of lower well-being because of poor emotional regulation and relationship difficulties (Mikolajczak, Nelis, Hansenne, & Quoidbach, 2008). High TEI individuals are less prone to clinical disorders (Petrides, Furnham, & Mavroveli, 2007; Petrides, Perez-Gonzalez, & Furnham, 2007). Meta-analysis showed that TEI had a moderate association with mental health (r = .36), psychosomatic health (r = .33) and physical health (r = .27; Martins et al., 2010). Examination of the relationship between ACES and TEI and how they relate to well-being would be useful clinically as it could inform potential risks for low well-being and inform treatment to increase well-being. Research, albeit limited, has indicated that ACEs and coping style are associated. Experiencing many ACEs may result in the individual associating certain people and environments with trauma, which consequently interferes with their normal coping (Finkelhor et al., 2007). Abuse history has been associated with increased avoidance and emotion-focused coping and reduced task-focused coping (Bal, Crombez, Oost, & Debourdeaudhuij, 2003; Shikai, Uji, Shono, Nagata, & Kitamura, 2008). Typically, strategies that facilitate problem solving (e.g., task focused) are viewed as adaptive, whereas those that encourage excessive focus on emotions are not (Folkman & Lazarus, 1985). Low levels of task-focused coping have been associated with high levels of depression, alcohol and drug use behaviors (Christensen & Kessing, 2005). However, avoidant coping strategies have been associated with both negative (Min, Farkas, Minnes, & Singer, 2007) and positive outcomes (Dashora, Erdem, & Slesnick, 2011). Therefore, findings on the relationship between coping style and well-being are unclear. Protective factors in diathesis stress model The diathesis stress model recognizes that individuals may have protective factors that promote resilience against stressors (Slavik & Croake, 2006). Social support is hypothesized to be a protective factor. The main-effect model suggests that social support has a general beneficial effect regardless of stressors, as it provides positive experiences and a sense

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of self-worth and stability in the individual’s social life (Cohen & Wills, 1985). The moderating/buffering hypothesis postulates that support is beneficial and protects or ‘buffers’ individuals from potentially negative consequences of stressful experiences (Yap & Devilly, 2004). However, findings for the effects of social support on well-being or psychological distress have been mixed for both models. Research has found that different forms of social support (support by parents versus peers) may have different influences on well-being. Parental support but not peers support predicted future increased in depressive symptoms (Lewinsohn et al., 1994; Stice, Ragan & Randall, 2004; Windle, 1992). Research on the moderation effects of social support between stressors and various forms of well-being have been mixed, with some finding support moderated the relationship (Walker et al., 2010) and others finding it did not moderate the relationship (Cohen, Hammen, Henry, & Daley, 2004; Measelle, Stice, & Springer, 2006). Coping style has been cited in the literature as a protective factor. Task-focused coping is hypothesized to be protective as it encourages problem solving. The literature on avoidance coping as a protective factor has been mixed. Current study This study examined the relationship between ACEs, stressors, and well-being and examined if the number of current stressors mediates the relationship between ACEs and well-being. It examined if perceived support from family, friends, religion, and coping styles moderated the relationship between stressors and well-being. It was hypothesized that ACEs would be correlated with higher number of current stressors and lower levels of well-being. It was expected that number of stressors would mediate the relationship between ACEs and well-being. It was hypothesized that perceived support and task-focused coping would moderate the relationship between stressors and well-being in that higher perceived support and task-focused coping would reduce the negative impact of stressors on well-being and vice versa for emotion and avoidance coping. Increased understanding of these relationships could inform treatment guidelines for individuals who experienced ACEs to enhance their well-being. It could also inform guidelines on who may be at risk of lower well-being so preventative measures could be focused on those at risk. Method A cross sectional study was conducted in two mental health and addiction treatment centers in Dublin, Ireland. Ethics approval was granted by ethics committees in Trinity College Dublin’s School of Psychology and by the two treatment centers. Participants were recruited from service users consecutively referred to the treatment centers between June 2010 and January 2011 (n = 141). The first 35 family/friends of service users who attended the treatment center to visit with no mental health or substance use difficulties (as determined by SCID criteria) were also recruited. All 176 participants were white, Irish nationals between the ages of 18–68, 86 of whom were male and 90 female. Thirty-five had no disorder, 26 had a substance dependence, 50 had a mood disorder, 15 a substance induced mood disorder, and 50 had a dual diagnosis (diagnoses were determined by the Structured Clinical Interview for DSM-IV-TR [SCID] criteria). Each individual was approached to participate in the study when they were fully detoxified and their mood was stable. One eligible participant refused to participate in the study because of medical illness. All participants who started the study completed it. After signing informed consent the participants were asked to answer questions regarding how they generally felt or viewed themselves and not to focus specifically on when they were elated, depressed or intoxicated. Measures An interview was used to gather information on demographics and early experiences. Information gathered included demographic information (e.g., age, employment), contact with biological parents in childhood (childhood was defined as <16 years old), death of parent(s) in childhood, history of being bullied in childhood, and family history of substance dependence (FHSD) or mood disorder (FHMD; family history was defined as at least one first degree biological relative and/or at least two second degree biological family members with the disorder.) The Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition with Psychotic Screen (SCID-I/PW/PSY SCREEN; First et al., 2002) was used to determine Axis 1 diagnosis/es. The SCID Axis I was used as it is commonly noted in the literature and is deemed the “gold standard” in diagnosing mental health disorders (Shear et al., 2000). The Childhood Trauma Questionnaire – Short Form (CTQ; Bernstein & Fink, 1998) was used to gain dimensional scores for history of emotional, physical, and sexual abuse and emotional and physical neglect (5 items for each abuse/neglect type). Participants rated their experiences when they were growing up by scoring items on a 5-point Likert scale from never true, rarely true, sometimes true, often true or very often true. Cut-offs for moderate to severe range (as outlined by the manual) was used. This scale was chosen because it is brief and has been shown to be valid and reliable with a variety of clinical and community samples (Baker & Maiorino, 2010). The Cronbach alpha for each subscale was: physical neglect (˛ = .77), emotional neglect (˛ = .91), emotional abuse (˛ = .82), physical abuse (˛ = .85), sexual abuse (˛ = .98), and total abuse (˛ = .93). Number of adverse child experiences (ACEs) was tallied by allocating 1 point to each of the following (a) the number of Child Trauma Questionnaire abuse types in the moderate–severe cut-off range (max 5 points), (b) death of a parent in childhood, (c) no contact with at least one biological parent during childhood, (d) bullied in childhood, (e) FHSD, and (f)

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FHMD. Number of ACEs could range from 0 to 10. Similar criteria were used in the ongoing adverse childhood experiences study (N = 17,000) by the Centers for Disease Control and Prevention (2006). The Trait Emotional Intelligence Questionnaire (V1.50) - Long Form (Petrides, 2009; TEIQue) was used to measure TEI. It consists of 153 items rated on a 7-point scale ranging from 1 (completely disagree) to 7 (completely agree; Petrides & Furnham, 2003). It includes four factors: well-being, self-control, emotionality, and sociability, which were summed to obtain a total TEIQue score. The TEIQue was chosen as a recent meta-analysis found the TEIQue showed the strongest association with mental health (r = .50) compared to all other trait and ability EI measures (Martins et al., 2010). The Cronbach alpha coefficient for the total TEIQue score was .82. The TEIQue Factor Well-Being was used to measure a generalized sense of well-being. This factor consists of happiness (8 items), self-esteem (11 items), and optimism (8 items). Each item was rated on a 7-point scale ranging from 1 (completely disagree) to 7 (completely agree; Petrides & Furnham, 2003). Individuals with high well-being scores feel positive, happy and fulfilled (Petrides, 2009). The Cronbach alpha coefficient for the well-being factor was .89. The NEO-Five Factor Inventory (NEO-FFI; Costa & McCrae, 1992) measured the personality traits of openness, conscientiousness, extraversion, agreeableness and neuroticism dimensionally. It consists of 60 items (12 items per trait) and is rated on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). The NEO-FFI was used as it is a brief, reliable measure of the big five personality traits. Costa and McCrae (1992) found the NEO-FFI accounts for about 85% of the variance in convergent validity criteria, as derived from ratings of similar traits using adjective endorsement, spouse, and peer ratings. Cronbach alpha were: neuroticism (˛ = .91), extraversion (˛ = .80), openness (˛ = .71), agreeableness (˛ = .75), and conscientiousness (˛ = .88). The Coping Inventory for Stressful Situations (CISS; Endler & Parker, 1990) was used to measure task-focused coping (16 items), emotion-focused coping (16 items), and avoidance coping (16 items) dimensionally. Avoidance coping is broken into two components: distraction (8 items) and social diversion (5 items). Individuals indicate how much they engage in listed activities when they encounter a difficult or upsetting situation on a scale of 1–5, with 1 being not at all and 5 being very much. This scale has been shown to be reliable and valid in samples with mental health difficulties (McWilliams, Cox, & Enns, 2003). The current study found internal consistency to be .92 for task coping, .89 for emotion coping, .76 for avoidance coping, .74 for subscale distraction, and .70 for social diversion. The Recent Life Events Questionnaire (RLEQ; Department of Health, 1985) measured the number of stressors in the past year. Twenty stressors were listed and the participant ticked if this stressor occurred in the past year and included any other unlisted significant event. The number of stressors experienced in the past year was tallied for a total number of stressors score. The RLEQ was used as it is a comprehensive list of stressors which allows the participant to add further stressors they may have experienced. Perceived social support from family, friends and religion was recorded on three individual Likert scales ranging from 1 to 5, with 1 denoting low support and 5 high support. Likert scales were devised for this study as a brief measure of perceived social support across the three areas.

Data analysis All data analyses were conducted using SPSS version 16 for Windows. The data were screened for missing values, outliers, linear relationships, and normality. No missing values were found. Kurtosis, skew, and descriptive statistics suggested assumptions of normality were met. The relationship between ACEs and (a) number of stressors, (b) well-being, and (c) psychosocial resources were explored using Pearson’s correlations. Correlations that involved categorical variables were conducted using point-biserial coefficients (rpb). Likewise, correlations between psychosocial resources and (a) number of stressors and (b) well-being were examined using Pearson’s correlations. Correlations were interpreted using Cohen’s guidelines (1988, pp. 79–81), which indicate that r = .1–.29 is small, r = .3–.49 is medium and r = .5–1.0 is large. Multiple regressions examined if the relationship between number of ACEs and well-being score was mediated by number of stressors; the criteria for mediation analysis as set out by Baron and Kenny (1986) had to be met. To examine if each coping style and perceived support moderates the relationship between number of stressors and well-being hierarchical multiple regressions were completed. Independent variables were centered to reduce potential multicollinearity. When the regression analysis indicated a significant interaction effect, Modgraph (Jose, 2008) was used to plot a moderation effect chart and compute simple slope effects.

Results The relationship between early experiences and well-being and stressors All early experiences, except physical abuse and death of a parent in childhood, were significantly correlated with number of stressors and well-being. These ACEs were related to increased stressors and lower well-being scores (see Table 1). A moderate negative correlation (r = −.41, p < .01) was found between number of stressors and well-being score. Multiple regression was used to examine if the relationship between number of ACEs and well-being score was mediated by number of stressors. Baron and Kenny’s (1986) criteria for mediation were met (see Fig. 1). In the initial model number

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Table 1 Pearson’s correlations and point-biserial coefficients between early experiences and number of current stressors and well-being (N = 176). Early experiences

Well-being

Number of stressors in past year

−.417** −.390** −.239** −.448** −.355** −.106 −.166* −.219** −.272** −.266** .169* .083

.512** .412** .369** .398** .370** .139 .171* .359** .240** .201** −.155* .104

.286** .253** .218**

−.286** −.269** −.310**

Number of ACEs Total abuse Physical neglect Emotional neglect Emotional abuse Physical abuse Sexual abuse FHSDa FHMDa Bullied under age 16 yearsa Contact with both biological parentsa Parent died under age 16 yearsa Perceived support in childhood from: Family Friends Religion

Note: ACE: adverse child experience; FHSD: family history of substance dependence; FHMD: family history of mood disorder. Significant correlations are in bold. a Point-biserial coefficients. * p < .05. ** p < .01.

Number of Stressors B =.05, S.E .01, p<.001

B=-1.33, S.E .44, p<.01

Number of ACEs

Wellbeing (B=-.22, S.E .04, p<.001)

Fig. 1. Mediation of the relationship between number of ACEs and wellbeing by number of stressors.

of ACEs predicted 17% of unique variance in well-being scores. When number of stressors was added, the number of ACEs only explained 4.6% of the unique variance. This was a significant partial mediation effect (Sobel t = −2.84, p < .01). Correlations between number of ACEs, psychosocial resources, stressors and well-being Increased number of ACEs was significantly correlated with higher levels of neuroticism, TEI, openness, conscientiousness, emotion-focused and distraction coping, lower levels of agreeableness, and task-focused coping scores (see Table 2). The number of ACEs was not significantly related to extraversion, avoidance, or diversion coping (see Table 2). Higher neuroticism scores were correlated with higher stressors (.32**) and lower well-being (−.76**; see Table 3). Lower conscientiousness, agreeableness, and TEI were related to higher stressors and lower well-being (see Table 3). Both lower task-focused coping and higher emotion-focused coping were related to a higher number of stressors and lower well-being (see Table 3). Avoidance coping and its subscales were not significantly correlated with number of stressors. Table 2 Pearson’s correlations between number of adverse child experiences (ACEs) and personality traits, trait emotional intelligence and coping style (N = 176). Number of ACEs Personality Neuroticism Conscientiousness Agreeableness Openness Extraversion Trait emotional intelligence Coping style Task-focused Emotion-focused Avoidance Distraction Diversion Note: Significant correlations are in bold. * p < .05. ** p < .01.

.48** .29** −.31** .19* −.11 .45** −.36** .52** .06 .21** −.12

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Table 3 Pearson’s correlations between psychosocial resources, number of stressors and well-being (N = 176). Psychosocial resources Personality Neuroticism Extraversion Conscientiousness Agreeableness Openness Trait emotional intelligence Coping Emotion-focused coping Task-focused coping Avoidance coping Social diversion Distraction coping

Number of stressors

Well-being

.323** −.167* −.342** −.312** .115 −.361**

−.757** .661** .509** .317** .011 .893**

.304** −.338** .053 −.003 .062

−.602** .622** .255** .391** −.032

Note. Significant correlations are in bold. * p < .05. ** p < .01.

Moderation effects of coping styles and perceived support on the relationship between number of stressors and well-being Emotion-focused coping and number of stressors were entered at step one of the model and explained 40% of the variance in well-being scores F (2,173) = 57.6, p < .001 (R2 = .40). In the second step of the analysis, the interaction term between number of stressors and emotion coping was entered and the total variance explained by the model was 42%. This was a significant increase in variance explained in well being, R2 = .019, F change (3,172) = 5.57, p < .01. Thus, emotion-focused coping was a significant moderator of the relationship between number of stressors and well being (see Fig. 2). Simple slope analysis indicated that high (−1.23, t = −2.68), medium (−1.15, t = −5.75), and low levels of emotion-focused coping (−1.07, t = −2.42) were all significantly different from zero (p < .001). Therefore, all levels of emotion-focused coping moderated the relationship between number of stressors and well-being. In particular, medium and high levels of emotion coping when combined with medium or high levels of stressors resulted in a steeper decline in well-being. Distraction coping and number of stressors were entered at step one and explained 15% of the variance in well-being scores F (2,173) = 15.7, p < .001 (R2 = .15). In the second step, the interaction term between number of stressors and distraction coping was entered and the total variance explained by the model was 17%. This model was significant, R2 = .019, F change (1,172) = .3.76, p < .05. Therefore, distraction coping is a significant moderator between number of stressors and well-being (see Fig. 3). Simple slope analysis for low (−1.07, t = −13.73), medium (−1.15, t = −11.05), and high levels (−1.23, t = −6.49) of distraction coping were all significantly different from zero (p < .001). High levels of distraction coping reduce wellbeing when stressors are low, but when stressors are high, high levels of distraction coping appear to be protective and increases well-being score. Conversely, individuals with low levels of distraction coping have the highest well-being when they experience low levels of stressors but have the lowest level of well-being when they encounter high levels of stressors. Analyses showed task-focused, avoidance and diversion coping were not significant. Similarly, perceived support from family, friends, or religion did not significantly moderate the relationship between number of stressors and well-being. Discussion All ACEs (except physical abuse and death of a parent in childhood) were correlated with lower well-being and increased number of stressors. This finding supports a growing literature linking ACEs with reduced well-being and increased stressors in later life (e.g., Douglas et al., 2010). Number of ACEs experienced had a strong correlation with well-being and number of

Fig. 2. Moderating effect of CISS emotion coping on the relationship between number of stressors and wellbeing.

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Fig. 3. Moderation effects of CISS distraction coping on the relationship between number of stressors and wellbeing score.

stressors, which lends support to previous research findings that ACEs contribute additively to risk of increasing stressors and reducing well-being (e.g., Springer et al., 2007). This suggests that ACEs should be thoroughly assessed, as many ACEs may impact on well-being and this information should be used to develop a treatment plan. The relationship between number of ACEs and well-being was partially mediated by the number of stressors experienced; this finding supports the theory that one mechanism by which ACEs increase the risk of lower well-being or clinical disorder later in life is through increased life stressors. This highlights the need for victims of early abuse to engage in interventions designed to improve coping with stressors. In particular, more interventions are required for children experiencing ACEs to attempt to break the cycle of ongoing re-victimization throughout their lifespan. Contrary to expectations, physical abuse and death of a parent in childhood were not significantly correlated with psychosocial resources, well-being, or number of stressors. Participants may have experienced physical punishment, which was common in Irish society when many of the participants were at school as physical punishment was only outlawed in Irish schools in 1982 (Mc Guire & Cinneide, 2005). During this time physical punishment was deemed the norm in Ireland and so it may not have been perceived as abuse and therefore may not have been reported as abuse or impacted as much on well-being. This explanation is supported by 80% of participants endorsing never to the question, “I believe I was physically abused.” It is also supported by Nishina and Juvonen’s (2005) study which suggested that seeing other children being victimized buffers against humiliation and anger, perhaps as it helped children discount their personal culpability and deviance. This highlights the importance of understanding how individuals perceive their experience of ACEs because of culture, norms, or abuser justifications as this may impact on reporting and how the victim is impacted by these experiences. The lack of association between death of a parent and both stressors and well-being may be because of the fact that few participants in the sample had a parent die in childhood (n = 13) and none had a parent die through suicide. The relationship between death of a parent and stressors and well-being is complex as many mediating factors could affect this relationship. Mediating factors may include developmental stage at time of bereavement, demographic factors, variables relating to the death (e.g., if death was witnessed, participation in burial rituals), family dynamics, support pre and post the parental death, social and community integration, use of support services, and previous psychopathology (Cerel, Jordan, & Duberstein, 2008). Factors such as increased alternative supports from family members or the community may help children develop psychosocial resources that help them cope more effectively with stressors to reduce the impact on their well-being. Relationship between early experiences and big five personality traits and TEI In general, increased number of ACEs was related to higher neuroticism and lower conscientiousness, agreeableness, and TEIQue score. These findings extend the scant current literature that primarily focuses on the relationship between neuroticism and ACEs by showing the relationship between ACEs and all big five personality traits and TEI. The current findings relating early experiences, personality, and TEI support the theory that early internal working models of attachment or caring experiences (Ainsworth, 1969; Bowlby, 1973) organize and influence subsequent personality development and interpersonal relations throughout the life cycle (Blatt & Blass, 1990). Based on the present findings ACEs should be routinely explored in therapy. Furthermore, it highlights the importance of preventative measures of bullying, abuse and providing early parenting training and support to help parents provide a supportive and facilitative environment for their children. Relationship between early experiences and coping styles The findings support the link between number of ACEs and lower task and higher emotion coping (e.g., Shikai et al., 2008). This study adds to the literature by showing that lower task-focused and higher emotion-focused coping were related to increased stressors and lower well-being. Children and young adolescents could also be taught coping skills at school as part of an emotional intelligence program as this may help prevent or reduce the risk of clinical disorder and lower well-being.

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Relationship between psychosocial resources and well-being Most psychosocial resources were significantly correlated with number of stressors and well-being. Higher neuroticism and emotion-focused coping were highly correlated with increased number of stressors and lower well-being. Higher extraversion, conscientiousness, agreeableness, TEIQue score, and task-focused coping were all related to lower stress and higher well-being, suggesting these factors may be protective against psychological distress and should therefore be promoted. Although, this study cannot determine causality it supports and builds on limited previous findings suggesting that higher emotional intelligence (Carmeli, Yitzhak-Halevy, & Weisberg, 2009), task coping and lower emotion coping (Ben-Zur, 2009) and neuroticism (Wihelm et al., 2010) are associated with increased well-being. Notably, avoidance and social diversion coping increased well-being but were not correlated to stressors. Openness and distraction coping were not significantly correlated with number of stressors or well-being. The role of avoidance coping has been inconsistent in the literature, perhaps because of a more complex nonlinear relationship between avoidance coping and well-being (Dashora et al., 2011), situation specific effects (Shimazu & Kosugi, 2003), or because people use a combination of coping strategies in stressful situations (Folkman & Lazarus, 1985). The moderation findings highlighting situation specific effects of distraction coping (a subscale of avoidance coping) on the relationship between stressors and well-being supports this idea. To reconcile the inconsistent findings, large scale studies with sufficient power to examine the possible nonlinear relationships of avoidance coping and its subscales, the individual’s perceived control over the stressors, and their relationship with well-being are needed. Moderation effects of coping styles and perceived support on the relationship between number of stressors and well-being Distraction and emotion-focused coping significantly moderated the relationship between number of stressors and wellbeing. High distraction copers had the lowest well-being when stressors were low but highest well-being when stressors were high. This finding suggests distraction coping may have situation specific effects, whereby it is a risk factor for low wellbeing when stress is low (perhaps distraction from small stressors results in them amplifying) but a protective factor when stressors are high (perhaps as it gives the individual a break from their distress or that they perceive the stress is beyond their control). Similar situation specific effects of distraction coping were found in non-clinical sample studies (Rantanen, Mauno, Kinnunen, & Rantanen, 2011; Shimazu & Schaufeli, 2007). This finding suggests that temporary distraction coping techniques should only be encouraged when stressors are high, whereas distraction should be avoided when stressors are low and a more task-focused oriented approach encouraged to tackle small stressors before they escalate. High emotion-focused copers had lower well-being than low and medium emotion-focused copers. As stressors increased, high emotion-focused copers had a steeper reduction in well-being than medium and low emotion-focused copers, though they also experienced a reduction in well-being. This interaction effect adds to the understanding of how stress, emotionfocused coping and well-being are related. Interventions aimed at managing stressors and adaptive coping skills may benefit individuals with high emotion coping. Notably, task-focused, avoidance, and social diversion coping did not moderate the relationship between stressors and well-being. Concerns have been raised in the statistical literature about the low power of regression analysis to detect true interaction effects (Frazier, Tix, & Barron, 2004). Perhaps this study may not have had sufficient power to detect the effects. Alternatively, perhaps only a combination of these coping styles may moderate the relationship (e.g., high emotion-focused coping, low task-focused, and high avoidance). Further research should examine the moderating effects of these variables in larger samples and combinations of moderators to investigate their potential moderating effect on stress and well-being. Support from family, friends, or religion did not moderate the relationship between stress and well-being. This finding may be as a result of brief Likert scales being used in this study to measure social support, which may not have captured enough information on different support types to evaluate specific aspects of support. Furthermore, perceived support was measured, which may differ from measures of actual enacted support (Lakey, Orehek, Hain, & VanVleet, 2009). However, the current findings are consistent with a literature review that concluded there is very little prospective evidence supporting the buffering role of social support (Burton, Stice, & Seely, 2004). Inconsistent findings in the literature regarding the role of social support may be attributed to other factors influencing the importance of social support. For example TEI may act as a moderator in the relationship between social support and well-being. When TEI is high, individuals may self-regulate emotions in a way that promotes well-being, thus diminishing the strength of the relationship between social support and well-being. When TEI is low the relationship between social support and well-being may be stronger. Strengths and limitations This study linked theory with existing research findings to examine a general diatheses-stress model that may be applicable to a variety of clinical disorders. It measured a large number of early experiences and psychosocial resources to comprehensively examine their relationship and found support for the theory that number of stressors mediates the relationship between ACEs and well-being. It adds information on a variety of ACE’s relationship with stressors, well-being and psychosocial resources and information on how psychosocial resources were related to stressors and well-being. It highlights the complexity of the relationship of coping and well-being.

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Although findings are broadly in line with theoretical expectation, this study was cross-sectional and so cannot determine the causal direction of the relationships, and it may be the case that some of the relationships are accounted for by an unmeasured variable(s) not included in the model. Furthermore, participants in the clinical groups were in treatment and this may have influenced their responses in interview. Their responses may be different to individuals not seeking treatment. Retrospective recollection of reporting of abuse was used, which may have resulted in bias as there was the risk of early childhood trauma “amnesia” and the effects of mood state on recall and recovered or false memories. Many studies have found that retrospective accounts of ACEs (Dube, Williamson, Thompson, Felitti, & Anda, 2004) and abuse to be largely accurate (2007; McNally, 2003), whereas others noted bias was most likely to be participants underreporting trauma (Maughan, Pickles, & Quinton, 1995). Longitudinal studies or in-depth interviewing regarding early experiences to examine inconsistencies may reduce potential bias in retrospective recall. Additional well-being measures such as quality of life or life satisfaction should be investigated. Although this study examined numerous ACES, it did not include all possible ACES (e.g., domestic violence, family in prison). Conclusion ACEs were correlated with psychosocial resources, number of stressors, and well-being, which provide support to previous research findings that ACEs contribute additively to risk of increasing stressors and reducing well-being. 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