ACEs screening in adolescent primary care: Psychological flexibility as a moderator

Area of Science:

• Psychiatry
• Psychology
• Public Health

Background:

• Adverse Childhood Experiences (ACEs) screening is recommended in medical settings.
• Understanding which patients experience negative outcomes post-ACEs and how to intervene is crucial.
• Psychological flexibility's role in moderating ACEs' impact on health requires further investigation.

Purpose of the Study:

• To determine if psychological flexibility moderates the relationship between ACEs and depression.
• To investigate if psychological flexibility moderates the relationship between ACEs and elevated Body Mass Index (BMI).
• To test the hypothesis that increased psychological flexibility weakens the link between ACEs and negative health outcomes.

Main Methods:

• Validated self-report scales assessed ACEs, psychological flexibility (AFQ-Y8), depressive symptoms (PHQ9a), and BMI percentiles.
• Data collected during adolescent well-child checks in urban primary care settings.
• Analysis included 402 adolescents (72.6% Black, 81.8% publicly insured, 63.4% female).

Main Results:

• Psychological flexibility significantly moderated the association between ACEs and depressive symptoms.
• High psychological flexibility was linked to fewer depressive symptoms despite higher ACE exposure.
• No significant moderation was found for ACEs and BMI; ACEs were only related to BMIs above the 99th percentile.

Conclusions:

• Psychological flexibility differentiates adolescents experiencing increased depressive symptoms after ACE exposure in primary care.
• Psychological flexibility is a modifiable process and a potential target for interventions.
• Developing psychological flexibility may reduce negative health outcomes following ACEs.