Adverse Childhood Experiences, Psychological Distress, and Resilience in Health Professions Students

To determine the relationship between adverse childhood experiences (ACEs), social disadvantage, psychological distress, and resilience in graduate health professions students.

This study includes cross-sectional analyses from a longitudinal survey of medical, veterinary, and advanced practice provider students at matriculation to the University of California Davis in July 2019. The survey contained an expanded Adverse Childhood Experiences Questionnaire (ACEs-14), a measure of psychological distress (the Medical Student Well-Being Index [MSWBI]), and the Brief Resilience Scale. Responses were linked to demographics, including markers of social disadvantage (female gender, underrepresented in medicine [URM] status, and first-generation college graduate [first-gen] status). The relationships between ACEs, social disadvantage, psychological distress, and resilience were tested using linear or logistic regression.

Complete survey responses were provided from 240 of 357 students (67% completion rate). About two-thirds of students (67%, 161/240) reported ≥ 1 ACE, while a quarter (25%, 60/240) reported ≥ 4 ACEs. URM and first-gen students had higher odds of reporting ≥ 4 ACEs (odds ratio [OR] = 1.56; P = .049 and OR = 2.63; P < .001, respectively) than their nondisadvantaged peers based on binary logistic regression analysis. Higher ACEs-14 scores were associated with higher psychological distress scores ( P < .001). The majority of students reported normal or high resilience (normal: 76%, 183/240; high: 10%, 25/240) regardless of ACEs-14 scores. There was not a statistically significant relationship between ACEs-14 scores and resilience scores ( P = .936).

Health professions students from some socially disadvantaged backgrounds at this institution reported statistically significantly higher ACEs-14 scores than their nondisadvantaged peers. Childhood adversity was associated with increased psychological distress but not with low resilience. Implications for equity- and trauma-informed health professions education and interventions are discussed.