Unlocking the Campus Mind: Unveiling the Relationship between Childhood Experiences & College Students' Mental Health via Mixed-Methods Inquiry.

Abstract

Background: Adverse Childhood Experiences (ACEs) are a universal problem with serious impacts on mental and physical health. The current literature suggests that ACEs have a detrimental impact on college student's mental health functioning. However, there is a scarcity of research (1) exploring the relationship between ACEs and psychological outcomes among college students, and the factors that can mediate or moderate this association; (2) applying a real-time methodology to understanding how ACEs relate to emotional functioning among college students, and taking an idiographic approach through network analysis to assess the effects of ACEs; (3) identifying what universities can do to mitigate students' mental health issues using a qualitative framework. The current study aims to address these research gaps and explores the relationship between childhood experiences and mental health functioning among college-going young adults (age 18-27 years). Objectives: (1) To identify and establish the psychological outcomes /mental health functioning associated with the experience of childhood adversities among college-going students, while extending prior empirical evidence found in the international research sphere; (2) To examine the relationship between ACEs and emotional functioning via positive and negative affect and four distinct dimensions of emotions within the college population, in real-time. Further, using an exploratory methodology in the form of personalised networks to investigate the impact of ACEs on emotional functioning, and; (3) To explore potential strategies that Higher Education Institutions (HEIs) can employ to alleviate mental health challenges experienced by college students, and investigate the multifaceted factors contributing to these issues and identify the barriers confronted by students. Methods: This thesis adopted a mixed methods approach with pragmatism at its core, suggesting that qualitative and quantitative research can cohabitate and communicate with each other. Before outlining any concrete research goals, a comprehensive literature review was conducted to explore the association between ACEs and mental health functioning in college students and identify research gaps. This review was subsequently used to guide the development of three core research goals that addressed the research gaps identified above. Research goals one (R1) and two (R2) were pursued using quantitative methods, while research goal three (R3) employed a qualitative approach. For R1, participants (N=321) completed a survey questionnaire related to their mental health and childhood experiences. First, to understand the mediational role of Thwarted Belongingness (TB), Perceived Burdensomeness (PB) and psychological distress in the association between ACEs and Suicide Ideation (SI) in college students, we used a serial mediation approach via PROCESS model 80 (Hayes, 2017). Secondly, to extend our knowledge on how ACEs and Positive Childhood Experiences (PCEs) relate to college student's mental health, within the framework of Resiliency Theory, we conducted adjusted and unadjusted regression models and sample stratification to examine the impact of ACEs, PCEs and mental health functioning. Lastly, within R1, to assess if there is a relationship between COVID-19-related stress and ACEs, and other socio-demographic factors among college students, we used multiple linear regression to identify this relationship. For R2, to address ACEs relationship with emotional functioning and mental health in real-time, we collected data from 54 university students via the Neureka app. Participants completed the assessment on the Neureka app for 21 days (two times a day). We used time series to construct personalised networks using a vector-autoregressive (VAR) model with the Graphical Var for regularized networks package in R. The findings from the R1 and R2 then informed the final phase of the study (R3). R3 used qualitative, participatory, methodology involving semi-structured interviews (N=4) with college staff and an open-ended online survey (N=71) with college students to investigate the multifaceted factors contributing to mental health issues and identify the barriers confronted by students. Data analysis for R3 was informed by Braun and Clarke's (2006, 2012) thematic analysis techniques. Themes important to the description of a phenomenon associated with the research question were identified in both interview and online survey data. Results: In R1, our results revealed that ACEs and mental health problems were common among our sample college population. We found that 35% of the sample reported experiencing at least one, with 39.6% of the sample population reporting that they experienced between 4-12 ACEs. This research also highlighted the relationship between higher cumulative ACE scores and poorer mental health in the form of psychological distress and suicide ideation. We also found TB and PB acted as mediators between ACEs and SI. Further to this, R1 also elucidated that PCEs can neutralise the negative effects of ACEs on mental health functioning. Moreover, regression analysis revealed that students who were female, who had chronic illnesses, who experienced monetary concerns, and who expressed psychological distress experienced greater stress related to COVID-19. However, we did not find a relationship between COVID-19-related stress and ACEs. The results from R2 indicated that the total ACE score predicted a greater negative effect (r = 0.27, p = 0.03) and less positive effect (r = -0.32, p = 0.001) in real-time over a 21-day period. Associations between childhood experiences and three aspects of emotion dynamics (variability, inertia, and instability) also collected in real-time were not found to be significantly related. Network analysis of contemporaneous networks revealed that the most central symptoms of negative affect were `worried' and `anxious' across participants. Centrality is a way to quantify a symptom's influence in a network of other symptoms. For example, in our study `worried' was the most central symptom among college students, therefore if someone becomes more worried, they are then more likely to experience other negative emotions. Results from R3 highlighted that both college staff and students believe students are increasingly open and forthcoming regarding their mental health within university settings. Moreover, the stigma surrounding mental health issues has decreased. Students also highlighted that they were open to talking about sensitive topics such as childhood trauma and other mental health facets within higher education settings. However, with students being open to using college support services, the issue of these services being underfunded and under-resourced comes into light, specifically those relating to health and well-being, such as counselling support. Conclusion: ACEs have a detrimental impact on college student's mental health and are a highly relevant topic to investigate. Results from the present thesis suggest that ACEs are a substantial risk factor for students' poor mental health functioning. This research also highlights that Thwarted Belongingness and Perceived Burdensomeness are significant factors contributing to mental health problems. By fostering a supportive environment, loneliness can be alleviated. Further, it is imperative to consider PCEs as moderators when studying the relationship between ACEs and mental health functioning. By reducing the impact of mediators such as TB and PB in the ACE-negative psychological functioning relationship, interventions can be designed to mitigate the poor outcomes associated with ACEs and improve the mental health outcomes of college students. This research also showcased that network analysis and idiographic approaches can be viable methods for future research looking at the relationship between ACEs and emotional functioning via emotion dynamics in real-time. Interventions aimed at increasing positive affect and reducing negative affect may be advantageous for individuals who have undergone ACEs. Moreover, network analysis involving personalized networks presents novel possibilities and enhanced precision in comprehending the intricacies of emotion dynamics. Further to this, personalised networks have the potential to inform the construction and implementation of personalized treatments by defining the idiosyncratic structure of psychopathology on a person-by-person basis. Future research could look at developing interventions, using a personalised network approach, to specifically target specific emotions outlined via contemporaneous networks such as worry and anxiety, key emotions within this sample of students. Lastly, we discuss the Awareness to Action Model to advise trauma-informed care via three strands namely: (a) Active mental health dialogue across University; (b) Engaging with academics in trauma-informed care, and; (c) Tailored support for students in need. By recognizing the prevalence of trauma and its impact on individuals, universities can implement policies and practices that prioritize safety and promote healing. The implications of these findings for theory, policy, and practice are discussed.