Intergenerational Pathways Linking Caregiver Adverse Childhood Experiences (ACEs) to Child Mental Health: Mediating Roles of Caregiver Depression, Anger Reaction, and Negative Parenting

Background and Purpose: Caregiver adverse childhood experiences (ACEs) are traumatic and prevalent, with adverse intergenerational implications for child mental health. Although prior research links caregiver ACEs to children’s internalizing and externalizing behavioral challenges, the mechanisms underlying these associations remain insufficiently specified. This study examined whether maternal ACEs are associated with child internalizing and externalizing behaviors through caregiver depression symptoms, anger symptoms, and negative parenting practices, with attention to both homotypic and heterotypic pathways of intergenerational transmission.

Methods: Data were sourced from the Families and Children Thriving Study, a longitudinal investigation of low-income Wisconsin households at risk of child welfare involvement. The analysis included a fixed sample of 624 mothers with complete data on wave 3 and key study variables. Caregiver ACEs were assessed using the Childhood Experiences Survey within 90 days of program enrollment. Maternal depression and anger reactions were independently measured at wave 2 using the Patient Health Questionnaire-9 (PHQ-9) and the Dimensions of Anger Reactions-5 (DAR-5), respectively. Composite scales of negative parenting practices were measured at wave 3 using the Multidimensional Assessment of Parenting Scale. Child depression and externalizing behavior were independently assessed at wave 3 using the Patient-Reported Outcomes Measurement Information System (PROMIS) Sadness and Fear scales and the NIH Toolbox, respectively. Parallel mediation models were estimated using PROCESS to test whether caregiver depression, anger, and negative parenting practices mediated the associations between caregiver ACEs and child depression and externalizing behavior, adjusting for maternal age, number of biological children, education, and race/ethnicity.

Results: Maternal ACE exposure was associated with higher child depressive symptoms (b = 0.11, 95% CI [0.06, 0.16]) and child anger (b = 0.15, 95% CI [0.08, 0.21]) after accounting for the mediators. For both outcomes, the overall indirect effects were significant, including child depression (b = 0.05, 95% CI [0.03, 0.08]) and child anger (b = 0.07, 95% CI [0.04, 0.10]). Maternal depressive symptoms significantly mediated the associations of maternal ACEs with child depression (b = 0.03, 95% CI [0.01, 0.05]) and child anger (b = 0.05, 95% CI [0.02, 0.08]), and negative parenting practices also emerged as a significant mediator for child depression (b = 0.02, 95% CI [0.01, 0.04]) and child anger (b = 0.02, 95% CI [0.01, 0.04]). Maternal anger reactions did not significantly mediate either outcome.

Conclusion: This study shows that caregiver ACE exposure is associated with both child depression and externalizing behavior. Specifically, caregiver depressive symptoms and negative parenting emerged as significant mediating pathways linking caregiver ACEs to each of these outcomes. These findings suggest that prevention and intervention efforts may be strengthened by screening for caregiver depression and by supporting consistent, responsive, and noncoercive parenting among families with elevated adversity exposure. In practice, the results support trauma-informed, two-generation approaches in family-serving systems, including home visiting and other early intervention settings, that address caregiver mental health and parenting together. Continued research using longitudinal, multi-method designs can further refine the pathways most amenable to prevention and intervention.