Understanding Differential Depression Severity Among U.S. Adolescents: The Roles of Adverse Childhood Experiences, Family Resilience, and Neighborhood Safety

Background: Depression has become an increasingly prevalent health concern among adolescents in the U.S. Although numerous research has identified that adverse childhood experiences (ACEs) are associated with poor mental health outcomes among adolescents, relatively little research has examined how ACEs and contextual factors, particularly those related to family and neighborhood environments, are related to depression severity among adolescents already diagnosed with depression. Most prior studies have focused on the presence or absence of depression rather than variations in its severity, limiting understanding of heterogeneity within clinical samples. To address this gap, the current study examines how ACEs and contextual factors, including family resilience and neighborhood safety, are related to varying levels of depression severity among adolescents diagnosed with depression.

Methods: The current study used cross-sectional data from the 2024 National Survey of Children’s Health, a nationally representative sample survey of children’s health conducted by the U.S. Census Bureau. Caregivers of children completed the survey, and data were weighted to represent all noninstitutionalized children in the U.S., with a final analytic sample including 1,799 caregivers of children aged between 12 and 18 who were currently diagnosed with depression. Caregivers self-reported the severity of depression of their child (i.e., mild, moderate, severe). ACEs were measured by asking caregivers to indicate whether the child had experienced ACEs (e.g., parental divorce, racial/ethnic discrimination experiences, parental death). Contextual factors included family resilience and neighborhood safety. Multinomial logistic regression was conducted to explore associations among ACEs, contextual factors, and depression severity, controlling for child characteristics including age, race/ethnicity, sex, and household poverty level.

Results: Multinomial logistic regression analysis showed that the overall model was significant, F (22, 33,319) = 1.82, p<.05. The reference group consisted of caregivers of children with mild depressive symptoms. Higher ACEs were associated with a greater likelihood of being in the moderate depression group (RRR = 1.12, 95% CI [1.01, 1.24]) and the severe depression group (RRR = 1.21, 95% CI [1.04, 1.41]). Lower family resilience was associated with a higher likelihood of being in the moderate depression group (RRR = 1.43, 95% CI [1.09, 1.88]) but was not significantly associated with severe depression. Lower perceived neighborhood safety was associated only with an increased likelihood of severe depression relative to mild depression (RRR = 1.67, 95% CI [1.05, 2.66]).

Conclusions and Implications: ACEs were consistently associated with greater depression severity. Family resilience and neighborhood safety showed differential associations with depression severity. Family resilience was linked only to moderate depression, whereas neighborhood safety was associated only with severe depression. These differential patterns suggest that strengthening family resilience can be effective in addressing moderate depression and improving safe neighborhood environments can be critical for preventing severe depression. Clinical social workers and practitioners working with adolescents with depression should tailor interventions based on adolescents’ depression severity to enhance the effectiveness of interventions.