Family Resilience As a Buffer Against Adverse Childhood Experiences: Implications for Adolescent Mental Health

Background and Purpose: Adverse childhood experiences (ACEs) are strongly associated with poor mental health among adolescents. Family resilience, defined as the ability of families to adapt, problem-solve, and maintain hope during stress, has been proposed as a protective factor. However, evidence regarding whether family resilience reduces the impact of ACE exposure on adolescent anxiety and depression remains mixed. This study examines whether family resilience moderates this relationship using recent nationally representative data. It was expected that family resilience would attenuate risk, particularly at lower levels of cumulative adversity.

Methods: Data were drawn from the 2023-2024 National Survey of Children's Health. Analyses were restricted to adolescents ages 12-17 (n= 38,859; weighted population= 24.8 million). Survey-weighted logistic regression models examined associations between ACE exposure, family resilience, and caregiver-reported anxiety or depression. An interaction term tested whether family resilience modified the association between ACE exposure and adolescent anxiety and depression. Predicted probabilities were estimated using marginal effects. Models adjusted for adolescent sex, race/ethnicity, and household poverty level. Sensitivity analyses using continuous ACE count (0-10) and quadratic specifications were conducted to test non-linearity.

Results: Overall, 17.8% of adolescents had current anxiety or depression. ACE exposure was common: 50.9% reported no ACEs, 24.1% reported one ACE, and 25.0% reported two or more ACEs. Family resilience was present in 82.4% of families. ACEs were associated with higher odds of anxiety and depression in a dose-response pattern (1 ACE: OR= 1.85, 95% CI: 1.60–2.14; 2+ ACEs: OR= 4.13, 95% CI: 3.60–4.73). Adolescents in non-resilient families also had higher odds of anxiety and depression (OR= 1.66, 95% CI: 1.33–2.07). The interaction between ACEs and family resilience was statistically significant (p = .047). This effect was primarily observed among adolescents with one ACE (interaction OR= 0.69, 95% CI: 0.50–0.95, p= 0.025). The interaction was not statistically significant among those with two or more ACEs (OR= 0.90, 95% CI: 0.68–1.20, p= 0.492). Predicted probabilities were lower for adolescents in resilient families across all ACE levels, though differences at higher levels of ACE exposure were not statistically significant. Sensitivity analyses using continuous ACE count showed no significant interaction (OR= 1.00, p= 0.923), suggesting that buffering effects were not consistent across the full range of ACE exposure.

Conclusions and Implications: Family resilience may offer protection under moderate adversity but may be less effective when adversity is more severe or cumulative. For social work practice, resilience-building interventions may be most effective for families experiencing moderate adversity. For families with high ACE exposure, family-level interventions alone may be insufficient; social workers should also address structural needs including housing, economic supports, and caregiver mental health through resource linkage and care coordination. Routine screening for ACEs and family functioning in pediatric, school, and community settings could help identify families who may benefit from targeted resilience supports.