thesis statement about childhood trauma

Childhood Trauma - Free Essay Samples And Topic Ideas

Childhood Trauma refers to distressing or harmful experiences that happen to children, which may have long-lasting effects on their emotional and physical well-being. Essays could delve into the types of childhood trauma, its short and long-term impacts, intervention strategies, and how support systems can mitigate its adverse effects. We’ve gathered an extensive assortment of free essay samples on the topic of Childhood Trauma you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Effects of Childhood Trauma on Children Development

Anyone can experience trauma at any time. The trauma can be caused by nature, human beings or by oneself. People endure much when they experience trauma and their ability to handle it can determine the level of the effect of the trauma and their long-term well-being. Reportedly, children are incredibly susceptible to trauma because their brain and coping skills are still developing. Thus, they often grapple with long terms effects of uncontrolled trauma. While childhood trauma may vary regarding pervasiveness […]

Effects of Childhood Trauma on Development and Adulthood

It is no secret that experiencing childhood trauma can have many negative effects on an individual’s life both in childhood and adulthood. Trauma can include events such as physical or sexual abuse, surviving a serious car accident, witnessing a violent event, and more. As trauma is defined in the dictionary as a deeply distressing or disturbing experience, it is no surprise that a disturbing event during childhood can have negative effects throughout an individual’s lifetime. However, this paper will dive […]

Foster Care System Pros and Cons

"Foster care as a whole has become a broken and corrupt system that can no longer keep kids safe under its care. Everyday children are being placed in foster homes facing different forms of abuse, unloving parents, and even death. The system has only progressively gotten worse leaving behind children traumatized to a point where no amount of love or therapy can fix them. To inaugurate, the biggest issue with foster care is the inadequate placement of children in the […]

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Childhood Sexual Abuse – Preceding Hypersexualized Behavior

Hypersexual behavior is differentiated from paraphilia, or sexually deviant behavior, based on the criteria that hypersexual behaviors still fall within socially normal sexual activities (Kafka, 2010). Paraphilia refers to activities that do not fall within reasonably expected behavior, such as sexual interest in children or non-living entities (DSM-V, 2013). Both are defined as intense and frequent sexual behaviors that bring distress or other unintended negative consequences. This report looks at childhood sexual abuse, commonly referred to as CSA, in terms […]

Traumatic Childhood Memories

Most people are well aware of the concept of repression before ever stepping foot into a psychology class. The notion that a memory can be recalled after years of ignorance is a commonplace assumption, bringing with it the further assumption that it is a well-proven theory with the backing of researchers of psychology. Upon closer scrutiny, both the definition of and support for repression are seen as they truly are—complicated and controversial. The theory of repression originated with Jean-Martin Charcot […]

The Consequences of Homelessness – a Childhood on the Streets

“A therapeutic intervention with homeless children (2) often confronts us with wounds our words cannot dress nor reach. These young subjects seem prey to reenactments of a horror they cannot testify to” (Schweidson & Janeiro 113). According to Marcal, a stable environment and involved parenting are essential regarding ability to provide a healthy growing environment for a child (350). It is unfortunate then, that Bassuk et al. state that 2.5 million, or one in every 30 children in America are […]

Multiple Iimitations in Childhood

The researchers mentioned multiple limitations. While all the children in the study showed improved classroom compliance after implementation of the child play sessions, these changes were limited in a few of the children due to inconsistent compliance issues. Also, the changes made between the baseline and treatment phases was difficult to distinguish because this was a nonclinical sample and some of the children at baseline had only minor compliance issues. Future research should include post-intervention follow-up measures to provide an […]

Resilience through Childhood Trauma Shadows: Understanding and Healing

Within the intricate tapestry of human experience, the canvas of childhood unfurls as a pivotal chapter—a realm where innocence dances with curiosity, shaping the contours of the individuals we're destined to become. Yet, for some, this idyllic canvas is stained with the inky shadows of childhood trauma, casting a pall over the vibrant hues of youth and echoing through the corridors of time. Childhood trauma, a spectral presence, manifests in myriad forms. It is not merely the jagged edges of […]

Reimagining Childhood Trauma: a Psychologist’s Perspective

Childhood trauma, a labyrinthine phenomenon, often evokes conventional responses from psychologists. However, as practitioners, it is incumbent upon us to explore unconventional perspectives that may shed new light on this intricate subject. Traditionally, childhood trauma has been viewed through a lens of pathology, emphasizing its detrimental effects on mental health. While this perspective is undeniably valuable, it overlooks the resilience and adaptive capacities inherent in human nature. Instead of focusing solely on the scars left by trauma, let us consider […]

Childhood Trauma Unveiled: the Resilience and Redemption of Beth Thomas

Beth Thomas, a name that may not ring a bell for many, carries a story of resilience, transformation, and the power of compassion. Born in 1960, Beth's early life was marked by unimaginable challenges that would have left most broken. However, her journey from a traumatic childhood to a life of purpose is nothing short of remarkable. Growing up in Oklahoma, Beth Thomas experienced a childhood marred by abuse and neglect. Her parents, overwhelmed by their own struggles, failed to […]

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How To Write an Essay About Childhood Trauma

Introduction to the complexity of childhood trauma.

Writing an essay about childhood trauma involves addressing a deeply sensitive and complex subject that has profound psychological and social implications. In your introduction, begin by defining childhood trauma, which can include experiences of abuse, neglect, witnessing violence, or enduring severe hardship. Emphasize the lasting impact these experiences can have on an individual’s development, mental health, and overall well-being. This introductory section should provide a foundation for exploring the various dimensions of childhood trauma, including its causes, symptoms, and long-term effects. It should sensitively set the stage for an in-depth analysis of this critical issue.

Examining the Causes and Manifestations of Childhood Trauma

In the body of your essay, delve into the various causes of childhood trauma. This can range from personal experiences such as physical or emotional abuse, to broader societal issues like war, poverty, or discrimination. Discuss the immediate and long-term psychological effects of trauma on children, which can manifest as anxiety, depression, behavioral issues, or difficulties in forming relationships. It’s important to base your analysis on research and studies in psychology and child development. The purpose of this section is to provide a comprehensive understanding of how childhood trauma occurs and its immediate impact on a child's life.

Long-Term Effects and Coping Mechanisms

Focus on the long-term effects of childhood trauma and the coping mechanisms individuals might develop. Explore how early traumatic experiences can shape personality, affect emotional regulation, and influence patterns of behavior into adulthood. Discuss the concept of resilience and the factors that contribute to positive outcomes in spite of traumatic experiences. This part of the essay should also consider the various therapeutic approaches used to support individuals with a history of childhood trauma, emphasizing the potential for healing and growth. Highlight the importance of early intervention and continued support for those affected by childhood trauma.

Concluding Thoughts on Addressing Childhood Trauma

Conclude your essay by summarizing the key points about the complexities and impacts of childhood trauma. Reflect on the importance of awareness, education, and societal support in addressing and preventing childhood trauma. Emphasize the role of communities, educators, healthcare professionals, and policymakers in creating environments that support the mental and emotional well-being of children. Your conclusion should not only provide closure to your essay but also encourage further thought and action on this crucial issue, underscoring the collective responsibility to protect and nurture the well-being of children.

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Home > Theses > 242

Cal Poly Humboldt theses and projects

Childhood and trauma: the effects of adverse childhood experiences on the brain, behavior, and learning in the elementary school classroom.

Aeryn Aguilar , Humboldt State University Follow

Graduation Date

Spring 2019

Document Type

Master of Arts degree with a major in Education

Committee Chair Name

Dr. Eric Van Duzer

Committee Chair Affiliation

HSU Faculty or Staff

Second Committee Member Name

Dr. Claire Knox

Second Committee Member Affiliation

Subject categories.

A variety of studies have been conducted on how trauma, caused by emotional, physical, or verbal abuse, impact children’s lives. Many of the studies which involved observations and assessments were done with the preexisting knowledge that these children had been through a traumatic experience. Instead of looking at behavior of known cases, this study’s goal is to find out whether or not children’s observable behaviors can predict cases of trauma. For example, is acting out or defiance a key sign of trauma or is it part of the typical development for the elementary school-age group? This thesis takes into account three major elements effected by trauma: the brain, behavior, and the learning process. Within this paper, the importance of all three in the case of children and traumatic experiences is explained. Within the research study, behavior is examined by first observing classrooms of nine year-old, elementary school children using certain criteria to predict which of the children might have traumatic backgrounds. Using the Trauma Symptom Checklist for Children (TSCC-A) to assess and measure posttraumatic stress, the scores of the assessment are compared to the observations, to determine if such correlations can be made between certain behaviors and past traumatic experiences. The purpose of this research is to aid public elementary school staff in understanding how trauma effects children in the classroom and what the results of those effects means for the children’s learning processes.

Citation Style

Recommended citation.

Aguilar, Aeryn, "Childhood and trauma: The effects of adverse childhood experiences on the brain, behavior, and learning in the elementary school classroom" (2019). Cal Poly Humboldt theses and projects . 242. https://digitalcommons.humboldt.edu/etd/242

Since May 29, 2019

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Childhood Trauma

1 the impact of childhood trauma on attachment and self-esteem.

Introduction The purpose of this study was to test the association with childhood emotional abuse. The purpose was to test whether the association with childhood emotional abuse was either positive towards being fearful or negative towards having a secure attachment. Understanding Childhood Emotional Abuse and Attachment Five hundred and fifty-four undergrad students participated in this […]

2 Childhood Trauma Sensitive Approaches to Education

Introduction I am currently working in a self-contained behavior classroom as a Special Ed. Instructional Assistant in Milwaukie, Oregon. We currently have eight students in K-2nd grade. Our district divides the behavior classrooms into two levels: Elementary K-2nd grade and Intermediate 3rd-5th grade, and they are housed in various elementary schools in the district. In […]

3 The Impact of Childhood Trauma on Brain Development and Function

Abstract current article will provide an overview of the research literature on how trauma impacts brain development. An exploration of trauma is outlined, as well as the sources of childhood trauma. Understanding how the brain develops and how trauma impacts this development provides the means to better understand traumatized children. This article is a literature […]

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4 The Impact of Early Childhood Trauma on Family and Marriage Relationships

Introduction One of the major aspects to look at when researching trauma and how it can affect family and marriage relationships is what early childhood trauma can cause later, further down the line. When a parent or caregiver openly rejects the child or is not responsive to the needs of the child, it is possible […]

5 Unraveling the Impact of Unresolved Childhood Trauma on Adult Well-being

Introduction If a child experiences trauma, it should not be surprising that traumatic problems may still be present into adulthood. It could bring up and ruin happiness, relationships, or any area of adult life. Maybe they haven’t been feeling themselves lately. And they’ve been wondering: Am I suffering from unresolved childhood trauma? They thought it […]

The Relationship Between Trauma and Resiliency in Children

Jennifer Shore, MA

Executive Director, Focus for Health | BIO

February 18, 2020

Children are forced to face things every day that are hard to imagine; death of a loved one, incarceration of a caregiver, living with an addicted parent, enduring incest or sexual abuse by the hands of a family member, and the list can go on and on.  Research on Aversive Childhood Experiences (ACE’s) have brought the concepts of trauma and resiliency into the forefront. The general idea of the research is the higher the number of ACE’s a child had, the more at risk they are. What warrants future exploration, is what are the factors that lessen the impact of the negative experiences. How does a child with high ACE’s become traumatized and scarred for life, while another child with a similar experience can thrive in adulthood?  What are the protective factors that mitigate the lifelong negative impact of traumatic exposure?

Resilience is the reason that some people bounce back from trauma easily and “beat the odds” and others don’t.  There are variables that promote the likelihood of a better recovery from traumatic exposure, such as a caregiver’s healthy psychological functioning, emotional and physical availability, and sensitivity to the child’s emotional needs.

• impaired learning
• compromised health
• difficulties with emotional self-regulation that last into adulthood

Emerging research is exploring those factors that can minimize the injury caused by childhood trauma.

Positive, Supportive Relationships

What is interesting about this research is the importance that close relationships (family, friends, and community) have in both causing trauma and recovering from it.  Studies show that children with secure attachment relationships with their caregiver(s) are better able to regulate their responses to upsetting situations, compared to children with less secure caregiver attachments.

If you’re wondering if your actions have already damaged your children beyond repair- you’re not alone. The answer is no, not if you take appropriate measures for your children. Many parents, often well intentioned or coming from a place of their own unresolved trauma, have knowingly or unknowingly, exposed their children to aversities that have affected their emotional, intellectual, and even physical development. If, because of your own personal limitations (being in a destructive or toxic relationship, struggling with personal addiction), you can’t be the caregiver your child requires, it is important you find a way to get them that support from another caring, supportive adult.

Learn Emotional Self-Regulation/ Self- Mastery

Learning positive ways of self-regulation is a critical feature of adults who thrive in the world. When children grow up in a house with violence and addiction, chances are they do not have good role models who demonstrated positive ways of managing their emotional pain. Being able to identify your emotions and verbalize how you are feeling without acting out or numbing those feelings is a critical feature of those who display resiliency.

As the understanding about TIC grows, many schools and children-serving organizations, develop programs that improve children’s ability to recognize and manage their emotions through meditation, yoga, art, music, or sports. Research has found that engaging survivors in “neutral, fun” tasks and physical games can allow them to experience feeling relaxed and gives them a chance to feel a sense of mastery or accomplishment over a task. These activities create needed opportunities to learn social skills, gain a sense of self control, and teach ways to develop social boundaries with other people.

Control Physiological Arousal

• medication management
• neuro-biofeedback
• mindfulness meditation
• traumatic re-enactment
• traditional individual or group therapy
• trauma theater
• Eye Movement Desensitization and Reprocessing (EMDR)

Everyone responds differently to both type and duration of treatment, but the mere act of seeking help represents a step in the healthy direction of self-care. Self-care does not come naturally to those who suffered childhood abuse or neglect, so learning the behaviors of self-care are critical to becoming a healthy adult.

Adopt and Optimistic View of the World

Post- Traumatic Growth (PTG)

“Turn your wounds into wisdom. ”- Oprah Winfrey (Victim of rape at age 9 and on-going sexual abuse from ages 10 to 14).

Recommended For You

Executive Director, Focus for Health

Jen joined the Focus for Health team in January 2019. Jen has spent most of her career in the field of human services, specifically working with high-risk populations and people with disabilities. Throughout the years, she has incorporated her interest in wellness and nutrition into her career. Jen has partnered with various organizations throughout the last 25 years and has written numerous cook books and wellness manuals geared towards people with disabilities as well as WIC and SNAP recipients. When Jen is not working, she can be found cooking, gardening, and driving her kids to sports practices.In addition to her work in human services, Jen is very involved with various boards and organizations in her community. Jen has degrees in Psychology from Rutgers University and Fairleigh Dickinson University.

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Relationships between childhood trauma and mental health during the COVID-19 pandemic: a network analysis

1 Department of Neurology, Changxing People’s Hospital of Zhejiang Province, Huzhou, China

2 Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

3 Institute of Brain Science and Department of Physiology, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China

Huayun Huang

Pengfei fan, meifeng zhou.

4 Zhejiang Philosophy and Social Science Laboratory for Research in Early Development and Childcare, Hangzhou Normal University, Hangzhou, China

5 Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Childhood trauma has been found to have an important impact on mental health. However, little is known regarding the intercorrelations between childhood trauma and mental health during the COVID-19 pandemic. This study aimed to investigate such complex interplay between childhood trauma, depression, anxiety, post-traumatic stress level during the COVID-19 pandemic, and fear of COVID-19 using network analysis.

A total of 1,247 college students were recruited and were asked to complete a series of questionnaires, including the Childhood Trauma Questionnaire, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Post-traumatic Stress Checklist—Civilian version, and Fear of COVID-19 Scale. The Gaussian graphical model with the scores of the questionnaires as nodes was estimated. The partial correlations between nodes were calculated as edges. Moreover, network comparison tests were conducted to compare the network patterns between participants with high levels of childhood trauma and low levels of childhood trauma.

Childhood trauma was found to be connected to depression, anxiety, and post-traumatic stress level. The node of childhood trauma exhibited the strongest strength and the highest expected influence in the network. Participants with high levels of childhood trauma and participants with low levels of childhood trauma showed comparable network structure and global strength.

Our findings revealed a complex network pattern between childhood trauma and different mental health problems, indicating that childhood trauma might be a risk factor for mental health during the COVID-19 pandemic.

1. Introduction

The COVID-19 pandemic has become a global health crisis. Apart from the significant challenges to public health, the pandemic has serious impacts on individual’s mental health worldwide ( 1 ). The prevalence of psychological distress, depression, anxiety, and post-traumatic stress symptoms has significantly increased during the pandemic ( 2–5 ). Importantly, previous studies suggested that individuals with childhood trauma are at higher risk of experiencing more mental health problems during the COVID-19 pandemic ( 6 , 7 ).

Childhood trauma refers to experiences that are emotionally or physically harmful or distressing, occurring during the developmental period of childhood ( 8 ). Previous studies have documented a relatively high prevalence of childhood trauma in college students ( 9 , 10 ). For example, a survey among 21 countries by the World Mental Health Initiative recruited 51,945 adults and found approximately 40% of the population had adverse childhood experiences ( 11 ). Childhood trauma includes various types, including physical and emotional abuse, sexual abuse, or neglect ( 12 ). Different types of childhood trauma have distinct impacts on neuropsychological development ( 13 ). Physical and emotional abuse or neglect has been found to lead to emotion dysregulation and cognitive decline ( 14 , 15 ). It has been considered a risk factor contributing to a wide range of psychological difficulties and mental disorders ( 16 , 17 ). Moreover, individuals who have been exposed to traumatic events in childhood have been found to have higher levels of fear and stress in response to later stressors ( 18 ).

Since the end of 2019, the COVID-19 pandemic has become an ongoing and significant stressor for individuals worldwide ( 6 ). Recent studies have explored how individuals with childhood trauma experienced such stressor during the pandemic ( 7 , 19–21 ). Moreover, significant correlations between adverse childhood experiences and mental health problems during the pandemic have been found ( 19–21 ). For example, Guo et al. ( 19 ) found that individuals with higher levels of adverse childhood experiences (including physical abuse, emotional abuse, sexual abuse, family neglect, and household dysfunctions) had increased levels of anxiety and post-traumatic stress symptoms. Doom et al. ( 21 ) found that higher levels of adverse childhood experiences were significantly associated with higher levels of depression during the COVID-19 pandemic. Furthermore, individuals with childhood abuse have been found to have increased levels of COVID-19 fear and post-traumatic stress symptoms ( 6 ). Therefore, previous research indicated that individuals with childhood trauma might be more susceptible to heightened anxiety, depression, and post-traumatic stress symptoms during the COVID-19 pandemic. Previous studies on the mental health consequences of the COVID-19 pandemic have found greater increases in depression, anxiety, and post-traumatic stress level in the general population ( 2–5 , 22 , 23 ). Therefore, the present study will focus on the above three mental health problems.

Network analysis, which is a novel method to investigate the relationships and interactions between different symptoms, has been used extensively in psychology and psychiatry ( 24 , 25 ). In network analysis, symptoms are represented as nodes, and the relationships between symptoms are represented as edges ( 26 , 27 ). Importantly, an edge linking two nodes represents the independent relationship after controlling for the effects of the rest nodes in the network. The network structure and the network properties such as centrality and betweenness could be examined. Therefore, network analysis can elucidate the interactive pattern of symptoms ( 28 ). Some studies have utilized network analysis to explore the network structure of psychological state during the pandemic ( 29–32 ). Feng et al. ( 29 ) used a network approach to examine the relationships between depression and intolerance of uncertainty in university students. Ge et al. ( 30 ) and Ventura-Leon et al. ( 32 ) explored the network structure involving depression and anxiety symptoms. However, limited studies examined the network structure between childhood trauma and other mental health problems.

Therefore, this study aimed to use network analysis to investigate the relationships between childhood trauma, depression, anxiety, post-traumatic stress level during the COVID-19 pandemic, and fear of COVID-19. As previous findings using a non-network approach have found that individuals with higher levels of childhood trauma reported more mental health problems during the COVID-19 pandemic ( 19–21 ), we hypothesized that (1) childhood trauma would be connected to mental health problems and fear of COVID-19, (2) the node of childhood trauma would have high centrality indices, and (3) compared with participants with low levels of childhood trauma, participants with high levels of childhood trauma would have more mental health problems. The networks of both groups would exhibit different structures.

2. Materials and methods

2.1. participants and procedure.

A total of 1,247 students (361 males; mean age = 19.80 years, SD = 1.48) were recruited from Hangzhou Normal University in Hangzhou, China. The participants who gave consent completed a set of self-report questionnaires online. Each participant received 10 RMB as an incentive. The invalid responses were detected using 5 pairs of validity check items ( 33 , 34 ). Participants with scores over 3 were excluded due to low-quality responses. This study was approved by the Research Ethics Review Board of the School of Basic Medical Sciences, Hangzhou Normal University.

2.2. Measures

2.2.1. the childhood trauma questionnaire—short form.

The CTS-SF is widely used to assess childhood trauma ( 35 , 36 ). The CTQ-SF comprises 28 items rated from 1 (never true) to 5 (very often true). The higher scores indicate greater severity of childhood trauma the participant experienced. The CTQ-SF had five subscales: emotional abuse (node: CTQ1), physical abuse (node: CTQ2), sexual abuse (node: CTQ3), emotional neglect (node: CTQ4), and physical neglect (node: CTQ5). The Chinese version of the CTQ-SF has been shown to have good psychometric properties ( 35 ). The Cronbach’s alpha for the CTQ-SF in the present study was 0.78.

To compare the network pattern between participants with high and low levels of childhood trauma, the CTS-SF was further used to define participants with high levels of childhood trauma and participants with low levels of childhood trauma. A total CTQ score higher than 1 SD above the mean score of the whole sample was defined as “high levels of childhood trauma” (⩾ 54) and a lower total CTQ score (< 54) was classified as “low levels of childhood trauma” ( 37–39 ).

2.2.2. The patient health questionnaire

The PHQ-9 is a 9-item questionnaire for assessing depressive levels ( 40 , 41 ). Each item is rated on a 5-point Likert scale (from 0 as “no day” to 4 as “almost every day”), with higher scores indicating higher levels of depression. The Chinese version of the PHQ-9 has been found to have good reliability and validity ( 40 ). The Cronbach’s alpha for the PHQ-9 in this study was 0.86. The total score of the PHQ-9 was added as an indicator of depressive levels (node: PHQ) in the network analysis.

2.2.3. The generalized anxiety disorder scale

The GAD-7 is a 7-item questionnaire used for measuring generalized anxiety ( 42 , 43 ). Items of the GAD-7 are rated on a 4-point Likert scale (from 0 as “no day” to 3 as “almost every day”). The higher scores indicate higher levels of anxiety. The Chinese version of the GAD-7 has been found to have good test–retest reliability and convergent validity ( 42 ). The Cronbach’s alpha for the GAD-7 in this study was 0.90. The total score of the GAD-7 was added as an indicator of anxiety (node: GAD) in the network analysis.

2.2.4. The post-traumatic stress checklist—civilian version

The PCL-C is a 17-item self-report scale for measuring post-traumatic stress symptoms ( 44 , 45 ). In the present study, the PCL-C was used to measure the post-traumatic stress level during the COVID-19 pandemic. The PCL-C consists of three subscales, including re-experiencing (node: PCL1), avoidance (node: PCL2), and hyperarousal (node: PCL3). Each item is rated on a 5-point Likert scale (from 1 “not at all” to 5 “extremely bothered”), with higher scores indicating more severe symptoms. The Chinese version of the PCL-C has shown good internal consistency and validity ( 44 ). The Cronbach’s alpha for the PCL-C in the present study was 0.93.

2.2.5. The fear of COVID-19 scale

The FCV-19S is a valid tool for assessing individuals’ fear of COVID-19 ( 46 , 47 ). It contains 7 items with a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The higher scores of the FCV-19S indicate higher levels of fear of COVID-19. The Chinese version of the FCV-19S has been shown to have good reliability and validity ( 46 ). The Cronbach’s alpha for the FCV-19S in the present study was 0.87. The total score of the FCV-19S was added as an indicator of fear of COVID-19 (node: FCV).

2.3. Data analyses

2.3.1. descriptive analyses.

All descriptive statistics were computed in IBM SPSS Statistics 21 (IBM Corp., 2012). The mean and standard deviation of age, education duration, and total and subscale scores of all questionnaires were calculated for the entire sample as well as groups of participants with high and low levels of childhood trauma. We examined gender differences in the scores of questionnaires using independent sample t -tests. Pearson correlation analysis and partial correlation analysis were conducted to investigate the relationship between the scores of the CTQ-SF and other questionnaires’ scores in the entire sample ( Supplementary Table S1 ). Independent sample t -tests were conducted to examine the group differences in fear of COVID-19, depression, anxiety, and post-traumatic level. Moreover, we included age, gender, and years of education as covariates to examine the group differences using analysis of covariance (ANCOVA).

2.3.2. Network estimation

Packages of bootnet ( 48 ), qgraph ( 49 ), and networktools ( 50 ) in R studio software (Version: 2023.06.0 + 421, available at https://posit.co/download/rstudio-desktop/ ) were used to construct networks in our study. We used the Gaussian graphical model as the estimation model. The partial correlation matrix was computed using the Extended Bayesian Information Criterion Graphical Least Absolute Shrinkage and Selection Operator (EBICglasso) procedure to improve the accuracy and interpretability of our network ( 51 , 52 ). Bonferroni correction was applied to control for a false positive rate ( 53 ). Symptoms were represented as the nodes, and correlations between nodes were represented as the edges, ranging from −1 to 1.

2.3.3. Network centrality

R packages of qgraph ( 49 ) and networktools ( 50 ) were used to calculate the centrality of nodes in the networks. Centrality was a measure used in a network to quantify the significance of nodes within that network based on the connectedness and interactions of each node with other nodes. Centrality indices, including strength, closeness, and betweenness, were computed. Expected influence is referred to evaluate the predicted significance of certain nodes in the entire network. It was argued that in a network with both positive and negative edges, the expected influence is more appropriate to assess the nature and strength of the significance of nodes ( 54 ). Hence, we included the expected influence as the fourth centrality index. Results were converted to z -scores to compare different centrality indices on the same scale.

The bridge centrality between clusters of symptoms represented the importance of certain nodes in serving as a connecting link or shared manifestation between various sets of symptoms ( 55 ). Subscales of childhood trauma and PTSD were set as two clusters of symptoms. Depression and anxiety were considered a cluster of symptoms. Finally, fear of COVID-19 was set as an independent cluster of the symptoms. Bridge centrality was calculated to identify nodes that connect symptoms of the four different mental disorders.

2.3.4. Network accuracy and stability

R packages of bootnet (Version 1.5) ( 48 ) and ggplot2 ( 56 ) were used to examine the accuracy and stability of our network. The bootstrapping method was applied with 1,000 iterations. The edge weights accuracy test was conducted to examine the reliability of our network to describe our sample characteristics. The centrality stability test was employed to illustrate the stability of our network across samples, which was quantified by the correlation stability coefficient (CS coefficient). In order to consider a network stable, the coefficient should be at least 0.25 and preferably above 0.5 ( 48 ).

2.3.5. Network comparison tests

Network comparison tests (NCTs) were performed using the R package of NetworkComparisonTest to explore the differences between the two networks constructed by samples of participants with high and low levels of childhood trauma as well as between gender-stratified groups ( 57 ). A two-tailed permutation test ( n  = 10,000) with p  < 0.05 was used to compare the global strength, centrality invariance, and edge weights of the two networks. Bonferroni correction was applied in multiple comparisons to control for a false-positive rate ( 53 ).

3.1. Sample characteristics

Demographic information and a descriptive summary of the questionnaires’ scores are shown in Table 1 . Based on the scores of the CTS-SF, 125 participants had high levels of childhood trauma and the rest of the participants were grouped as having low levels of childhood trauma ( n  = 1,122). The independent sample t -test found that participants with high levels of childhood trauma had significantly higher levels of depression, anxiety, fear, and post-traumatic stress symptoms for COVID-19. The results remained unchanged after controlling for age, gender, and years of education (see Supplementary Results and Supplementary Table S2 ). Male participants had significantly higher levels of childhood trauma and post-traumatic stress symptoms for COVID-19 and lower levels of depression and anxiety than female participants (see Supplementary Table S5 ).

Demographic information and descriptive statistics of questionnaire scores.

High CTQ, participants with high levels of childhood trauma; Low CTQ, participants with low levels of childhood trauma; Edu, education duration; CV, fear of Coronavirus disease 2019 (COVID-19) scale; PHQ, patient health questionnaire; GAD, generalized anxiety disorder questionnaire; PCL, post-traumatic stress disorder checklist—civilian; Total, total score of the post-traumatic stress disorder checklist—civilian; PCL1, re-experiencing; PCL2, avoidance; PCL3, hyperarousal; CTQ, childhood trauma questionnaire; CTQ1, emotional abuse; CTQ2, physical abuse; CTQ3, sexual abuse; CTQ4, emotional neglect; CTQ5, physical neglect.

3.2. Network estimation

The network visualization of the entire sample ( n  = 1,247) with 11 nodes is shown in Figure 1 . As expected, positive correlations were found between the nodes that represented the subscales, indicating relatively strong “within-subscale” edges. As for the “between-scale” edges, the strongest one was the edge between the PHQ (the score of depression) and the GAD (the score of anxiety) (regularized partial correlation = 0.57), followed by the edge between the FCV (the score of fear of COVID-19) and the PCL1 (the score of the re-experiencing subscale) (regularized partial correlation = 0.29). Moreover, the PCL3 (the score of the hyperarousal subscale) was positively connected to the PHQ (the score of depression) and the GAD (the score of anxiety) (the partial correlations were 0.22 and 0.19, respectively). The CTQ1 (the score of emotional abuse subscale) was found to be positively connected to the PHQ (the score of depression), the GAD (the score of anxiety), and the PCL2 (the score of the avoidance subscale), and the CTQ5 (the score of the physical neglect subscale) was found to be positively connected to the PCL3 (the score of the hyperarousal subscale).

(A) Visualization of the regularized network for the entire sample. Clusters of symptoms are represented by different colors. The gray node represents the fear of COVID-19. The light blue nodes represent depression and anxiety. The green nodes are a combination of traumatic symptoms post-COVID-19. Symptoms of childhood trauma are represented by the yellow nodes. Blue lines mean positive connections between nodes, whereas red lines mean negative connections. Thicker and shorter edges represent larger partial correlations. (B) Centrality indices plot include strength, betweenness, closeness, and expected influence. Values were converted to standardized z -scores. FCV, fear of Coronavirus disease 2019 (COVID-19) scale; PHQ, patient health questionnaire; GAD, generalized anxiety disorder questionnaire; PCL, post-traumatic stress disorder checklist—civilian; CTQ, childhood trauma questionnaire.

3.3. Network centrality

Figure 1 and Table 2 display the four centrality indices of the 11 nodes, which reflect the structural position and significance of each node. The CTQ1 (the score of emotional abuse subscale), the CTQ2 (the score of the physical abuse subscale), and the PCL2 (the score of the avoidance subscale) were the top three nodes in strength centrality, indicating that these nodes had the strongest connections with other nodes in the network. As for the betweenness centrality, the PCL2 (the score of avoidance subscale), the CTQ1 (the score of emotional abuse subscale), and the PHQ (the score of depression) had the most interactions with other nodes in the network. Regarding the closeness centrality, the PHQ (the score of depression), the PCL3 (the score of the hyperarousal subscale), and the CTQ1 (the score of emotional abuse subscale) had the shortest average distance with the other nodes, which suggested that these nodes were more closely connected with the other nodes in the network.

Centrality and expected influence of nodes in the network.

FCV, fear of Coronavirus disease 2019 (COVID-19) scale; PHQ, patient health questionnaire; GAD, generalized anxiety disorder questionnaire; PCL, post-traumatic stress disorder checklist—civilian; CTQ, childhood trauma questionnaire.

The results of the bridge centrality test are shown in Figure 2 and Supplementary Table S3 . The PCL3 (the score of the hyperarousal subscale) had the greatest centrality in both the strength and expected influence, showing the occurrence of hyperarousal in all of the four clusters of symptoms.

Bridge centrality indices plots of strength (left) and expected influence (right) for the entire sample ( n  = 1,247). FCV, fear of Coronavirus disease 2019 (COVID-19) scale; PHQ, patient health questionnaire; GAD, generalized anxiety disorder questionnaire; PCL, post-traumatic stress disorder checklist—civilian; PCL1, re-experiencing; PCL2, avoidance; PCL3, hyperarousal; CTQ, childhood trauma questionnaire; CTQ1, emotional abuse; CTQ2, physical abuse; CTQ3, sexual abuse; CTQ4, emotional neglect; CTQ5, physical neglect.

3.4. Network accuracy and stability

Figure 3 presents the network stability and accuracy test of the entire sample. Results showed a strength centrality stability coefficient of 0.75, meaning excellent stability of the network. Additionally, as illustrated in Figure 3 , the accuracy test showed small confidence intervals (CIs), indicating a reliable estimation of the edge weights.

(A) Bootstrapped confidence intervals (CIs) of edge weights for the entire sample ( n  = 1,247). Dots fitted on the red line are sample edge weights and on the black line are bootstrapped means. The gray area indicates the 95% CIs. (B) Average correlations of strength centrality with the original sample when n % of sample cases were dropped. Lines indicate the means and the areas indicate the range from the 2.5 quantile to the 97.5 quantile.

3.5. Network comparison test

The visualized networks of the sample with high ( Figure 4A ; n  = 125) and low ( Figure 4B ; n  = 1,122) levels of childhood trauma as well as their centrality test are presented in Figure 4 . The centrality and expected influence of the network for the two groups are shown in Supplementary Table S4 . The global strength invariance test found no significant differences between the two networks (the strength difference was 0.28, p  = 0.645), indicating that the two networks shared similar global strength of connections. The network invariance test also found no significant differences between the two networks ( M  = 0.27, p  = 0.309). However, the node with the strongest betweenness for participants with high levels of childhood trauma was the CTQ1 (the score of the emotional abuse subscale), while the PCL3 (the score of the hyperarousal subscale) was the node with the strongest betweenness in the network for participants with low levels of childhood trauma. Moreover, the edge invariance test shows significant differences in FCV-CTQ1, CTQ3-CTQ4, and CTQ4-CTQ5. In addition, the network comparison test did not find a significant difference between the male and the female groups ( Supplementary Table S6 ).

(A) Network visualization of people with high levels of childhood trauma ( n  = 125). (B) Network visualization of people with low levels of childhood trauma ( n  = 1,122). The gray nodes represent the fear of COVID-19. The light blue nodes represent depression and anxiety. The green nodes are a combination of traumatic symptoms post-COVID-19. Symptoms of childhood trauma are represented by the yellow nodes. Blue lines are positive correlations between nodes, and red lines are negative correlations. The thicker and shorter the lines, the stronger and closer the connections. FCV, fear of Coronavirus disease 2019 (COVID-19) scale; PHQ, patient health questionnaire; GAD, generalized anxiety disorder questionnaire; PCL, post-traumatic stress disorder checklist—civilian; CTQ, childhood trauma questionnaire. (C) Centrality indices plot, including strength, betweenness, closeness, and expected influence, of the two networks. The red line represents individuals with high levels of childhood trauma and the blue line represents individuals with low levels of childhood trauma. Centrality values are presented in z -scores.

4. Discussion

Applying network analysis, the network structure between various types of childhood trauma and mental health problems during the COVID-19 pandemic was modeled. Consistent with our hypothesis, we found that the nodes of childhood trauma were connected to depression, anxiety, and post-traumatic stress level. Moreover, the nodes of childhood trauma showed the strongest strength centrality, indicating the important role of childhood trauma in the network. The network comparison test between participants with high and low levels of childhood trauma revealed different network structures. Furthermore, compared with participants with low levels of childhood trauma, participants with high levels of childhood trauma showed significantly higher levels of depression, anxiety, fear, and post-traumatic stress for COVID-19. Our findings suggest that individuals who have experienced childhood trauma may be more susceptible to experiencing these mental health difficulties during the COVID-19 pandemic.

Childhood trauma (the CTQ1 node and the CTQ2 node) was found to have the strongest strength centrality in the network based on the whole sample, indicating that childhood trauma played a central role in the network structure and highlighting the significant impact that childhood trauma can have on mental health outcomes during the pandemic. Our findings are consistent with previous studies which found positive correlations between childhood trauma and mental health problems during the COVID-19 pandemic ( 6 , 58 ). Regarding the betweenness centrality and the closeness centrality, the findings suggested that the post-traumatic stress level (the PCL2 node and the PCL3 node), depression (the PHQ node), and childhood trauma (the CTQ1 node) played an important role in the network. These findings are in line with previous findings ( 59 , 60 ). Childhood trauma we measured includes emotional abuse (the CTQ1 node), physical abuse (the CTQ2 node), sexual abuse (the CTQ3 node), emotional neglect (the CTQ4 node), and physical neglect (the CTQ5 node). Our findings found that emotional abuse has the highest centrality indexed in the whole network. Notably, individuals with more childhood trauma (especially emotional abuse) have been found to experience more psychological distress during the coronavirus ( 61 ). Therefore, interventions on emotion regulation mechanisms ( 62 ) may have potential effects on mental health for individuals with childhood trauma during the COVID-19 pandemic. Although studies using network analysis to examine the impacts of childhood trauma on mental health were scarce, some authors have adopted this approach to explore the impacts of the COVID-19 pandemic on mental health ( 63–66 ). For example, Zavlis et al. ( 63 ) included depression, anxiety, trauma symptoms, COVID-specific anxiety, and viral exposure to construct the network. They found no associations between viral exposure and symptoms, which may support our findings of weak connections between the FCV node with other nodes ( 63 ). Furthermore, Ventura-Leon et al. ( 64 ) revealed that the symptoms of depression and anxiety were the most central symptoms in their network. Meanwhile, they found that the depressive symptoms bridged the symptoms of stress and anxiety ( 64 ), which was similar to our network structure. Bridge centrality is usually used to understand comorbidity in network analysis ( 55 ). Hyperarousal had the highest bridge centrality in our study, demonstrating its significance in the development of both fear of the pandemic, depression, anxiety, and PTSD problems and its high co-occurrence with childhood maltreatment. This result was in line with the study, which found that hyperarousal symptoms have a mediation effect between childhood maltreatment and depression ( 67 ). Our findings indicate that hyperarousal might be a risk factor for mental health problems.

Additionally, when comparing the network structures between participants with high and low levels of childhood trauma, different structure was observed. This suggests that the presence and severity of childhood trauma can lead to variations in the network connections and dynamics of mental health problems during the pandemic. In terms of group effect, participants with high levels of childhood trauma displayed significantly more mental health problems compared with those with low levels of childhood trauma. Such findings are consistent with previous findings, which demonstrated more trauma symptoms and mental distress in individuals with childhood abuse ( 60 , 68 ). Moreover, it has been widely recognized that childhood trauma is a risk factor contributing to the development of mental disorders, such as affective disorders, post-traumatic stress disorder, and schizophrenia ( 15 , 69 , 70 ).

It is important to note that this study has several limitations. First, the data collected relied on self-report measures, which may be subject to recall bias or social desirability bias. Second, the participants recruited in our study were college students. The findings may not be generalizable to other populations. Future research should aim to replicate these findings in diverse samples. Finally, the sample size of the group with high levels of childhood trauma was relatively small. A larger sample size is recommended for future studies to conduct network comparison tests.

In conclusion, the present study applied network analysis to investigate the intercorrelations of childhood trauma, depression, anxiety, fear, and post-traumatic stress levels related to COVID-19. The findings support the specific links between childhood trauma and mental health problems. These findings underscore the critical need for targeted interventions and support for individuals who have experienced childhood trauma, particularly during times of the COVID-19 pandemic.

Data availability statement

Ethics statement.

The studies involving humans were approved by the Research Ethics Review Board of the School of Basic Medical Sciences, Hangzhou Normal University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

X-lC and HHei collaboratively designed the study. JX and HHua recruited participants and collected data. LZ analyzed the data. X-lC, LZ, and JX wrote the drafts of the manuscript. PF, MZ, and HHei interpreted the findings and commented on the manuscript critically. All authors contributed to the article and approved the submitted version.

This study was supported by a grant from the Research Project of Shanghai Science and Technology Commission (20dz2260300), the Fundamental Research Funds for the Central Universities, and the Starting Research Fund from Hangzhou Normal University.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors would like to thank all the participants who took part in the studies.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1251473/full#supplementary-material

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• Published: 29 April 2024

The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China

• Ningdan Fan 1   na1 ,
• Huanhuan Fan 1   na1 ,
• Ruiqing Luo 1 , 2 ,
• Yu Wang 1 ,
• Yushun Yan 1 ,
• Xiao Yang 1 ,
• Min Wang 1 ,
• Yikai Dou 1 ,
• Rongjun Ni 1 ,
• Jinxue Wei 1 ,
• Wanqiu Yang 3 , 4 &
• Xiaohong Ma 1  

Scientific Reports volume  14 , Article number:  9797 ( 2024 ) Cite this article

Metrics details

• Human behaviour
• Post-traumatic stress disorder

Childhood trauma is strongly linked to emotional distress. However, few studies have explored the impact of sense of coherence (SOC) on the relationship between childhood trauma and emotional distress in college students. This study aimed to explore its impact on the relationship between childhood trauma and emotional distress. Analyzing data from 2307 Chinese college students, we found that SOC moderated the association between childhood trauma and anxiety/depression levels. Females showed higher SOC and lower anxiety/depression despite experiencing more childhood trauma. Multiple linear regression revealed that anxiety was negatively associated with SOC( P  < 0.001) and grade( P  = 0.027), and positively with childhood trauma( P  < 0.001) and male gender( P  = 0.004). Similarly, the depression exhibited similar associations. SOC moderated negatively the relationship between CTQ and anxiety, as well as between CTQ and depression. Childhood trauma is associated with increased emotional distress risk among college students, but a strong SOC can reduce this risk.

Introduction

Leaving home to attend post-secondary school can pose significant challenges, including stress, depression, and anxiety, particularly for freshman, as they may struggle to adjust to their new environment 1 . Various external factors can contribute to emotional problems among college students, including financial hardships, social isolation, relationship challenges, discrimination and physical health problems 2 , 3 . The pressure to obtain a college degree, often viewed as a key marker to success, further complicates these challenges 1 . The internal factors may arise from childhood trauma, which could manifest as a sense of displacement upon leaving home for college 4 .

It is during this developmental transition that the consequences of childhood emotional maltreatment may become salient for college students 5 . College students who have experienced child maltreatment may have developed maladaptive coping strategies in an effort to cope with the effects of their past abuse 5 , 6 . For example, college students who experience emotional neglect in childhood may feel that they are poor and unworthy of being loved and have difficulty trusting others. Therefore, they are unable to participate well in interpersonal interactions, which means that they engage in fewer prosocial behaviors in college.

The concept of sense of coherence (SOC) encapsulates an individual’s cognitive predisposition towards life, encompassing the perception of life events as identifiable, foreseeable, and explicable. It entails a belief in one’s capacity to navigate stress through internal and external resources, viewing challenges as avenues for growth and achievement 7 . Collectively, these facets form the holistic SOC framework, shaping individuals’ cognitive evaluations of life occurrences and guiding their coping mechanisms and psychological responses in the face of adversity 8 . Previous studies have found that individuals with higher SOC levels tend to report fewer negative life events and psychological symptoms. Furthermore, while a greater number of negative life events correlated with a higher incidence of physical disorders in general, this association was particularly evident among individuals with a weaker SOC 9 .

Resilience refers to an individual’s ability to recover and adapt in the face of adversity, stress, or trauma. There is a close relationship between SOC and resilience 10 . SOC is a resource that enhances resilience to use adaptive coping strategies to buffer the negative effects of stress, developing positive subjective well-being 8 . Specifically, individuals with a higher SOC tend to better cope with life challenges because they tend to view life events as comprehensible, manageable, and meaningful. This positive cognitive orientation helps them maintain psychological stability, thereby mobilizing resources, seeking support, and ultimately overcoming difficulties more effectively. Therefore, SOC can be seen as an important internal factor in the development of resilience, promoting individuals’ adaptation and growth in the face of adversity 8 . Given the prevalence of childhood trauma and emotional problems in college students, it is imperative that we continue to examine the role of SOC as a promotive and protective factor.

Childhood maltreatment is a significant concern in China. Previous studies have found that 36.6% of the population reported experiencing physical child abuse 11 . Additionally, a study specifically focused on the prevalence of childhood sexual abuse of college students was reported to be 24.8% in female and 17.6% in male participants, respectively 12 . The most common types of childhood trauma reported in Chinese college students were emotional neglect, physical neglect, and psychological abuse 13 , 14 , 15 , 16 . Furthermore, childhood maltreatment has also been identified as a risk factor of relevant psychological outcomes in college students. Previous studies have consistently found that the experience of physical and sexual abuse in childhood would increase the risk of various psychological and behavioral disorders, such as depression, anxiety, substance abuse and personality disorders 17 , 18 , 19 , 20 , 21 . Subsequent research has found similar consequences for emotional abuse (psychological abuse but no physical harm) and emotional neglect (emotional deprivation or lack of emotional support), which confer psychological and behavioral problems such as depression. It is important that effective strategies are implemented to prevent and address childhood trauma, as well as to provide support and resources for those who have experienced it.

However, to our best knowledge, existing literature did not thoroughly investigate this hypothesis among college students through the lens of SOC, especially in China during COVID-19 restrictions. Therefore, this study aims to examine the effects of childhood traumatic experiences on negative emotions including depression and anxiety, and furthermore, to explore the role of SOC in this process among Chinese college students.

Materials and methods

Participants.

This cross-sectional study was conducted among college students in southwest China from December 2020 to January 2021. The survey was created and distributed using an online survey website ( http://www.wjx.cn ). Inclusion criteria were as follows: undergraduates in China took part in the study voluntarily and native Chinese speakers. The exclusion criteria were as follows: the questionnaire information is incomplete or the occupation is not a student. A total of 2334 participants were enrolled in this study. Among them, 19 questionnaires were excluded due to occupation not being categorized as “student,” and 8 were disqualified due to missing general information pertinent to the study content, including gender and age. Consequently, 2307 questionnaires were deemed valid, resulting in an effective rate of approximately 99%.

All participants were provided with a comprehensive study description and provided informed consent online. The study was approved by the corresponding Institutional Review Board (IRB) of the Institute of Psychology (A20021), Chinese Academy of Sciences, and the whole process was performed in conformity with the Declaration of Helsinki.

Assessments

Sense of coherence (soc).

The sense of coherence (SOC) scale used in this study is an abbreviated version of the SOC-13 self-report questionnaire, which measures the level of SOC 7 , 22 . This questionnaire is a 7-point Likert scale which is semantic and differential scale with a positive attribute at one endpoint and a negative attribute at the other endpoint. The SOC total score ranges from 13 to 91, with higher scores indicating a stronger sense of coherence. We used the total score for analysis in our main text. The Chinese version of the SOC scale has satisfactory reliability as well as convergent and discriminant validity 23 , 24 , 25 . The internal consistency for SOC was pretty good in this sample (ω = 0.89, Cronbach’s α = 0.794) 26 , 27 .

Childhood trauma questionnaire (CTQ)

The CTQ is a 28-item self-report questionnaire which was used to evaluate traumatic experiences in childhood (before 16 years old), including various forms of abuse and neglect 28 , 29 . The CTQ comprises 25 clinical items, where scores are counting towards the total, and 3 validity items. It is a 5-point Likert scale ranging from 1 (“never”) to 4 (“always”). We used the total score of CTQ for analysis in our main text, five subscales were also analyzed in our Supplementary materials. The CTQ has good reliability and validity in Chinese college student samples, and exhibited high internal consistency in this study (ω = 0.96, Cronbach’s α = 0.845) 27 , 30 , 31 .

Generalized anxiety disorder questionnaire (GAD-7)

The GAD-7 scale is a 7-item version used to screen for generalized anxiety disorder (GAD) and assess its severity in respondents over the past two weeks 32 . The scale is a 4-point Likert scale (ranging from 0- “not at all” to 3- “nearly every day”). The cutoff point score of the scale is 5 33 . In this study, internal consistency of GAD-7 was excellent 34 (ω = 0.94, Cronbach’s α = 0.930) 27 .

Patient health questionnaire 9 (PHQ-9)

The PHQ scale is a 9-item version, which is widely used to measure for assessing depression severity over the past two weeks with good reliability and validity. The scale is a 4-point Likert scale (ranging from 0- “not at all” to 3- “nearly every day”). The cutoff point score of the scale is 5 35 . In our sample, internal consistency of PHQ-9 was excellent (ω = 0.93, Cronbach’s α = 0.914) 27 .

Statistical analysis

Statistical analyses were performed by the Statistical Package for the Social Sciences (SPSS) 24.0 and R software (version 4.6), and a significance level of 0.05 was set for all two-tailed tests. T-tests were used to assess the statistical differences of sample characteristics between male and female. To explore the overall relationship among multiple variables, we applied path analysis to test the relationship among interrelated study variables in a hypothesized model. In our model, GAD-7 and PHQ-9 were modeled as outcome variables, while CTQ was modeled as an observed variable, and SOC was modeled as a moderator. Path analysis estimated both the direct and indirect effects one variable had on the outcome variable. Third, we conducted an analysis of the moderating effect 36 , which takes CTQ as the independent variable, GAD-7 or PHQ-9 as the dependent variable, and SOC as the moderating variable among them, so as to further explore the impact of SOC on the relationship between CTQ and GAD-7/PHQ-9. Multiple regression analysis was performed to examine the relationship between mental health problems, SOC, and other causes. A two-sided p < 0.05 is regarded as statistically significant, with * indicating p < 0.05, whereas **p < 0.01, ***p < 0.001 in the current study.

Sociodemographic characteristics

A total of 2307 college students were included in the study, comprising 1012 freshman and 1295 upperclassmen (723 sophomores, 555 juniors, and 17 seniors) from 16 colleges in Southwest China and eastern coastal areas. Of the participants, 1263 (54.7%) were male, and 1044 (45.3%) were female. The mean (SD) age of participants was 19 (1.29) years (range: 17–26), with no significant gender difference (Table 1 ).

Gender differences in clinical characteristics

Females have higher levels of SOC than males, particularly in comprehensibility and manageability, while no significant gender difference is observed in meaningfulness. Moreover, females have more significant childhood trauma than males, including physical abuse, sexual abuse, emotional neglect and physical neglect, see Table 1 .

Multiple linear regression models

After controlling for age, gender and grade, childhood trauma was significantly associated with the severity of both anxiety ( P  < 0.001) and depression severity ( P  < 0.001). Conversely, students with low SOC were more likely to report symptoms of anxiety ( P  < 0.001) or depression ( P  < 0.001) than those with medium or high SOC. In addition, freshmen were at a higher risk of experiencing anxiety compared to upperclassmen ( P  = 0.027). Males have higher levels of anxiety ( p  = 0.004) and depression ( P  = 0.035) than females (Fig.  1 ).

Multiple linear regression analysis of GAD-7/ PHQ-9 and five factors. GAD-7, Generalized Anxiety Disorder Questionnaire 7; PHQ-9 Patient Health Questionnaire 9, SOC sense of coherence, CTQ childhood trauma questionnaire.

In our path analysis, significant mediating effect was also observed for SOC in the relationship between CTQ and GAD-7/PHQ-9, please see Supplementary Table S2 , however, we did not focus on this result in our discussion because we believe that the moderation effect is more important.

The moderating effects of SOC

Our results showed that SOC had negative moderating effects on the association between CTQ on GAD-7 (T = − 2.905, P  < 0.001) and PHQ-9 (T = − 3.930, P  < 0.001) (Table 2 and Table 3 ). This indicates that SOC can weaken the effect of CTQ on depression and anxiety among college students (Fig.  2 A, B ). As shown in the moderating effect diagram (Fig.  2 C, D ), participants with higher scores of SOC experienced a dampened influence of CTQ on anxiety and depression, and vice versa.

Moderating effect of SOC on the relationship between CTQ, GAD-7 ( A , C ) and PHQ-9 ( B , D ). SOC sense of coherence, GAD-7 generalized anxiety disorder questionnaire 7, PHQ-9 patient health questionnaire 9, CTQ childhood trauma questionnaire.

A major finding in this study revealed that a childhood trauma seems to sensitize individuals. When other negative events or stress occur later in their lifetimes, they are then more prone to develop emotional distress. Our results suggest that this sensitization is partially explained by a weakening of their SOC, which is consistent with our hypothesis.

In our sample, females had more significant childhood trauma than males, which was in line with the previous studies 37 , 38 . Previous research has indicated that female may be more inclined to report certain types of childhood trauma, while estimates of the male sexual abuse may be influenced by under-reporting due to a reluctance to disclose such abuse 39 . Besides, consistent with the previous study, we observed that childhood trauma was one of the risk factors for depression and anxiety 29 . Researchers proposed that early adversity may lead to neural and social cognitive changes that affect the formation and enhancement of psychological congruence in subjects and may constitute a pathophysiological process underlying psychiatric disorders such as depression and bipolar disorder 40 , 41 . This assumption of causality is also supported by prospective studies showing that the number of people with psychiatric disorders would be reduced by one-third if childhood trauma was removed from the population as a risk factor 42 . These studies provide further support for the impact of childhood trauma on negative emotion and even psychiatric disorders such as depression and bipolar disorder.

The present study also found that female have higher SOC than male, consistent with previous study on adolescents and teachers, which also reported sex-specific differences in SOC 43 , 44 . Perhaps it could be attributed to females’ greater attentiveness to their thoughts and more effective self-expression. They tend to utilize available resources effectively to cope with pressure and alleviate its impact, even when experiencing similar stressors as males. This confluence of evidence underscores the need for continued exploration into potential gender disparities in the current level of SOC. This study also showed a significant negative correlation between undergraduate students’ SOC and their level of depression and anxiety. This is consistent with the results of previous studies demonstrating SOC significantly negatively predicted their anxiety and depression levels 45 , 46 . The relationship between SOC and negative emotions such as depression and anxiety illustrates that when individuals can show adequate and comprehensive awareness of various stresses in the outside world, are able to face and solve problems actively, and maintain confidence in life persistence, the probability that negative emotions will further progress to disease is reduced. This illustrates that the effect of cognition on negative emotions is not unilateral and involves factors such as comprehension, prediction, etc.

Our result shows that SOC exhibited a notable negative moderating effect on depression and anxiety among college students,which highlighted the pivotal role of SOC in mitigating emotional distress, aiming to offer fresh perspectives for addressing mental health concerns within this demographic. Feldt et al. proposed that a heightened level of SOC hinges upon two factors: the availability of ample resources to navigate stress and the capacity to mobilize those resources to effectively address stressors. These resources encompass physical, emotional, and cognitive elements that facilitate individual growth 47 . Childhood and adolescence mean the stage at which individual development is critical. Other researchers insisted that parenting played a pivotal role in shaping adolescents’ SOC 48 , 49 , 50 . Family resources and climate have a substantial influence on the perception of SOC. A good family environment and parent–child relationship are important sources of emotional resources during childhood and adolescence. Parents’ own educational attainment and ways of parenting then provide resources for children’s and adolescents’ cognitive development. In contrast, as a structural linear equation modeling about the effects of varied variables on students’ level of SOC indicated, at-risk home environments struggle to provide the developing child and adolescent with the required resources, and the emergence of cumulative risk further compromises the ability to unearth and mobilize resources during childhood and adolescence, resulting in impaired development at the level of their SOC 50 . This enlightens us that more work is needed in the future to develop children’s and adolescents’ cognitive abilities and improve parents’ educational levels and cognitive abilities. Group interventions are a well-established method for strengthening college students’ SOC. A randomized controlled trial using a CBT-based group counseling program showed significant improvement in students’ SOC scores 51 . This highlights the potential of integrating stress coping and emotion management training into the curriculum. Additionally, training programs for both students and faculty on these skills could foster a more supportive learning environment and further enhance SOC levels 52 . Research on technologies to improve SOC in college students is ongoing 53 .

While our sample was collected during the COVID-19 pandemic, this study focuses on the independent relationship between childhood trauma and emotional distress in college students during this period. In another large-scale survey of college students in China, acute stress, anxiety and depressive symptoms are prevalent during the COVID-19 pandemic. Multiple epidemic and psychosocial factors, such as family members being infected, massive media exposure, low social support, senior year and prior mental health problems were associated with increased risk of mental health problems 54 . The COVID-19 pandemic can be seen as a major stressful event, and SOC also has a protective effect on the emotions of college students during this period. It is noteworthy that certain pertinent studies have indicated that the effect of SOC on depression was modified by negative epidemic information exposure. With the increase of negative epidemic information exposure, the predictive effect of SOC on depression is increasing gradually. These findings demonstrated that negative epidemic information exposure was associated with an increased psychological distress in the sample. A high SOC also played a certain protective role in the adaptation of college students in the post-epidemic period 55 .

The current cross-sectional study has limitations in its capacity to examine the temporal relations among childhood trauma, SOC and negative emotions. Longitudinal analysis is needed for comprehensively understanding the effects of the study variables, and future studies would benefit from more extended analysis. Secondly, utilizing a more comprehensive and objective measure of SOC could provide a more nuanced insight into the relationships explored in this study. Additionally, the attempt at a full SEM analysis resulted in a poor model fit in this study. We acknowledge that relying solely on the structural model for our analysis may lead to limited interpretation of the results, as the estimates derived from this approach could be based on an imperfect measurement model. Consequently, the interpretation of our findings should be conducted with caution. Finally, due to the relatively homogenous nature of the undergraduate sample, caution should be exercised in generalizing the findings to all college students. Future studies with more diverse and representative samples are warranted, and our endeavor will involve collecting data from multiple colleges across the nation for a larger-scale survey. Our upcoming research will strive to dig deeper into exploring the contributing factors involved.

This study emphasizes that childhood trauma can increase the risk of emotion distress, and the SOC negatively moderates this process, theoretically offering a certain level of protection for college students’ mental health. University psychological education is crucial in equipping students with specific skills to enhance their SOC and mental health.

Data availability

The datasets generated and analyzed during the present study are not publicly available due to no permission from the ethics committee, but are available from the corresponding author on reasonable request.

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Acknowledgements

This work was supported by the Ministry of Science and Technology of the People’s Republic of China (No. 2022ZD0211700), the National Natural Science Foundation of China (No. 82001432), the Sichuan Science and Technology Program (Nos. 2022YFS0346, 2022YFS0348), the 135 Project from West China Hospital of Sichuan University (Nos. 2023HXFH006, 2023HXFH040), China Postdoctoral Science Foundation (Nos. 2020TQ0213, 2020M683319) and Sichuan University (No. 2022SCUH0023).

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These authors contributed equally: Ningdan Fan and Huanhuan Fan.

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Mental Health Center and Laboratory of Psychiatry, West China Hospital of Sichuan University, Chengdu, 610041, China

Ningdan Fan, Huanhuan Fan, Ruiqing Luo, Yu Wang, Yushun Yan, Xiao Yang, Min Wang, Yikai Dou, Rongjun Ni, Jinxue Wei & Xiaohong Ma

Chongqing Mental Health Center, Chongqing, China

Ruiqing Luo

School of Ethnology and Sociology, Yunnan University, Kunming, China

Wanqiu Yang

School of Medicine, Yunnan University, Kunming, China

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All authors have made significant scientific contributions to this manuscript. N.D.F., W.Q.Y., and X.H.M. conceived and designed the data collection. Y.K.D., X.Y., Y.S.Y., and Y.W. performed the data curation. J.X.W., M.W., and R.J.N. analyzed the data. H.H.F., N.D.F., R.Q.L., and X.H.M. wrote the manuscript. All authors reviewed the manuscript.

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Fan, N., Fan, H., Luo, R. et al. The impact of childhood trauma on emotional distress and the moderating role of sense of coherence among college students in China. Sci Rep 14 , 9797 (2024). https://doi.org/10.1038/s41598-024-60537-1

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DOI : https://doi.org/10.1038/s41598-024-60537-1

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