98. The Effects of Adverse Childhood Experiences and Childhood Socioeconomic Disadvantage on Depression and Suicidality in Adolescence and Emerging Adulthood: A Scoping Review

Adverse childhood experiences (ACEs) and socioeconomic disadvantage (SED) in childhood have each been associated with increased risk of poor mental health outcomes during adolescence and emerging adulthood. Previous research also suggests that ACEs are more likely to occur in populations with greater SED. However, competing theories exist about the exact nature of the associations among all three factors, thereby impacting our ability to address the current youth mental health crisis. The purpose of this scoping review is to analyze the state of the literature on the association between ACEs, childhood SED, and adolescent/emerging adult depression and suicidality. We conducted a systematized search of four databases (PubMed, CINAHL, PsycINFO, Scopus) using database-specific search strings including terms like “adverse childhood experiences,” “poverty,” “socioeconomic status,” “depression,” and “suicide.” We also hand searched through reference lists of identified articles and using the discovery engine ResearchRabbit.ai. Two independent reviewers screened titles and abstracts. Data extraction was conducted using a custom table and critical appraisals for quality and reporting transparency were completed for each article. Out of 4,605 unique abstracts screened, 382 articles were read in their entirety and 16 relevant articles were identified for inclusion, including six studies based on international samples and four studies using nationally-representative data of the United States. Sample sizes ranged from 223 to 362,663 participants. There was notable heterogeneity across measures used to assess SED, ACEs and depression/suicidality outcomes. Results were mixed across all studies. Six studies support the idea that increased ACEs and childhood SED exhibit an additive effect on depression/suicidality outcomes and nine studies support that ACEs primarily mediate the association between childhood SED and depression/suicidality outcomes. Four studies assessed for a synergistic relationship between childhood SED and ACEs on depression/suicidality outcomes with two finding that childhood SED significantly modifies the association between ACEs and depression/suicidality outcomes. This review supports that a significant association exists between ACEs and depression/suicidality outcomes despite controlling for childhood SED; however, there is inconclusive evidence regarding the nature of childhood SED when it is introduced into the relationship. Future research including more robust assessments of childhood SED, more consistent measurement of ACEs, and more sophisticated analytic approaches may contribute to a clearer understanding of the complex relationship between childhood SED, ACEs and depression/suicidality. Such clarification is critical for determining future research and policy agendas aimed at preventing and treating poor mental health in youth and emerging adults.