Associations between positive childhood experiences and emotion regulation skills among young adults in Mainland China
Zhiyuan Yu, PhD RN CNE¹, Annika Limson, BA², Krista Woodward, MPH MSW³, Laura Kubzansky, PhD⁴, Farah Qureshi, ScD⁵, Lin Wang, PhD RN⁶
1 – Johns Hopkins School of Nursing
2 – Johns Hopkins School of Education
3 – Johns Hopkins School of Public Health
4 – Harvard School of Public Health
5 – Johns Hopkins School of Public Heath
6 - Shanghai Jiaotong University School of Nursing
Disclosure
- This international collaborative study was funded by the Shanghai Jiao Tong University Innovation Grant and was approved by the Institutional Review Board at Shanghai Jiao Tong University
- Data for this study was collected and shared by study team in Shanghai Jiao Tong University, data analysis and manuscript/presentation preparations were completed collaboratively with study team in Johns Hopkins University.
- There is no conflict of interest, or disclosing any conflict of interest that may exist
Background – ACEs and PCEs
- Emotional Regulation
- Cognitive Reappraisal
- Taking a step back and recognizing positives
- Expressive Suppression
- Includes ruminating tendencies
Gaps in knowledge
- Role of PCEs
- Non-US samples
- Impact on ER modifiable by interventions
Purpose: To examine the relationships between ACEs, PCEs and ER
(a) Correlations between numbers of ACE and PCE exposures with ER
H1: greater exposure to ACEs will be associated with less adaptive ER strategies (i.e., greater emotion suppression and less cognitive reappraisal)
H2: greater exposure to PCEs will be associated with more adaptive ER strategies (i.e., greater cognitive reappraisal and less emotion suppression)
(b) The extent to which PCEs effect of ER in the context of ACEs
H3: greater exposure to PCEs will be associated with more adaptive ER strategies, even after adjusting for ACEs
Methods
- A cross-sectional design
- August – November 2020
- Mainland China
- Convenience and snowball sampling
- Eligibility
- 18 – 35 years old
- Enrolled in an undergraduate or graduate program
- Agreed to participate
- Recruited Virtually
Methods
- 9,468 eligible participants completed the survey
- Covariates
- Age, gender, year in university, marital status
- Data Analysis
- SPSS 27
- Descriptive Statistics
- Correlations (H1 and H2)
- Multiple regression analysis (H3)
Study Variables | Measures | Description | Psychometric Properties |
Adverse Childhood Experiences (ACEs) | The Simplified Chinese version of ACE-International Questionnaire (SC-ACE-IQ; WHO, 2016) | 12 categories of childhood adversities; total score 0-12; higher scores, higher exposure to ACEs | Test-retest reliability over 2-wk in this sample, ICC=0.88 |
Positive Childhood Experiences (PCEs) | The Simplified Chinese version of Positive Childhood Experiences Scale (C-PCEs; Bethell et al., 2019) | 9 categories of positive childhood experiences; total score 0-9; higher scores, higher exposure to PCEs | Cronbach’s α = 0.72; test-rest reliability, ICC=0.75 in this sample |
Emotional Regulation (ER) | The Simplified Chinese version of the Emotional Regulation Questionnaire (ERQ; Gross & John, 2003) | 6 items in the cognitive reappraisal domain, 4 items in the suppression domain; 7-point Likert scale; 0 (strongly disagree) - 7 (strongly agree); higher the score (mean score) in each category, greater use of the ER domain | The internal consistency of entire ERQ, reappraisal domain, and suppression domain were 0.78, 0.85, and 0.78, respectively in this sample |
Results 1: Participant Characteristics
- Female (75.3%)
- Average age was 20.1 (SD=1.7) years, ranging from 18 to 35 years
- 96.4% of the participants were undergraduate students
- Majority were single (79.8%)
Results 2: ACEs and PCEs types and levels of exposure
M = 1.09 (SD = 1.42; range 0-12)
M = 6.47 (SD=2.59; range 0-9)
Results 3: Correlations between numbers of ACE and PCE exposures with ER
ACEs | PCEs | ER-Reappraisal | ER-Suppression | |
ACEs | - | -.39** | -.01** | .04** |
PCEs | - | .28** | -.11** | |
ER-Reappraisal | - | .14** | ||
ER-Suppression | - | |||
Note. **<0.001 | ||||
Results 4: Multiple regressions – PCE Cognitive Reappraisal
Coefficientsᵃ | ||||||
Model | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | ||
B | Std. Error | Beta | ||||
1 | (Constant) | 4.503 | 0.155 | 29.116 | 0.000 | |
PCE total score | 0.096 | 0.004 | 0.278 | 27.077 | 0.000 | |
Age imputed | -0.001 | 0.008 | -0.002 | -0.148 | 0.882 | |
Sex_binary | -0.046 | 0.022 | -0.022 | -2.120 | 0.034 | |
Sophomore | -0.033 | 0.026 | -0.017 | -1.263 | 0.206 | |
Junior | -0.009 | 0.029 | -0.005 | -0.325 | 0.745 | |
Senior_above | -0.050 | 0.039 | -0.021 | -1.274 | 0.203 | |
Married_cohabit | -0.045 | 0.089 | -0.005 | -0.505 | 0.614 | |
Other_category | -0.045 | 0.026 | -0.018 | -1.740 | 0.082 | |
Results 4: Multiple regressions – ACE Cognitive Reappraisal
Coefficientsᵃ | ||||||
Model | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | ||
B | Std. Error | Beta | ||||
1 | (Constant) | 5.255 | 0.158 | 33.195 | 0.000 | |
ACE total score | -0.059 | 0.007 | -0.096 | -8.986 | 0.000 | |
Age imputed | -0.004 | 0.008 | -0.008 | -0.524 | 0.600 | |
Sex_binary | -0.034 | 0.022 | -0.016 | -1.531 | 0.126 | |
Sophomore | -0.051 | 0.027 | -0.026 | -1.856 | 0.063 | |
Junior | -0.032 | 0.030 | -0.017 | -1.058 | 0.290 | |
Senior_above | -0.065 | 0.041 | -0.027 | -1.594 | 0.111 | |
Married_cohabit | -0.055 | 0.092 | -0.007 | -0.593 | 0.553 | |
Other_category | -0.029 | 0.027 | -0.012 | -1.090 | 0.276 | |
Results 4: Multiple regressions – PCE Cognitive Reappraisal, controlling ACEs
Coefficientsᵃ | ||||||
Model | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | ||
B | Std. Error | Beta | ||||
1 | (Constant) | 4.473 | 0.156 | 28.704 | 0.000 | |
ACE total score | 0.010 | 0.007 | 0.017 | 1.493 | 0.135 | |
PCE total score | 0.098 | 0.004 | 0.284 | 25.471 | 0.000 | |
Age imputed | -0.001 | 0.008 | -0.002 | -0.127 | 0.899 | |
Sex_binary | -0.045 | 0.022 | -0.021 | -2.087 | 0.037 | |
Sophomore | -0.034 | 0.026 | -0.017 | -1.275 | 0.202 | |
Junior | -0.010 | 0.029 | -0.005 | -0.329 | 0.742 | |
Senior_above | -0.052 | 0.039 | -0.022 | -1.334 | 0.182 | |
Married_cohabit | -0.051 | 0.089 | -0.006 | -0.573 | 0.567 | |
Other_category | -0.047 | 0.026 | -0.019 | -1.816 | 0.069 | |
Results 4: Multiple regressions – PCE Suppression
Coefficientsᵃ | ||||||
Model | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | ||
B | Std. Error | Beta | ||||
1 | (Constant) | 4.322 | 0.200 | 21.637 | 0.000 | |
PCE total score | -0.045 | 0.005 | -0.102 | -9.794 | 0.000 | |
Age imputed | 0.012 | 0.010 | 0.017 | 1.131 | 0.258 | |
Sex_binary | -0.488 | 0.028 | -0.183 | -17.510 | 0.000 | |
Sophomore | 0.030 | 0.034 | 0.012 | 0.894 | 0.372 | |
Junior | 0.013 | 0.037 | 0.005 | 0.340 | 0.734 | |
Senior_above | -0.160 | 0.051 | -0.053 | -3.168 | 0.002 | |
Married_cohabit | -0.211 | 0.115 | -0.020 | -1.836 | 0.066 | |
Other_category | -0.089 | 0.033 | -0.028 | -2.668 | 0.008 | |
Results 4: Multiple regressions – ACE Suppression
Coefficientsᵃ | ||||||
Model | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | ||
B | Std. Error | Beta | ||||
1 | (Constant) | 3.967 | 0.198 | 20.006 | 0.000 | |
ACE total score | 0.030 | 0.008 | 0.038 | 3.626 | 0.000 | |
Age imputed | 0.013 | 0.010 | 0.019 | 1.270 | 0.204 | |
Sex_binary | -0.493 | 0.028 | -0.185 | -17.611 | 0.000 | |
Sophomore | 0.038 | 0.034 | 0.015 | 1.122 | 0.262 | |
Junior | 0.023 | 0.038 | 0.009 | 0.611 | 0.541 | |
Senior_above | -0.154 | 0.051 | -0.051 | -3.029 | 0.002 | |
Married_cohabit | -0.208 | 0.116 | -0.020 | -1.800 | 0.072 | |
Other_category | -0.097 | 0.034 | -0.030 | -2.884 | 0.004 | |
Results 4: Multiple regressions – PCE Suppression, controlling ACEs
Coefficientsᵃ | ||||||
Model | Unstandardized Coefficients | Standardized Coefficients | t | Sig. | ||
B | Std. Error | Beta | ||||
1 | (Constant) | 4.328 | 0.201 | 21.496 | 0.000 | |
PCE total score | -0.045 | 0.005 | -0.103 | -9.094 | 0.000 | |
ACE total score | -0.002 | 0.009 | -0.003 | -0.241 | 0.810 | |
Age imputed | 0.012 | 0.010 | 0.017 | 1.128 | 0.259 | |
Sex_binary | -0.488 | 0.028 | -0.183 | -17.510 | 0.000 | |
Sophomore | 0.031 | 0.034 | 0.012 | 0.895 | 0.371 | |
Junior | 0.013 | 0.037 | 0.005 | 0.340 | 0.734 | |
Senior_above | -0.160 | 0.051 | -0.053 | -3.156 | 0.002 | |
Married_cohabit | -0.210 | 0.115 | -0.020 | -1.823 | 0.068 | |
Other_category | -0.089 | 0.033 | -0.028 | -2.651 | 0.008 | |
Limitations
- Cross-sectional design
- Self-report, shared method bias, recall bias
- Context of COVID-19
- Voluntary (potentially high SES) sample
- Not generalizable to other Chinese or US populations
Conclusion
- Greater exposure to ACEs was associated with less adaptive ER strategies (greater emotion suppression and less cognitive reappraisal)
- Greater exposure to PCEs was associated with more adaptive ER strategies, even after adjusting for ACEs
Thank you!
zyu46@jhu.edu