Life experience pathways to college student emotional and mental health: A structural equation model

Abstract

Objective: Previous research suggests that both adverse childhood experiences (ACEs), positive childhood experiences (PCEs), and current life experiences are associated with emotional wellbeing and mental health. The purpose of this study was to explore the influence of these life experience and coping processes on college student emotional and mental health. Participants: College students (N = 555) were recruited from a large western university. Methods: Participants completed an online cross-sectional survey measuring early and current life experiences, cognitive and emotional coping efforts, and emotional and mental health outcomes. Data were analyzed using structural equation modeling. Results: There was an indirect effect of PCEs on emotional and mental health through cognitive and emotional coping efforts. No association was observed between ACEs and mental health. Conclusions: Increases in PCEs are protective, enhance coping efforts, and strengthen emotional and mental health outcomes among college students.

Keywords:

• Adverse childhood experiences
• college students
• mental health
• positive childhood experiences
• stress

Introduction

Mental health issues, especially depression and anxiety, have become a growing concern on college campuses in recent years. In 2018, a World Health Organization (WHO) survey of 14,000 college freshmen worldwide found that more than a third of students reported dealing with a mental health challenge.¹ This global public health challenge is amplified in the United States (US) where according to a survey conducted by the Association for University and College Counseling Center Directors in 2018, 58.9% of students seeking counseling at university counseling centers reported anxiety as their top concern (up from 46.2% in 2013), followed by depression at 48.0% of students (up from 39.3%), and social isolation/loneliness at 18.5%.² Additionally, university counseling center utilization across the country reflects this trend. Between 2009 and 2015, utilization increased by 30–40%, while academic enrollment only increased by 5%.³ In addition, anxiety and depression has been identified as major factors negatively affecting academic performance. In the US, 42% of students report that their struggle with mental health made it difficult for them to function.⁴

Understanding the underlying antecedents or root causes of mental health issues is important for developing prevention programming. Students who attend college are exposed to numerous transitions that involve changes from what one is normally familiar or comfortable with.⁵ These include but are not limited to changes in living, social, and academic environments. These current life experiences can produce a stress response among students that when left unchecked with healthy coping strategies, lead to mental health issues. Additionally, early life experiences also have the potential to influence mental health later in life. Adverse childhood experiences (ACEs) represent traumatic stressful events that occur in childhood (0–17 years) and include experiencing violence, abuse, neglect or being exposed in the household to substance abuse, mental health problems, parental separation, or household member receiving jail/prison time.^6,7 As many as 16% of adults report having four or more ACEs, which are linked to poorer health outcomes, health risk behaviors, and socioeconomic challenges.⁸ Research has demonstrated the association of ACEs with mental health outcomes,^9–12 even among college students.¹³

Research has also focused on the influence of positive childhood experiences (PCEs) and their ability to promote resilience when faced with stressful life experiences—ultimately contributing to improved mental and physical health outcomes later in life.^14–17 These experiences include such protective factors as connectedness to school; positive relationships with peers, family members, and non-parent adults; meaningful beliefs; and positive parenting including predicted routines.^14,15 Crandall et al. found that PCEs offset the effect of ACEs on anxiety among a sample of young adults and those with a greater number of PCEs experienced less anxiety later.¹⁷

Theoretical models from psychology help to explain the link between more negative life experiences (stressors) and mental health. The diathesis-stress model purports that mental disorders are the result of a genetic or biological predisposition to a mental disorder in combination with exposure to environmental stressors.¹⁸ Research has demonstrated that for individuals with a predisposition, the tipping point for psychopathology is lowered as stress level increases.¹⁹ That is, the more stress one is exposed to the more likely one will develop mental illness. However, not all individuals respond to external stressors in the same way and as such, are much less likely to develop mental illness. Therefore, the stimulus-response mechanism associated with the diathesis-stress model can be mediated by cognitive appraisal and efforts to cope as hypothesized by the transactional model of stress and coping.^20,21 In this model, emotional well-being is a function of both cognitive appraisal and coping effort as one responds to environmental stressors. Cognitive appraisal is composed of both primary and secondary appraisal and occurs when a stressor is evaluated as positive, negative, or irrelevant. Secondary appraisal occurs when a self-assessment regarding personal control over the outcome and related emotions is conducted. Coping efforts such as problem management or emotional self-regulation determine healthy adaptation to stressors and ultimately mental well-being.

While the diathesis-stress model and transactional model of stress and coping provide valuable insight on the antecedents to mental health, additional understanding can be gleaned from concepts such as thriving, which has emerged from positive psychology research. Thriving among college students has been described as optimal functioning in academic engagement and performance, interpersonal relationships, and psychological well-being.⁵ This state of existence is more than simply the absence of mental illness, but is characterized by positive emotions, healthy social functioning, and a sense of psychological well-being.²² Individuals who are in a state of thriving tend to be more successful and both physically and mental healthier.

The purpose of this study was to assess the influence of early and current life experiences on college student emotional well-being (thriving) and mental health (depression, anxiety). Attention was given to early life experiences as measured by adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) as well as current life experiences as measured by current stressful life events. The study also assessed whether coping efforts (cognitive and emotional self-regulation) meditated the effects of early and current life experiences on college student emotional well-being and mental health. Consistent with stress theories, we hypothesized that early life experiences (ACEs and PCEs) and current life experiences would influence college student mental and emotional wellbeing with coping effort (cognitive and emotional self-regulatory processes) meditating these relationships.

Material and methods

Sample

A 163-item cross-sectional survey was administered to a convenience sample of students who were at least 18 years of age and currently enrolled at Brigham Young University (Provo, Utah). Students were recruited through campus booths, fliers, social media posts (Facebook, Instagram), and direct email. Potential respondents were provided with an online link to the survey and were presented with information about the purpose of the study and survey. Those who consented to participate were screened for eligibility (age and student status). The approximate length of the survey was 20 minutes. Following completion of the study students were redirected to an online form with the option to provide their email address and be entered into an optional drawing for one of ten $50 (US) campus gift cards. The study was approved by the Brigham Young University institutional review board.

Measures

The survey included items measuring early life experience (ACEs and PCEs) and current stressful life events. Coping efforts for cognitive self-regulation were assessed using an executive functioning scale while emotional self-regulation was assessed using cognitive reappraisal and expressive suppression scales. Thriving, mental health (depression and anxiety), and demographic measures were also included.

Adverse childhood experiences

Participants’ past exposure to ACEs (adverse childhood experiences) was measured using the (CDC) ACEs module from the Behavioral Risk Factor Surveillance System.²³ Responses were dichotomized (0 “never experienced the ACE” and 1 “experienced the ACE at least once). The cumulative ACE score was calculated by summing all positively endorsed items for total scores that could range from 0 to 11 ACEs. Higher scores indicate more adverse childhood experiences. Sample items included “Did you live with anyone who was a problem drinker or alcoholic?” and “How often did anyone at least 5 years or older than you or an adult ever touch you sexually?” Since the original 1998 ACEs study, the ACE questionnaire has been widely used in adult populations of all ages.⁶

Positive childhood experiences

Items for PCEs were taken from the Benevolent Childhood Experiences Scale.¹⁴ Respondents answered either “yes” or “no” to the 10 items. Positively endorsed items were given a score of 1 and summed together, with a higher score indicating more PCEs during childhood. Sample items included “Did you have at least one caregiver with whom you felt safe?” and “Did you have a predictable home routine, like regular meals and a regular bedtime?”. The PCEs is a relatively new measure developed in 2019 but has been used in adult populations including college-aged young adults and shown to be predictive of depression and anxiety in these populations.^15,17

Current stressful life events

Stressful life events were measured using the Student Stress Scale, a version of the Life Events Scale adapted from the Holmes-Rahe Social Readjustment Scale.^24,25 This scale includes 31 items such as “Fired from a job” and “First semester in college”, to which participants responded “yes” or “no”, depending on whether they had experienced that event in the past 12 months. Two of the 31 items (“failing an important course” and “change in the health of a family member”) were inadvertently omitted in programming our survey. Each event is given a weight ranging from 20 to 100 according to the amount of stress and readjustment generally caused by the event.^24,25 A total score was created by summing each positively endorsed item with higher scores indicating higher stress. The Social Readjustment Scale was validated in a college student population in 1974.²⁶

Executive functioning

Executive functioning was measured using the attention, working memory, and novel problem-solving subscales from the Learning, Executive, and Attention Function (LEAF) scale, as developed by Castellanos, Kronenberger, and Pisoni.²⁷ Respondents indicated on a scale of 0 (not a problem, average for age) to 3 (very often, major daily problem) how often/to what extent the behavior described in each item affected them. Sample items included… “Not stay focused on learning material”, “Have trouble doing more than one thing at a time”, and “Resist learning anything that is unfamiliar, new, or different”. Scores were reverse coded such that higher scores indicated higher executive function. The LEAF has been previously used in adult populations and demonstrates excellent internal consistency (α = .96).¹⁶

Emotion regulation

Emotion regulation was measured as cognitive reappraisal (reinterpretation of situations) and expressive suppression (reduced outward expression emotion), as developed by Gross and John.²⁸ Respondents indicated their agreement with 10 items on a 7-point scale ranging from “Strongly disagree” to “Strongly agree”. Factor analysis confirmed the two-factor structure. Higher scores for cognitive reappraisal improved cognitive reappraisal and more expressive suppression. The Gross and John emotion regulation measures were developed in four samples of college students and demonstrated good internal consistency for both cognitive reappraisal (α range: .75–.82) and emotion regulation (α range: .68–.76).²⁸

Thriving

Student thriving was measured using the 10-item Brief Inventory of Thriving (BIT), developed by Su et al.²² and included items such as “I am achieving most of my goals” and “My life has a clear sense of purpose”. Respondents indicated agreement on a 5-point scale, with 1 being “strongly disagree” and 5 being “strongly agree.” The BIT has shown good internal consistency among undergraduate students (α = .75).²² Two items from the Flourishing Scale (FS), developed by Diener et al.²⁹ were included as those two items covered aspects of thriving that were not fully addressed in the BIT. The Flourishing Scale has shown good internal consistency (α = .87) and convergent validation in samples of undergraduate students in the US and Singapore.²⁹ The two items were “I am engaged and interested in my daily activities” and “My social relationships are supportive and rewarding”. For these two items respondents indicated agreement on a scale of 1 (strongly disagree) to 7 (strongly agree) which was scaled to match the 5-point response options of the BIT. A single factor for the 12-items was confirmed using factor analysis. Cronbach’s alpha indicated good internal consistency for the 12 items (α = .93). Higher scores indicated better thriving.

Mental health

For this article, mental health outcomes were defined as depression and anxiety. Depression was measured using the Patient Health Questionnaire-9 (PHQ-9).³⁰ Participants were asked to indicate how often, over the last 2 weeks, they were bothered by problems such as “Feeling down, depressed, or hopeless,” and “Feeling tired or having little energy”. They responded on a scale of 1 (Not at all) to 4 (Nearly every day). Anxiety was measured using the General Anxiety Disorder-7 (GAD-7),³¹ following the same format as the PHQ-9, but with items such as “Worrying too much about different things” and “Feeling afraid as if something awful might happen”. Higher scores on both scales indicated more depression or anxiety symptoms. The PHQ-9 and the GAD-7 are widely used self-report screening tools for depression and anxiety.^32,33 These measures have consistently high internal consistency and diagnostic validity across populations of adolescents and adults around the world.

Demographic controls

Demographic data included age, sex, gender, sexual orientation, religion, race, relationship status, and year in school. Although we asked about non-binary and transgender gender identity as well as several categories for sexual orientation and race, due to the homogeneity of our sample, these categories were collapsed as follows: age (in years), sex (male vs. female), sexual orientation (heterosexual vs. non-heterosexual), race (white vs. nonwhite), and relationship status (single, never married, engaged or in a committed partnership, or married).

Analysis

The data were cleaned, and preliminary analysis conducted in SAS (version 9.4, SAS Institute Inc., Cary, NC). Frequencies and proportions were calculated to describe the sample. A chi-square test for the difference in proportions was used to test for bivariate differences in the distribution of depression and anxiety by demographic characteristics. To create latent variables for each construct (executive function, cognitive reappraisal, expressive suppression, thriving, depression, and anxiety) confirmatory factor analysis (CFA) was conducted in MPlus version 7 (Muthen and Muthen 1998–2012). Items with factor loadings <.40 were dropped. Model fit for the measurement model was assessed using the root mean square error of approximation (RMSEA) and the comparative fit index (CFI). RMSEA < 0.08 and CFI > 0.90 indicated adequate model fit.³⁴

After defining the measurement model, structural equation modeling (SEM) was used to assess the relationships of interest. This methodology is advantageous over traditional regression as it allows the assessment of multiple relationships simultaneously and controls for measurement error. Depression and anxiety were regressed on thriving, executive function, cognitive reappraisal, expressive suppression, PCE score, ACE score and stressful life events. Similarly, thriving was regressed on executive function, cognitive reappraisal, expressive suppression, PCE, ACE score and stressful life events. Finally, executive function, cognitive reappraisal, expressive suppression were regressed on PCE score, ACE score and stressful life events. Depression and anxiety were correlated with each other as were executive function and both measures of emotion regulation. ACE score, PCE score, and stressful life events were also correlated with each other. After identifying the final structural model, demographic control variables were added to the model by regressing the dependent and independent variables on the controls. Model fit cutoffs for structural models were the same as those used in CFA. The model was estimated using variance-adjusted weighted least squares approximation, which is appropriate for categorical data. Missing data were minimal and Full Information Maximum Likelihood was used to account for missing data. Indirect effects were analyzed using 5000 bootstraps to ensure robust standard errors.³⁵

Results

Descriptive data

A total of 555 eligible students completed the survey, with ages ranging from 18–47 (M = 21.72 (2.85). Table 1 provides the demographic characteristics of the sample and the distribution of characteristics by depression and anxiety status. Briefly, approximately 30% were male and 16% reported being Hispanic or nonwhite race. A total of 15% of the sample reported that they were gay, lesbian or bisexual. Participants were grouped into clinical categories based on PHQ-9 and GAD-7 scores.^30,31 Approximately 40% of the sample was classified as having moderate to severe depression, while approximately 32% were classified as having moderate or severe anxiety. The mean depression score was 9.12 (SD = 6.05), and the mean anxiety score was 7.23 (SD = 5.4). The mean ACE score was 1.43 (SD = 1.46)/1.39 (SD = 1.39), and the mean PCE score was 8.88 (SD = 1.37).

Table 1. Sample demographics.

		Depression			Anxiety
	Full sample	Moderate to severe	Mild or none		Moderate to severe	Mild or none
	n (%)	n (%)	n (%)	p-value	n (%)	n (%)	p-value
Age
18–20 years	153 (27.7)	73 (32.9)	80 (24.2)	.16	60 (34.5)	93 (24.6)	.05
21–22 years	238 (43.1)	88 (39.6)	150 (45.5)		73 (42.0)	165 (43.7)
23–24 years	124 (22.5)	48 (21.6)	76 (23.0)		34 (19.5)	90 (23.8)
25+ years	37 (6.7)	13 (5.9)	24 (7.3)		7 (4.0)	30 (7.9)
Sex
Male	168 (30.3)	60 (27.0)	108 (35.5)	.17	35 (20.0)	133 (35.1)	.0003
Female	386 (69.7)	162 (73.0)	224 (67.5)		140 (80.0)	246 (64.9)
Sexual orientation
Heterosexual	472 (85.1)	170 (76.2)	302 (91.0)	<.0001	135 (77.1)	337 (88.7)	.0004
Non-heterosexual	83 (15.0)	53 (23.8)	30 (9.0)		40 (22.9)	43 (11.3)
Race ethnicity				.48
White, non-Hispanic	468 (84.3)	191 (86.7)	277 (83.4)		152 (86.9)	316 (83.2)	.27
Hispanic or nonwhite	87 (15.7)	32 (14.4)	55 (16.6)		23 (13.1)	64 (16.8)
Relationship status				.03
Single, never married	338 (60.9)	151 (67.7)	187 (56.3)		115 (65.7)	223 (58.7)	.09
Engaged or in a committed partnership	104 (18.7)	35 (15.7)	69 (20.8)		34 (19.4)	70 (18.4)
Married	113 (20.4)	37 (16.6)	76 (22.9)		26 (14.9)	87 (22.9)

Moderate to severe depression was more common in those with a non-heterosexual identity (p < .0001) and in those who were single, versus those who were partnered (p = .03). Moderate to severe anxiety was more common in females compared to males (p = .0003) and in those identifying as heterosexual compared to those identifying as lesbian, gay or bisexual (non-heterosexual; p = .0004).

Measurement model

CFA for the full measurement model indicated adequate fit (RMSEA = .06; CFI = .93). Factor loadings ranged from .42 to .95.

Structural model

Figure 1 displays the results of the structural model (Model Fit: RMSEA 0.056; CFI: 0.931). Executive functioning and thriving were negatively associated with depression and with anxiety; stressful life events were associated with more depression and more anxiety. No other variables were directly associated with depression or anxiety. PCEs were indirectly associated with depression and anxiety through executive functioning, expressive suppression, cognitive reappraisal, and thriving. Stressful life events were indirectly associated with depression through executive functioning and thriving and with anxiety through executive functioning only. Table 2 includes the full results of the mediation analyses.

Figure 1. Structural equation model for the relationship between childhood and current stressors, executive function, emotion regulation, thriving, and depression and anxiety.

Table 2. Significant indirect pathways.

PCE → Thriving → Depression: z = −4.92, p < .001

PCE → Executive Function → Depression: z = −4.03, p < .001 PCE → Executive Function → Thriving → Depression: z = −.92, p < .001

PCE → Cognitive Reappraisal → Thriving → Depression: z = −4.71, p < .001

PCE → Expressive Suppression → Thriving → Depression: z = −3.37, p < .001

Stressful Events → Executive Function → Depression: z = 2.36, p < .05

Stressful Events → Executive Function → Thriving → Depression: z = 2.28, p < .05

PCE → Thriving → Anxiety: z = −3.09, p < .01

PCE → Executive Function → Anxiety: z = −4.12, p < .001 PCE → Executive Function → Thriving → Anxiety: z = −2.61, p < .01

PCE → Cognitive Reappraisal → Thriving → Anxiety: z = −2.80, p < .01

PCE → Expressive Suppression → Thriving → Anxiety: z = −2.46, p < .05

Stressful Events → Executive Function → Anxiety: z = 2.38, p < .05

Race was the only control variable that was significantly associated with depression in the structural model. Those who were Hispanic or nonwhite experienced less depression (b = −.063; p value = .018) as compared to those who were White. Females reported more anxiety than males (b = .133; p value <.0001) and increasing age was associated with less anxiety (b = −.068; p value .038)

Discussion

Mental and emotional health challenges are prevalent among college students.³⁶ The purpose of this study was to determine the influence of early and current life experiences on mental and emotional health among a sample of US college students. The study also explored the mediating effects of coping efforts as measured by cognitive and emotional self-regulatory processes. Findings are best interpreted from the perspective of three pathways: (1) the PCEs pathway, (2) the ACEs pathway, and (3) the current stressful life events pathway.

First, the PCEs pathway predicted higher levels of thriving and lower depression and anxiety as mediated through all three coping or self-regulatory processes (executive functioning, cognitive reappraisal, and expressive suppression). These findings support the hypothesis that PCEs significantly influence thriving and mental health as mediated through coping efforts (cognitive and emotional self-regulation). Students with higher PCEs appear to be more resilient to life stresses as they have greater executive functioning and emotional self-regulation skills. These findings are consistent with previous research linking PCEs with improved self-regulation in young adulthood³⁷ and better cognitive functioning in older adults.³⁸ One possible assumption is that PCEs contribute to a greater sense of control over life circumstances. While evidence exists that PCEs directly lower the odds of poor mental health among adults,¹⁵ findings from the current study among college students suggest that PCEs enhance coping efforts which in turn boost thriving.

Second, the ACEs pathway revealed no indirect or direct pathway to college student mental and emotional health. While higher ACE scores were associated with executive suppression, the mediating pathway to mental and emotional health was not significant. This finding was contrary to our hypothesis and previous research linking college student ACEs with mental health outcomes³⁹ and emotional regulation as a mediating variable.⁴⁰ However, most prior research examining ACEs and young adult health have not also examined cumulative measures of advantage. The results of the current study suggest the greater role that PCEs play in the mental and emotional well-being of college students. This is consistent with a prior study that indicated in unadjusted models that ACEs may be predictive of worse young adult mental health, but these relationships were no longer significant once PCEs were accounted for.¹⁷ Similarly, a number of studies have demonstrated that among adults in general, PCEs are more predictive of mental health than ACEs.¹⁵ Thus, it may be that the more important deficit that college students may face is the absence of PCEs rather than the presence of ACEs. In saying this, it is important to note that the findings do not suggest that ACEs have no bearing on college student mental health. Reducing abuse and trauma should always be an important goal. Additionally, the findings demonstrate a negative correlation between ACEs and PCEs and a positive correlation between ACEs and current stressful life events. Longitudinal data are necessary to examine whether PCEs and current stressful life events may mediate the relationship between ACEs and later health.

Third, the current stressful life events pathway revealed a direct relationship between current stressful life events and mental health outcomes (depression and anxiety) with only one cognitive self-regulating process (executive function) mediating a relationship with thriving, depression, and anxiety. Research suggests that executive control and cognitive emotion regulation mediate depression.^41,42 Rumination, a poor form of cognitive self-regulation, has been found to negatively affect depression.⁴³ These studies help corroborate why executive functioning (cognitive self-regulation) in this study was correlated with diminished depression and anxiety. It stands to reason that maladaptive executive functioning, including self-blame, catastrophizing and rumination are believed to contribute to both depression and anxiety but should be verified with new research. Current stressful life events were directly and positively associated with depression but negatively associated with anxiety. Stressful life events have been shown to directly increase depression,⁴⁴ which helps verify this study’s findings. It was also reported that cognitive self-regulation actions are expected to mediate depression, like this study. They specifically identify lower-core self-evaluations or fatalism as keys to regulate depression. Current stressful life events appear to influence college student’s ability to cognitively self-regulate, and problem solve, ultimately impacting mental and emotional well-being. Finally, current stressful life events were directly but inversely related to anxiety. In this study, our model identified that every direct or indirect pathway between stressful life events and anxiety was inversely related. This unexpected finding may be partially explained by recent research among female adolescents in vocational school that found stressful life events and subjective well-being are negatively related and likely moderated by perceived social support and lessening anxiety sensitivity over time.⁴⁵ Another recent study involving older adults and the stressful life events during COVID-19 identified lower anxiety symptoms compared to other age categories due to the moderating effect of age and the mediating effect of resilience.⁴⁶ We did not measure resilience or social support using unique instruments, nor did we look at older age categories for comparison. However, these specific areas may be important considerations for future studies involving college student mental health.

This study supports the hypothesis that early life experiences and current stressful events influence mental and emotional wellbeing; however, the mediating effects of cognitive and emotional coping efforts varied across life experience pathway. Of note, PCEs are especially protective among college students and contribute to stronger emotional and mental health outcomes through multiple pathways. These findings have important implications for campus mental health efforts. For example, universities should consider assessing PCEs to obtain a more complete picture of early life experiences among college students. While assessments of childhood experiences can be broadly administered across a college campus to help inform campus-wide prevention effects, adding PCEs as a screener in campus clinical settings may help determine student needs and assets.^47,48 Additionally, those in campus mental health service settings can help students who have low PCEs strengthen their “positive childhood memories” as a tool for strengthening mental health.⁴⁸ Furthermore, conversations with college students about the importance of PCEs, whether in educational settings through course curricula or clinical settings through counseling, may help increase the likelihood PCEs are experienced by the next generation.⁴⁹ Finally, although not assessed in this study, it may also be useful for universities to consider how to support college students to develop positive adult experiences, which may serve as “turning points” for students who experienced high ACEs, low PCEs, or who are currently managing stressful life events.⁵⁰

Additional research should continue to explore ways to mitigate the effect of early and current life experiences to improve adult mental health. Specifically, longitudinal research measuring ACEs and PCEs as well as stress and coping through the adult years is needed.

Limitations

Findings should be interpreted with consideration for the following limitations. First, the study was based on a convenience sample, which may not be representative of our university population or the population of university students in the US. Our sample was similar to the distribution of race/ethnicity among BYU students (81% Caucasian) but overrepresented females. Second, the sample was very homogenous particularly with respect to race/ethnicity and religious identity. Brigham Young University is owned and operated by The Church of Jesus Christ of Latter-day Saints and the large majority of students identify with the Church (98%). As such, these findings may not be representative of students at other US institutions. Third, the study was cross-sectional and relied on self-report which may lead to recall or response bias. This may be particularly true for measures of executive function for which task-based measures are more reliable. However, it is important to note that short-term (2 week) recall of current depression/anxiety systems using the PHQ-9 and GAD-7 are the gold standard for clinical evaluation of depression and anxiety symptoms.

Conclusions

In summary, this study found that PCEs and current life experiences influence symptoms of depression and anxiety among college students. However, the pathways to mental health varied depending on the type of life experiences—whether PCEs or current stressful life events. Findings also revealed no association between ACEs and mental health while indirect and direction associations were observed in the current stressful life events pathway. Only the PCEs pathway was associated with thriving and mental health as mediated by all three self-regulatory cognitive and emotional coping efforts. These findings suggest the important role of PCEs in not only enhancing student coping efforts, but also in strengthening mental and emotional health outcomes.

Conflict of interest disclosure

The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States of America and received approval from the Institutional Review Board of Brigham Young University.

Funding

No funding was used to support this research and/or the preparation of the manuscript.