Graduation Year
2026
Document Type
Dissertation
Degree
Ph.D.
Degree Name
Doctor of Philosophy (Ph.D.)
Degree Granting Department
Public Health
Major Professor
Chighaf Bakour, MD, Ph.D.
Co-Major Professor
Ellen Daley, Ph.D., MPH.
Committee Member
Jason Beckstead, Ph.D.
Committee Member
Tony Tan, Ehd.D.
Committee Member
Janice Zgibor, R.Ph., Ph.D.
Keywords
adverse childhood experiences, allostatic load, longitudinal, resilience, young adults
Abstract
Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that occur before age 18 such as physical, sexual, and emotional abuse, neglect, and household instability and are associated with the leading causes of adult morbidity and mortality in the United States. The mechanisms underlying these associations are not yet fully understood, but the link between ACEs, chronic stress, and allostatic load is one potential pathway. Although ACEs are associated with the leading causes of adult morbidity and mortality, many individuals continue to lead healthy lives through adulthood despite exposure to ACEs. This dissertation used data from Waves I – V of the National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine the association between ACEs and adult morbidity, specifically chronic stress and allostatic load, and whether these relationships were moderated by psychological resilience.
The first study used Add Health Waves I – V to examine the association between ACE scores, Epstein-Barr Virus (EBV) IgG titers, and allostatic load in adulthood. EBV titers are a strong correlate of chronic stress and allostatic load is a measure of multi-system health risk, often equated as the cumulative “wear and tear” on the human body. After adjusting for relevant confounders, the association between ACEs and EBV titers at Wave IV was not significant. ACE scores were associated with increased allostatic load scores at Waves IV (β = 0.032) and exhibited a borderline association with allostatic load scores at Wave V (β = 0.051). Trajectory analysis, which identified clusters of individuals with similar patterns of change in allostatic load scores from early to mid-adulthood, found ACE scores were also associated with having a medium (OR = 1.08, 95% CI: 1.02 – 1.15) or high allostatic load trajectory (OR = 1.18 95% CI: 1.06 – 1.32) from Waves IV - V.
The second study used Add Health Waves I – IV to examine the association between correlates of resilience in childhood (i.e., self-esteem and parental warmth) and psychological resilience in adulthood and whether these relationships differ by ACE exposure history. ACE scores were negatively correlated with resilience scores at Wave IV (b = -0.987, SE b = 0.294, β = -0.073), while high self-esteem and parental warmth in adolescence were associated with resilience among individuals with and without a history of ACEs. While self-esteem and parental warmth remained associated with resilience after adjusting for ACE scores, interaction terms revealed ACE exposure did not modify the association between self-esteem, parental warmth, and resilience.
The final study used Add Health Waves I – V to examine whether psychological resilience and correlates of resilience (i.e., adolescent parental warmth and self-esteem) modified the association between ACE scores and allostatic load. After adjusting for resilience scores, parental warmth, and self-esteem, ACE scores were no longer associated with increased allostatic load scores at Wave V. However, stratified models revealed ACE scores were associated with increased allostatic load scores among individuals with low psychological resilience (b = 0.112, SE b = 0.053, β = 0.075) or low parental warmth (b = 0.155, SE b = 0.053, β = 0.105). High psychological resilience, parental warmth, and self-esteem attenuated the association between ACE scores and having a medium or high allostatic load trajectory.
Using Add Health, this dissertation illustrates the long-term biological toll adverse childhood experiences have on the human system through mid-adulthood. ACEs are associated with multi-system health risk in young and mid-adulthood, as demonstrated through their association with allostatic load, but this relationship can be offset by high levels of psychological resilience in young adulthood and parental warmth and self-esteem in adolescence.
Scholar Commons Citation
Desch, Jill Krier, "The Long-Term Biological Toll of Adverse Childhood Experiences and the Role of Psychological Resilience" (2026). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/11271
