Graduation Year


Document Type




Degree Granting Department

Community and Family Health

Major Professor

Jeanine Coreil, Ph.D.

Co-Major Professor

Roger A. Boothroyd, Ph.D.

Committee Member

Martha Coulter, Ph.D.

Committee Member

Randy Borum, Psy.D.

Committee Member

Paul Greenbaum, Ph.D.


Stressors, Cumulative exposures, Adverse events, Welfare, Mental distress


Recent scholarly efforts have sought to examine the cumulative impact of deleterious adverse childhood exposures on various mental health outcomes. Lifetime prevalence rates for depressive disorders are approximately 20% among adolescents. Depression is ranked as the leading cause for disability and fourth leading contributor to the global burden of disease in the world.

The purpose of this study was to determine the cumulative impact of adolescent adverse experiences on outcomes of depression, suicide ideation, and overall mental distress in a cohort of 125 adolescent girls receiving public assistance. The adverse exposures studied were personal victimization, household dysfunction, and community violence exposures.

Across the three categories of exposures, adolescents reported that community exposures were the highest 92.8%, followed by household dysfunction 89.6 %, and lastly, personal victimization 80%. Over 40% reported experiencing more than seven adverse exposures. There was a doubling in the incidence of depression by the fourth year, and an almost ten percent increase in mental distress by the fourth year. Evidence of a significant direct association was found for those experiencing victimization with depression and suicide ideation. The total Adolescent Adverse Exposures (AAE) score was positively correlated with the CES-D scores in the last three years of the study, however not with suicide ideation. The cumulative impact or 'dose-response' relationship of such exposures on depression, suicide ideation, or change over time was not found.

In contradiction with general beliefs and existing literature, a significant negative association was found with depression and having a parent incarcerated or experiencing the divorce of parents. This finding suggests given the homogeneity of this population, experiencing both poverty and high levels of exposure to victimization, that having an incarcerated parent or parental divorce may be potentially protective mitigating the stressful experiences of continued victimization.

The results of this study offer evidence of high prevalence rates of adversity occurring in the lives of these already at risk adolescents. A call for efforts to reduce community violence and personal victimization in the context of poverty are needed to prevent the growing rates of depression and suicide ideation for these fragile families and adolescence.