The Intersection of Depressive Symptoms, Adverse Childhood Experiences, and Protective Factors Among Adolescents: Epidemiological Evidence from Minnesota, 2016 and 2019

Prevalence of mental health problems among US youth has increased in recent years, and there is a dearth of epidemiological research at the state level that integrates risk and protective factors into population-based surveillance. We utilized the developmental assets framework to measure protective factors; we assessed (1) prevalence of depressive symptoms, high adverse childhood experiences (ACEs; ≥ 4 ACEs), and few developmental assets (≤ 2 assets) over time, and (2) associations among these three phenomena. Using 2016 and 2019 Minnesota Student Survey data, we utilized descriptive statistics, multivariable logistic regression, and post-estimation analyses (adjusting for school clustering and demographics). Using pooled data, we examined how high ACEs and few assets predicted depressive symptoms and we tested three-way interactions for high ACEs, few assets, and survey year. There were statistically significant increases in prevalence of depressive symptoms, high ACEs, and few assets between 2016 and 2019. High ACEs (AOR = 2.74; 95% CI = 2.61, 2.89) and few assets (AOR = 3.13; 95% CI = 3.00, 3.26) were positively related to depressive symptoms; interactions were statistically significant. Additive interactions showed that, compared to their counterparts, adolescents with high ACEs and few assets had the highest prevalence of depressive symptoms, and this group exhibited the largest increase in prevalence between 2016 and 2019. Depressive symptoms are highest among adolescents with high risk and few protective factors, and recent increases in the prevalence of depressive symptoms appear to have disproportionately occurred among these adolescents. We offer a potential roadmap for following the Centers for Disease Control and Prevention recommendations to integrate ACEs and protective factors into local public health efforts.