ADVERSE CHILDHOOD EXPERIENCES, RESILIENCE AND MENTAL HEALTH PROBLEMS AMONG SECONDARY SCHOOL ADOLESCENTS IN IBADAN, SOUTH WEST NIGERIA

Abstract

Background: Children and adolescents as a vulnerable group are exposed to a wide range of adverse childhood experiences (ACEs), which significantly impact their mental health. Young people exposed to ACEs are more likely to develop mental health problems and have poorer academic outcomes compared to their counterparts. Resilient factors are protective factors such as problem solving skills, intelligence and optimism that help to buffer the effects of ACEs. Studies reveal that the presence of resilient factors can improve adolescent mental health outcomes in the presence of ACEs. Objective: The aim of this study was to determine exposure to Adverse Childhood Experiences (ACE), resilience and mental health problems among secondary school adolescents in Ibadan, Nigeria. The study also sought to examine the relationship between ACE, resilience and mental health problems. Methods: This study was a descriptive cross sectional study conducted in six public and private secondary schools in Ibadan, Oyo State. A Socio Demographic Questionnaire, the Adverse Childhood Experiences International Questionnaire (ACE-IQ), the Strengths and Difficulties Questionnaire (SDQ), the Becks Depression Inventory (BDI), the Becks Anxiety Inventory (BAI) and the 10-item Connor Davidson Resilience Scale (CD-RISC 10) were used to collect data on socio demographic information, adverse childhood experiences, mental health problems and resilience from 409 secondary school adolescents. Participants were randomly selected from secondary schools in Ibadan North Local Government Area of Ibadan. The number of participants chosen from each school was determined by proportional allocation based on the size of the school. The selection of participants from each class in each school was done using systematic random sampling techniqueData was cleaned, coded and analysed using SPSS version 23. The socio demographic characteristics of respondents, ACE exposure, resilience and mental health problems were determined using frequency tables and percentage. Association between exposure to ACE and socio demographic variables were determined using Chi square. T-test and linear regression were used to examine the association between ACE and mental health problems, ACE and resilience scores, mental health problems and resilience scores. Level of significance was 5%. Results: The mean age of respondents was 14 years (SD=1.7). Majority (72.6%) of the participants were from public schools, monogamous homes (84.8%) and were living with their parents as at the time of the study (81.2%). The average number of adverse childhood events experienced by secondary school adolescents in this study was 4 (SD=1.9). The most frequently reported ACEs were emotional neglect (91%), community violence (85.3%), peer violence/bullying (62.1%) and violent treatment of parent/household member (50.1%). Slightly over half (54.5%) of the respondents had abnormal scores on total difficulty SDQ subscale. Peer problems (75.1%) and conduct problems (41.1%) were the most commonly reported mental health problems and emotional problems (20%) were the least reported. The prevalence of depression and anxiety in this study were 17.8% and 55.7% respectively. Adolescents who had been emotionally abused (p=0.006), physically abused (p=0.016) and bullied (p=0.014) were significantly more likely to have higher SDQ scores than those who had not experienced these forms of abuse. Depression (β=0.600, p=0.016) and anxiety (β=0.867, p<0.001) were significantly associated with adverse childhood experience. Participants who reported physical neglect (β=-4.104, p=0.001) and violent treatment of parent/household member (β=-4.480, p<0.001) were less likely to report resilience than those that did not. Participants who reported difficulties on the SDQ scale were less likely to report resilience than those who did not (β= -3.957, p=0.008). The predominantly used method ofcoping was emotion focused coping (53.1%), followed by problem focused coping (22.5%) and then avoidant coping strategy (11.3%). Majority of study participants suggested that good teachers and teaching methods (30.9%), extracurricular activities (26.9%) and counselling and social services (23.8%) would help improve coping skills among adolescents in schools. Conclusion: Adverse Chilhood Experiences and mental health problems were prevalent in this study. Adolescents who had been exposed to ACE were more likely to report mental health problems and less likely to be resilient. There is need to focus on school mental health intervention services and strengthen resilient coping among adolescents who have been exposed to childhood adversities. There is also need to focus on assets and strengths of children and adolescents, enhance protective factors that can mitigate risks and exposures to adversities in order to regain mental health and thrive in the face of adversities