UCLA

Early life adversity exposing vulnerable individuals to potential harm during the first 18 years of life increases the risk for a wide range of adverse physical and mental health outcomes. Childhood adversity is an example of a public health problem that requires “systems thinking” through consideration of social, environmental, familial, psychological, and biological/genetic factors. Understanding the mechanisms of these complex concepts and synthesizing this information into a comprehensive model is necessary.

The widely accepted Adverse Childhood Experience (ACE) measure captures exposure to childhood maltreatment and household dysfunction. ACEs have been shown to associate with nonspecific risk for a wide range of adverse mental health conditions across all socioeconomic groups. Using a social determinants of health framework, ACEs can be viewed as a consequence of upstream vulnerability factors that are structural (i.e., rooted in cumulative disadvantage when families face socioeconomic and relational adversity). ACEs can also be viewed as a psychosocial risk factor impacting mental health independent of other social patterns (e.g., among those with higher socioeconomic status).

Although sexual minority groups appear disadvantaged concerning both ACE exposure and mental health outcomes, the literature describing links between ACEs and mental health is limited among men who have sex with men (MSM), particularly those of low-income and minoritized status. The primary research aim in this dissertation is to investigate if exposure to ACEs (recalled from the first 18 years of life) predict poor mental health outcomes (drug use, depressive and anxiety symptoms) among mostly Black and Latino low-income MSM in adulthood, adjusting for a wide range of sociodemographic and behavioral factors. This research question was explored in three separate studies, based on a Life Course Perspective. Each study examined the cumulative ACE score, dimensional approaches (separating ACEs into categories of childhood maltreatment and household dysfunction), and selective approaches (considering individual ACEs) on these mental health outcomes. All studies investigated whether specific resilience factors (i.e., perceived social support, and sleep quality) buffer the hypothesized associations between ACEs and mental health through effect modification (i.e., moderation).

Data for this dissertation comes from the mSTUDY (Men Who Have Sex with Men and Substance Use Cohort at UCLA Linking Infections, Noting Effects [MASCULINE]), a longitudinal study of HIV-positive and HIV-negative MSM with varied substance use behaviors. Participants were assigned male sex at birth, English-speaking, ages 18-45; and if HIV-, reported having sex with men in the past twelve months (n=297). Multilevel commands using participant ID were used for mixed effects in random intercept logistic and ordinal regression models.

The results of this research suggest that ACEs have significant associations with mental health during adulthood among mostly Black and Latino low-income MSM in Los Angeles. While relationships between ACEs and mental health are well documented, evidence linking these among MSM is sparse, particularly among those with multiple forms of cumulative disadvantage. In this research, the total ACE score predicted depressive and anxiety symptoms, and the outcome of self-reported drug use trended toward significance. The dimension of childhood maltreatment predicted depressive and anxiety symptoms, but not drug use. Selective approaches identified that childhood sexual abuse predicts depressive symptoms; and emotional neglect predicts anxiety. Only the association between childhood sexual abuse and depressive symptoms survived adjustment for the other nine ACEs.

Perceived social support emerged as a buffering factor for drug use in the cumulative and selective approaches. Sleep quality did not emerge as a resilience factor (moderator) for any outcomes of depressive and anxiety symptoms, suggesting that the association between ACEs and these outcomes did not differ by sleep quality. This dissertation’s findings contribute to our understanding of how ACEs might impact mental and behavioral health outcomes among socially disadvantaged MSM. One limitation is that the sample was not randomly selected. Several recommendations for future research (including ACE measurement) are proposed.