Electronic Theses and Dissertations


Sanjaya Regmi



Document Type


Degree Name

Doctor of Philosophy


Social & Behavioral Sciences

Committee Chair

Satish Kedia

Committee Member

Kenneth Ward

Committee Member

Xichen Mou

Committee Member

Marian Levy


Adverse childhood experiences (ACEs) have enduring implications for various behavioral and mental health issues, necessitating a thorough examination of factors that mitigate their adverse effects. The present research draws upon the Healthy Outcomes from Positive Experiences (HOPE) framework and the socioecological model to investigate the moderating role of different types of resilience, including child resilience, family resilience, safe neighborhoods, and supportive neighborhoods, on the associations between ACEs, substance use disorder (SUD), and depression. This study also explores the relationships between ACEs and mental health care needs and service utilization among children and adolescents in the United States. We conducted cross-sectional studies utilizing combined data from the National Survey for Children's Health (NSCH), covering four years (2016-2019) for the first paper (N = 54,434) and the second paper (N = 94,369) and two years (2018-2019) for the third paper (N = 43,213). Data analyses were performed using a hierarchically well formulated model of logistic regression analysis. Propensity score matching was used for the first paper, in which we found that family resilience moderates the association between ACEs and SUD (B = -0.07, SE = 0.02, p < .01), whereas all resilience (i.e., child, family, safe neighborhood and supportive neighborhood) ) decreases the log odds of SUD except supportive neighborhood while holding ACEs=0 and all other variables constant. In the case of depression, both child resilience (B = -0.03, SE = 0.01, p < .001) and family resilience (B = -0.02, SE = 0.01, p < .05) moderate the association between ACEs and depression, while all resilience reduces the log odds of depression while holding ACEs = 0 and all other variables constant. ACEs show a dose-response association with SUD among adolescents, depression among children and adolescents, and mental health care needs among children and adolescents. Furthermore, ACEs have a strong positive association with mental health care utilization in the past year among children and adolescents. These findings offer valuable guidance for clinicians, public health professionals, and policymakers, providing insights to help effectively address the impact of ACEs.


Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest.


Open Access