Wenyi Chen

Childhood bereavement (CB) resulting from a parent or primary caregiver death is associated with a range of adverse outcomes. Little is known about the association between CB and adult flourishing in the context of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs). In a cross-sectional observational study, we examined how ACEs, PCEs, and adult flourishing differs by self-reported CB history among 9468 Chinese young adults (18–35 years), of which 4.3% experienced CB (n = 409). Data collection included convenience sampling among university students in Mainland China. Respondents voluntarily completed an online survey between August and November 2020. Descriptive statistics, chi-square tests, and logistic regressions examined frequencies and differences in ACEs, PCEs, and flourishing by the history of CB controlling for a few demographic covariates. Bereaved individuals reported significantly higher ACEs and lower PCEs. The odds of experiencing emotional, physical, and sexual abuse as well as household substance abuse, parental mental illness, and parental incarceration ranged from 2.0–5.2 times higher for bereaved individuals. Bereaved participants also reported significant negative relationships with Flourishing Index (β = −0.35, t = −4.19, p < 0.001) and Secure Flourishing Index (β = −0.40, t = −4.96, p < 0.001). Consistent with previous research, our findings demonstrate the lasting effects of CB on well-being. We discuss study implications for ACEs and PCEs screening and surveillance as well as grief counseling to promote flourishing among bereaved youth in China and beyond.

The purpose of this study was to examine the prevalence of PCEs among young adults in Mainland China and the extent to which the cumulative number of PCEs moderates the associations between ACEs and flourishing in adulthood. Between August and November 2020, we used convenience and snowball sampling to recruit 9468 young adults, ages 18–35, enrolled in undergraduate or graduate programs at universities in Mainland China to participate in a survey, which included measures on flourishing, exposure to ACEs and PCEs, and demographic characteristics. Approximately 92% of participants reported experiencing seven to nine PCEs, with harmonious family relationships (96.9%), feeling supported by friends (96.8%) and being treated fairly at school (96.3%) being the most common PCEs reported. Results of the multiple regression indicated that the cumulative number of PCEs statistically significantly moderated the relation between the cumulative number of ACEs and flourishing (interaction term b = −0.060 [−0.071, −0.049], p < 0.001, adjusted R² = 0.183); as the number of ACEs increased up through eight ACEs, decreases in flourishing were smaller among those with higher numbers of PCEs. PCEs are common among young adults from Mainland China and serve a potential buffering effect against exposure to ACEs.

Adverse childhood experiences (ACEs) are prevalent, costly, and associated with poor health outcomes in adults. Little is known about ACE prevalence rates or strategies for measuring ACEs among young adults in Mainland China. The aims of this study were to (a) translate the ACE-International Questionnaire (ACE-IQ) into Simplified Chinese, (b) assess the psychometric strength of the Simplified Chinese version of the ACE-IQ (SC-ACE-IQ), and (c) compare SC-ACE-IQ scores calculated using binary and frequency scoring methods. The ACE-IQ was translated from English to Simplified Chinese and evaluated for content validity, criterion validity, and test–retest reliability. Chinese young adults (n = 566) aged 18–38 years who were health science students were recruited in Shanghai, China from May to August 2020. ACE exposures were compared using binary and frequency scoring methods, as proposed by the World Health Organization (WHO). The SC-ACE-IQ has good content validity (S-CVI = 0.89) and test–retest reliability (ICC = 0.88). SC-ACE-IQ scores were associated with depressive (binary: r = 0.26, frequency: r = 0.29; p < 0.001) and anxiety (binary: r = 0.22, frequency: r = 0.24; p < 0.001) symptoms. Higher proportion of participants reported exposure to at least one ACE and four or more ACEs when using the binary scoring method compared to the frequency scoring method. The SC-ACE-IQ is a valid and reliable ACE measure for Chinese health science students. Using frequency methods may underestimate exposure to ACEs among this population. Researchers should carefully select scoring methods for different study populations and purposes.