Synopsis

The Role of Resilience Factors in Mediating the Impact of Childhood

Trauma on Adult Mental Health Outcomes

Submitted By
BC200400614

Sarrah Modi

DEPARTMENT OF PSYCHOLOGY,
VIRTUAL UNIVERSITY OF PAKISTAN

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 Chapter I

Introduction

In this part, a brief and comprehensive introduction to the topic under study is given. It includes:

Background of the Project

Childhood trauma, including physical, emotional, or sexual abuse, neglect, and adverse childhood
experiences (ACEs), is a significant public health concern with far-reaching consequences.
Numerous studies have demonstrated that exposure to childhood trauma can have a profound and
lasting impact on an individual's mental health and well-being, increasing the risk of developing
various psychological disorders, such as depression, anxiety, post-traumatic stress disorder (PTSD),
and substance abuse. However, not all individuals who experience childhood trauma go on to
develop mental health problems, suggesting that there may be protective factors or resilience
mechanisms that help mitigate the negative effects of these experiences.

1.1. Variable 1 (Resilience)

Resilience refers to the ability to adapt and thrive in the face of adversity, stress, or trauma. It is a
multidimensional construct that encompasses individual characteristics, social resources, and
environmental factors that support an individual's capacity to cope effectively with challenging life
events. Resilience factors, such as social support, emotion regulation skills, and a sense of purpose,
have been found to play a crucial role in promoting positive mental health outcomes among
individuals who have experienced childhood trauma.

1.2. Variable 2 (Mental Health Outcomes)

The impact of childhood trauma on adult mental health is well-documented in the literature.
Individuals who have experienced childhood trauma are at an increased risk of developing a wide
range of mental health problems, including depression, anxiety, PTSD, and substance abuse disorders.
Understanding the mechanisms by which resilience factors can mediate the relationship between
childhood trauma and mental health outcomes is crucial for developing effective interventions and
promoting better long-term outcomes for those affected by childhood adversity.

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 Chapter II

Literature Review
Extensive research has demonstrated the profound and lasting impact of childhood trauma on mental
health. Exposure to physical, emotional, or sexual abuse, neglect, and other adverse childhood
experiences (ACEs) has been consistently linked to an increased risk of developing a wide range of
psychological disorders in adulthood, including depression, anxiety, post-traumatic stress disorder
(PTSD), and substance abuse (Carr et al., 2013; McLaughlin et al., 2010; Teicher & Samson, 2016).
The detrimental effects of childhood trauma on mental health can be explained by the dysregulation of
biological stress response systems, disruption of attachment and interpersonal relationships, and the
development of maladaptive coping strategies (Anda et al., 2006; Teicher & Samson, 2016). Although
the link between childhood trauma and poor mental health outcomes is well-established, not all
individuals who experience childhood adversity go on to develop psychological problems. This
observation has led researchers to examine the role of resilience factors in mediating the impact of
childhood trauma on adult mental health (Bonanno, 2004; Southwick & Charney, 2012). Resilience is
a multidimensional construct that encompasses individual characteristics, social resources, and
environmental factors that support an individual's capacity to adapt and thrive in the face of adversity
(Luthar et al., 2000). Numerous studies have identified various individual-level resilience factors that
can help mitigate the negative effects of childhood trauma, including emotion regulation skills,
cognitive flexibility, self-efficacy, and a sense of purpose or meaning in life (Bonanno, 2004; Luthar et
al., 2000; Southwick & Charney, 2012). These factors are thought to promote adaptive coping
strategies, enhance psychological well-being, and foster posttraumatic growth in the face of childhood
adversity. In addition to individual-level factors, social and environmental resources have also been
shown to play a crucial role in promoting resilience among individuals who have experienced
childhood trauma. Factors such as social support, positive relationships with caregivers, access to
mental health resources, and participation in community-based programs have been associated with
better mental health outcomes for survivors of childhood adversity (Bonanno, 2004; Luthar et al.,
2000; Southwick & Charney, 2012). The mechanisms by which resilience factors can mediate the
relationship between childhood trauma and adult mental health outcomes are not yet fully understood.
Proposed pathways include the enhancement of emotion regulation skills, the promotion of positive
self-perception and self-efficacy, the facilitation of adaptive coping strategies, and the provision of a
sense of social belonging and support (Bonanno, 2004; Southwick & Charney, 2012). Further research
is needed to elucidate the specific mechanisms underlying the protective role of resilience factors in
the context of childhood trauma and mental health. Understanding the role of resilience factors in
mediating the impact of childhood trauma on adult mental health has important implications for the
development of effective interventions and treatment approaches. Interventions that aim to enhance
individual-level resilience factors, such as emotion regulation skills, cognitive flexibility, and a sense
of purpose, as well as interventions that target social and environmental resources, may be particularly
effective in promoting better mental health outcomes for survivors of childhood trauma (Bonanno,
2004; Southwick & Charney, 2012). Incorporating a resilience-focused approach into mental health
treatment and prevention programs may help to break the cycle of trauma and improve long-term
outcomes for individuals affected by childhood adversity.

2.1 Rationale of the Study

The proposed study aims to investigate the role of resilience factors in mediating the impact of
childhood trauma on adult mental health outcomes. While the link between childhood trauma and
mental health problems is well-established, the specific mechanisms by which resilience factors can
buffer the negative effects of childhood trauma are not yet fully understood. Exploring these mediating
pathways can provide valuable insights into the factors that promote resilience and adaptation in the
face of adversity, which can inform the development of more targeted and effective interventions for
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individuals who have experienced childhood trauma.

2.2 Objectives of the Study

1. To examine the relationship between childhood trauma and adult mental health outcomes,
including depression, anxiety, PTSD, and substance abuse.
2. To investigate the role of resilience factors, such as social support, emotion regulation skills,
and sense of purpose, in mediating the relationship between childhood trauma and mental
health outcomes.
3. To explore potential gender differences in the interplay between childhood trauma, resilience
factors, and mental health outcomes.

a. Hypotheses

H1: Childhood trauma will be positively associated with an increased risk of mental health problems
in adulthood, including depression, anxiety, PTSD, and substance abuse.
H2: Resilience factors, such as social support, emotion regulation skills, and sense of purpose, will
mediate the relationship between childhood trauma and adult mental health outcomes.
H3: The strength of the mediating effects of resilience factors on the relationship between childhood
trauma and mental health outcomes will differ between genders.

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 Chapter III

Method
3.1 Nature of Research

The proposed study will employ a quantitative research approach to investigate the relationships
between childhood trauma, resilience factors, and adult mental health outcomes.

3.2 Research Design

The study will utilise a cross-sectional, correlational research design to explore the associations and
mediating pathways between the variables of interest.

3.3 Research/Sampling Strategy

Non-probability, purposive sampling will be used to recruit participants for the study. The target
population will be adults (18 – 24 years old) who have experienced childhood trauma.

3.4 Sample

The study will aim to recruit a sample of approximately 100 people aged 18-24 years. Participants will
be screened for eligibility based on the following inclusion criteria:
 Age 18-24 years old.
 History of childhood trauma (physical, emotional, or sexual abuse, neglect, or adverse
childhood experiences)
 Ability to provide informed consent.
Exclusion criteria:
 Severe cognitive impairment or developmental disability
 Current psychotic episode or severe suicidal ideation

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 3.5 Assessment Measures

3.5.1 Demographic Information Questions

Participants will be asked to provide information about their age, gender, educational level,
employment status, and family history.

3.5.2. Scale I Title

Childhood Trauma Questionnaire (CTQ):

The Childhood Trauma Questionnaire (CTQ) is a 28-item self-report measure developed by Bernstein
et al. (2003) that assesses the severity of five types of childhood trauma: emotional, physical, and
sexual abuse, and emotional and physical neglect. Each subscale contains 5 items, and items are rated
on a 5-point Likert scale ranging from 1 (never true) to 5 (very often true). The CTQ has demonstrated
good internal consistency, with Cronbach's alpha values ranging from 0.66 to 0.92 for the different
subscales.

3.5.2. Scale II Title

Connor-Davidson Resilience Scale (CD-RISC)

The Connor-Davidson Resilience Scale (CD-RISC) is a 25-item self-report measure developed by
Connor and Davidson (2003) that assesses an individual's ability to cope with and adapt to adversity,
stress, and trauma. Items are rated on a 5-point Likert scale ranging from 0 (not true at all) to 4 (true
nearly all the time). The CD-RISC has demonstrated good internal consistency, with a Cronbach's
alpha of 0.89.

3.5.2. Scale III Title

Depression, Anxiety, and Stress Scale (DASS-21)

The Depression, Anxiety, and Stress Scale (DASS-21) is a 21-item self-report measure that assesses
the severity of symptoms of depression, anxiety, and stress. Items are rated on a 4-point Likert scale
ranging from 0 (did not apply to me at all) to 3 (applied to me very much or most of the time). The
DASS-21 has demonstrated good internal consistency, with Cronbach's alpha values ranging from 0.87
to 0.94 for the different subscales.

3.5.2. Scale IV Title

PTSD Checklist for DSM-5 (PCL-5)

The PTSD Checklist for DSM-5 (PCL-5) is a 20-item self-report measure developed by Weathers et al.
(2013) that assesses the presence and severity of PTSD symptoms. Items are rated on a 5-point Likert
scale ranging from 0 (not at all) to 4 (extremely). The PCL-5 has demonstrated good internal
consistency, with a Cronbach's alpha of 0.94.

3.6 Procedure

Participants will be recruited through a mental health centre in Karachi and online platforms.
Interested individuals will be provided with a link to an online survey platform, where they will
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complete the informed consent process and the study measures.

3.7 Ethical Considerations

 Approval from the university's Institutional Review Board (IRB) will be obtained before data
collection.
 Informed consent will be obtained from all participants.
 Participant confidentiality and privacy will be strictly maintained.
 Participants will be informed of their right to withdraw from the study at any time.
 Appropriate referrals and resources will be provided to participants who indicate the need for
mental health support.

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3.8 Proposed Analysis/Analyses

 Descriptive statistics will be used to characterize the sample.

 Pearson's correlation analyses will be conducted to examine the relationships between
childhood trauma, resilience factors, and mental health outcomes.
 Mediation analyses using the PROCESS macro for SPSS will be performed to investigate the
mediating role of resilience factors in the relationship between childhood trauma and mental
health outcomes.
 Moderated mediation analyses will explore potential gender differences in the mediating
pathways.

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 References

American Psychological Association. (2020). Publication manual of the American Psychological

Association (7th ed.). Washington, DC: Author.
Bernstein, D. P., Stein, J. A., Newcomb, M. D., Walker, E., Pogge, D., Ahluvalia, T., ... & Zule, W.
(2003). Development and validation of a brief screening version of the Childhood Trauma
Questionnaire. Child abuse & neglect, 27(2), 169-190.
Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: The Connor‐
Davidson Resilience Scale (CD‐RISC). Depression and anxiety, 18(2), 76-82.
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The
PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD
at www.ptsd.va.gov.

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 Appendix A

(Childhood Trauma Questionnaire)

Sr. Items Strongly Agree Neutral Disagree Strongly

No agree disagree
1 Physical and Emotional Abuse
2 Emotional Neglect
3 Sexual Abuse
4 Physical Neglect

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 Appendix B

(The Connor-Davidson Resilience Scale)

Sr. Items Strongly Agree Neutral Disagree Strongly

No agree disagree
1 Able to adapt to change
2 Close and secure relationships
3 When things look hopeless, I don’t
give up

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 Appendix C

(The Depression, Anxiety, and Stress Scale)

Sr. Items Strongly Agree Neutral Disagree Strongly

No agree disagree
1 I found it hard to wind down
2 I was aware of dryness of my mouth
3 I couldn’t seem to experience any
positive feeling at all

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 Appendix D

(The PTSD Checklist for DSM-5)

Sr. Items Strongly Agree Neutral Disagree Strongly

No agree disagree
1 Related, disturbing and unwanted to
memories of the stressful
experience?
2 Repeated, disturbing dreams of the
stressful experience?
3 Suddenly feeling or acting as if the
stressful experience were actually
happening again (as if you are
actually back there reliving it?)

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