Adverse childhood experiences, social support, and young adult mental health in the conflict-affected Kurdistan Region of Iraq

Abstract

Adverse Childhood Experiences (ACEs) have been widely recognized as a major social determinant of mental health outcomes. The existing literature on this topic, however, primarily focuses on high-income countries, and there is a notable lack of studies in low- and middle-income countries, especially in conflict-affected regions. This study aims to explore the prevalence and distribution of ACEs, the association between ACEs and mental health outcomes (i.e., Post-Traumatic Stress Disorder [PTSD] and anxiety), and the role of social support among a university student sample from the Kurdistan Region. The study employed a cross-sectional survey of 368 university students, selected via a two-stage cluster sampling strategy. In addition to ACEs, the survey measured symptoms of PTSD, anxiety, and perceived stress, as well as social support and sociodemographic variables. The results showed that 56.8% of the sample had an ACE score of one or more. Physical abuse, emotional abuse, and emotional neglect were the highest reported ACEs, respectively. Additionally, 39.4% of participants screened positive for PTSD, while 38.6% screened positive for generalized anxiety. ACEs were associated with a higher odds of screening positive for PTSD and generalized anxiety in adulthood. Students with greater perceived social support showed lowers odds of screening positive for PTSD and generalized anxiety, indicating a promotive role in the students’ mental health. The findings of this study highlight a need for improved mental health assessments, support for students facing greater adversity, and investment in accessible sources of mental health and psychosocial support.