Abstract 16823: The Mediating Effect of Perceived Stress on the Relationship Between Adverse Childhood Experiences and Depressive Symptoms in Rural Adults With Cardiovascular Disease

Background: Adverse childhood experiences (ACEs), defined as abuse, household dysfunction, and neglect before age 18, increase the risk of depressive symptoms and cardiovascular disease (CVD). Fifty-two percent of people have reported 1 ACE with 6.2% reporting 4 or more. People in rural environments experience higher levels of stress and depressive symptoms, but little is known about the relationship of ACEs with stress and depressive symptoms in rural adults with CVD.

Aim: To determine the prevalence of ACEs and the mediating effect of perceived stress on the relationship between ACEs and depressive symptoms in a sample of rural adults with CVD.

Methods: We used Hayes PROCESS for SPSS (model 4) to determine the mediating effect of perceived stress (Cohen’s Perceived Stress Scale) in the relationship between ACEs (ACE questionnaire), and depressive symptoms (Patient Health Questionnaire-9) controlling for age, gender, financial status, and perceived control.

Results: Of 210 rural adults with CVD (mean age 59 ± 13, ACE score 2.4 ± 2.5, and education 14 ± 3, 45.7% female, and 3.3% non-white) 20% reported 1 ACE with 30% reporting 4 or more. Adverse childhood experiences significantly predicted perceived stress (a = .2553, p = .001) and perceived stress significantly predicted depressive symptoms (b = .7419, p < .001). The total (c = .4881, p = .001) and direct effects (c’ = .2987, p = .038) of ACEs on depressive symptoms in this sample were significant, as was the indirect effect of perceived stress (ab = .4144, 95% CI [.2449 - .6231]).

Conclusion: The prevalence of ACEs in this sample of rural adults with CVD was 5 times higher than reported in the general population. Perceived stress is a mediator of the relationship between ACEs and depressive symptoms in rural adults with CVD. Interventions to decrease depressive symptoms in rural adults with CVD should include an assessment of ACEs and address management of perceived stress.