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Nurturing relationships in childhood boost adult mental health, relationships


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We're proud to announce major research that suggests that positive childhood experiences — such as supportive family interactions, caring relationships with friends, and connections in the community — are associated with reductions in chances of adult depression and poor mental health, and increases in the chances of having healthy relationships in adulthood. This association was true even among those with a history of adverse childhood experiences.

The findings, published today in JAMA Pediatrics, could encourage public health efforts and policies aimed at boosting positive childhood experiences in conjunction with reducing adverse childhood experiences (ACEs). Our research appeared today on NPR, Reuters, and HealthDay. My co-researchers on this study are: Jennifer Jones, MSW; Narangrel Gombojav, MD, PhD; Jeff Linkenbach, ED, and Robert Sege, MD, PhD.

Researchers have long known that ACEs — such as physical or emotional abuse or neglect, substance abuse and mental health problems in the household, exposure to violence, parental incarceration or divorce — can have lifelong negative effects on physical and mental health.

The association between ACEs and health effects is complex. Some individuals with multiple ACEs thrive while others do not. And, many without ACEs have health issues associated with adverse experiences, perhaps due to a lack of positive childhood experiences.

Positive childhood experiences are a key factor in influencing health and well-being, yet have not been sufficiently studied to date.

My colleagues and I found a significant connection between positive childhood experiences and adult respondents’ mental and emotional health. For those reporting six to seven positive childhood experiences, the odds of having depression or 14 or more poor mental health days in the previous months were 72 percent lower than for those reporting zero to two positive childhood experiences. Even for those reporting three to five positive childhood experiences, the odds of depression or poor mental health were 50 percent lower than those reporting zero to two positive childhood experiences. These associations held true even when respondents reported multiple ACEs.

Additionally, the odds that respondents answered “always” on the question about getting the social and emotional support they need as adults was 3.53 times greater for those reporting six to seven positive childhood experiences compared to those reporting zero to two. Even among those with no ACEs, only one-third reported always getting the social and emotional support they needed if they had zero to two positive childhood experiences. This was half the rate as those with six to seven such experiences.

Given the science linking social and emotional support to life expectancy, health and suicide, these findings have important implications.

For this study, we analyzed data from the Wisconsin Behavioral Risk Factor Survey, a yearly random digit-dial telephone survey conducted in collaboration with the U.S. Centers for Disease Control and Prevention. The survey collects state-level data about health-related risk behaviors, chronic health conditions, and the use of preventive services.

In the 2015 Wisconsin survey, the state included seven extra questions related to positive childhood experiences. These included whether the respondents (1) were able to talk with their families about their feelings, (2) felt that their families stood by them during difficult times, (3) enjoyed participating in community traditions, (4) felt a sense of belonging in high school, (5) felt supported by friends, (6) had at least two non-parent adults who took genuine interest in them, and (7) felt safe and protected by an adult in their home.

The study designed, tested, and used a new positive childhood experiences measure that showed a dose-response relationship between how many positive experiences adults reported and their mental and relational health. This new “cumulative positive” design captures aggregate experiences in the same way ACEs measure “cumulative risk.”

The survey also scored respondents’ ACEs and included questions about mental health, including diagnoses of depression and how many reported having poor mental health days in the past month. In addition, respondents were asked how often they got the social and emotional support they need (adult-reported social and emotional support). More than 6,000 adults ages 18 and older participated in the survey.

Children can thrive

This study offers the hopeful possibility that children and adults can thrive despite their accumulation of negative childhood experiences. People assume eliminating adversity automatically results in good health outcomes, but many people reporting lower adversity in childhood still had poorer mental and relational health outcomes if they did not also report having had positive childhood experiences.

Many people may assume that without adverse experiences like ACEs, children can be automatically presumed to have the positive nurturing experiences they need. Yet, research shows that it does not necessarily work that way. Studies on positive child development and flourishing point out that the absence of negative health is not the same as positive health. These aspects of health operate on what is called a “dual continuum”.

Findings from this study mirror those from a recent study we published in May 2019 that shows only about 40% of US school age children meet basic criteria for flourishing. This was assessed by whether or not a child was curious and interested in learning new things, could persist to complete tasks begun and was able to stay calm and in control when faced with normal daily challenges.  As in today’s JAMA Pediatrics study, we found that the quality of family relationships explained higher rates of flourishing for children, even among those facing adversities like ACEs.

This important research points to the need to foster nurturing parenting and to build a caring capacity in communities and society in order to turn the tide on the nation’s epidemic of mental and social problems. This includes record levels of social isolation, loneliness and suicide among youth and adults, a lack of optimism and hope and an unacceptable loss of the potential to experience well-being and a meaningful life for too many US citizens today.

Hope is on the horizon. After years of research findings calling for action, we are starting to see these issues gain attention nationally. For instance, the US Congress held an unprecedented hearingon July 11thof this year under the leadership of the US House Committee on Oversight and Reform.

Increasingly, studies are showing that children, youth and adults that lacked positive childhood experiences and/or had ACEs can heal from the impact these experiences can have on their ability to manage stress, regulate emotions, maintain healthy self-worth and positive relationships and stay interested, active and engaged in life. The good news is that we can heal.

Relational wounding requires relational healing, beginning with our relationship with ourselves and seeing the ways our lack of nurturance and exposure to ACEs can impact our self-image, self-care, ability to manage stress and build healthy relationships. We can change the way our experiences have impacted us by adopting a growth mindset, learning and adopting practices that promote self-reflection, help heal the nervous system and better manage stress and shift our view on life toward a more positive outlook where we see possibilities and take action to build the healthy relationships as adults we may have lacked as children. 

Many resources for healing are available and more are emerging every day. Studies are showing that by learning about how your childhood may have impacted this mantra of the ACEs movement rings true: "It is not what is wrong with you, but it is what happened to you". This builds self-compassion, reduces the stigma and shame people without childhood nurturance often carry and opens the door to healing. While formal treatment can be required to heal biological impacts, learn skills and help us integrate the trauma we may have experienced, there is much we can do to heal ourselves. Self, family and community led healing is essential; as is the adoption of proactive efforts to promote positive and relational health and trauma-informed approaches in health care, schools and society overall.


“Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels” was written by Christina Bethell, PhD, MPH, MBA; Jennifer Jones, MSW; Narangerel Gombojav, MD, PhD; Jeff Linkenbach, ED; and Robert Sege, MD, PhD.

Study leader Christina Bethell, PhD, MPH, MBA, is a professor in the Bloomberg School’s Department of Population, Family and Reproductive Health and director of the Child and Adolescent Health Measurement Initiative.

This study was funded by the Robert Wood Johnson Foundation (Grant 75448); a Health Resources and Services Administration grant (UA6MC30375); Casey Family Programs cooperative agreement to Health Resources in Action; the National Center for Advancing Translational Sciences, National Institutes of Health Award (UL1TR002544); the Wisconsin Children’s Trust Fund (now Wisconsin Child Abuse and Neglect Prevention Board).

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Dr. Bethell, I heard your compelling interview with study results on NPR and so appreciate your research and work on flourishing and relational healing. Thank you. I believe your work is on the leading edge and agree that "We are the medicine!"

This is great news. We can all make a difference. The work to be a part of, create and grow community makes a difference.

Please share this with members of your ACEs Connection community and other communities.

It is good news at a time when good news is welcome and needed. It is proof positive that positive relationships heal. 

Thank you to Dr. Christina Bethell and colleagues for your work. 

"This important research points to the need to foster nurturing parenting..."

Visit  We are pioneering a new kind of parenting education that reaches everyone, everywhere, all the time.

Christy, congratulations to you, Jennifer Jones, and the other authors of this important study.  You've put the spotlight on relational healing in this work as you did before the Oversight Committee earlier this year.  Thank you also for the compelling interview you did with NPR, making all the hard science come alive by sharing your personal story.  Another important hearing will be held on education and trauma in a House Education and Labor subcommittee on Sept. 11, with the new California Surgeon General, Dr. Nadine Burke Harris as the lead witness.  Momentum around ACEs science and trauma is rapidly building.  

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