Adverse childhood experiences (ACEs) may precipitate depressive symptoms among children and adolescents, yet whether resilience and sleep quality jointly mediate this link remains unclear. Therefore, this study aimed to investigate these potential mediating pathways. From April to June 2024, a total of 3258 children and adolescents were included for this cross-sectional study from 11 primary and secondary schools in Chaohu City, Anhui Province, China. We used a series of scales to assess their depressive symptoms, ACEs, resilience, and sleep quality. To explore the potential mediating pathways between depressive symptoms, ACEs, resilience, and sleep quality, the chain mediation analysis was conducted using the PROCESS macro (Model 6). The prevalence of depressive symptoms was 30.1% among children and adolescents. The multivariate logistic regression analyses showed that females, ACEs total score, resilience, and poor sleep quality were independent correlates of depressive symptoms. When the dimensions of ACEs were involved in the regression model, emotional abuse, physical abuse, emotional neglect, physical neglect and mother suffered from domestic violence were also independent risk factors. Notably, resilience and sleep quality had a chain-mediated effect between ACEs and depressive symptoms. A high proportion of children and adolescents reported depressive symptoms. Moreover, resilience and sleep quality may have a chain-mediated effect between ACEs and depressive symptoms. Hence, the impact of ACEs, resilience and sleep quality on depressive symptoms among children and adolescents should be highlighted and targeted interventions should be implemented.
Ji et al. (2025) studied this question.