Adverse childhood experiences and depressive symptoms among international students in the U.S.: The roles of acculturative stress and psychological flexibility

Research investigating the role of adverse childhood experiences (ACEs) in the mental health of international students is scarce. This cross-sectional study explored whether self-reported ACEs are associated with intensified depressive symptoms among international students, as well as the mediating role of acculturative stress and moderating role of psychological flexibility in the association. 153 international students in the U.S. completed an online questionnaire measuring the key variables. The PROCESS macro version 5.0 for SPSS was utilized for mediation and moderation analyses. The results revealed a high prevalence of ACEs in the present sample. ACEs was a strong and unique predictor of depressive symptoms. Acculturative stress significantly mediated the association between ACEs and depressive symptoms, while psychological flexibility moderated the association between ACEs and acculturative stress. Exploratory analyses illustrating the varied mediating and moderating effects for acculturative stress subtypes, including perceived discrimination, homesickness, perceived hate, fear, stress due to change, and guilt, were also discussed. The findings highlighted the importance of providing trauma-informed support for international students with ACEs exposure.