Title: A network analysis of resilience, perceived stress, and social support in nurses with adverse childhood experiences
Abstract:
Background: Adverse childhood experiences (ACEs) disrupt stress-regulation systems and are associated with emotional dysregulation, cognitive biases, and reduced coping resources in adulthood. Given the high-stress and high emotional-labor demands of nursing, nurses with a history of ACEs face compounded risks stemming from early adversity and occupational stress, which may impair their professional adaptation and psychological well-being. Resilience, perceived stress, and perceived social support are core psychological resources. However, their interactions are nonlinear and complex, and traditional linear analytical approaches are insufficient for elucidating their underlying network structure.
Objective: This study aimed to delineate the complex network linking resilience, perceived stress, and perceived social support among nurses with ACEs, and to identify key nodes within the psychological-resource network to inform targeted and effective mental-health support strategies.
Methods: A multicenter cross-sectional survey was conducted from December 2023 to January 2024 among 410 nurses with ACEs from seven tertiary hospitals in Shanghai, China. Data were collected using a demographic questionnaire, the Short Form of the Adverse Childhood Experiences International Questionnaire (SC-ACE-IQ), the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), the Perceived Stress Scale (PSS), and the Perceived Social Support Scale (PSSS). Data analyses were performed using SPSS 27.0 and R 4.5.1.
Results: A total of 392 valid questionnaires were obtained. The median ACE score (P25, P75) was 2 (1, 4), with the most common ACE categories being abuse (41.3%), neglect (54.6%), family dysfunction (67.8%), and bullying (8.4%). Participants’ mean scores indicated moderate levels of resilience (2.71 ± 0.87), perceived stress (2.70 ± 0.53), and perceived social support (5.47 ± 1.10). Network analysis showed a strongest positive association between “other support” and “friend support” (r = 0.916, P < 0.001). Resilience was negatively correlated with the “sense of loss of control” dimension of perceived stress (r = –0.67, P < 0.001). “Other support” exhibited the highest strength and betweenness centrality, while “family support” demonstrated the highest closeness centrality.
Conclusion: Findings suggest that enhancing “other support” may serve as a key leverage point for improving psychological well-being among nurses with ACEs. Nursing administrators should prioritize establishing structured peer-support systems and improving access to psychological services, while concurrently strengthening “family support”, to foster resilience and optimize nurses’ ability to cope with occupational stress.
