Evidence indicates that there are circumstances where one may experience stress or adversity earlier in life which can strengthen resilience later in life, which is called the “steeling effect” (5). For example, some adults who experienced great hardship due to the Great Depression during their childhood were more able to cope with difficult situations in adulthood (5). However, given the volume of research showing that childhood adversity can be very harmful to adult physical and mental health (6, 7) it cannot be assumed that cumulative childhood trauma will lead to a steeling effect in most adults. Instead, it is important to consider what beneficial experiences during adulthood serve as “turning points” (5) that help to combat prior traumatic life experiences and improve health. Turning points exert an independent positive impact on wellbeing even when there was prior adversity such as ACEs. One example of a turning point is a supportive marriage, which can give an adult a secure and safe relationship to help them through future hardships in adulthood (5, 8). Beyond marriage, other healthy relationships including feeling a sense of belonging in the community and having social supports contribute to higher levels of both physical and mental health among adults (9). Greater social connection may foster a sense of “coherence” or meaning and purpose in life that enhances adult mental health, physiological processes, and physical health (10). Further, there is a clear connection between higher levels of community belonging and better health outcomes among adults from both urban and rural areas as well as diverse socioeconomic backgrounds (11).

Beyond healthy relationships and belonging, there are other potential turning points. Personal religious practices founded on genuine personal beliefs beyond the actions of religious practice alone decrease mortality and can improve mental health (12, 13). Involvement in positive health-promoting self-care behaviors is related to a reduced likelihood of developing symptoms of anxiety and depression (14). Mental health can also be related to behavior changes. For example, at the start of the COVID-19 pandemic, those who had been physically active and less sedentary maintained good mental health while those who increased screen time and lessened physical activity experienced lower levels of mental health (14).

Several theoretical perspectives help to explain the influences of early childhood experiences on health outcomes and include the compensatory model of resilience, cumulative experiences models, and the stress buffering model.

Although there is literature on the positive benefits of specific events in adulthood, to our knowledge there is no literature examining the accumulation of positive experiences in adulthood and its direct, mediating, and moderating effects on mental health, after accounting for both ACEs and PCEs. Another gap in the current literature is understanding the relationship of childhood adversity and PAEs on adult health in younger vs. older adults in retrospectively reported childhood experiences. Age when trauma was experienced in childhood can impact how the experience affects individuals in adulthood (28). Further, it is possible that over time adults forget childhood adversities that still impact them (29). As such, the effects of PAEs on adult health may diminish over time as childhood adversities become more distal or diluted with the accumulation of more proximal events. Retrospective and prospective reports of childhood adversity have shown moderate agreement (29). Some childhood adversity, such as sexual abuse, is more likely to be underreported in prospective studies, while some ACEs are forgotten over time and thus underreported in retrospective studies (29). Beyond the effects of reporting childhood experiences, the effects of PAEs on health may vary based on developmental trajectories in adulthood. For example, younger adults are going through many important life transitions (e.g., marriage, education, employment, and housing relocation) that may be more influenced by the PAEs they have. Furthermore, mental illness is more prevalent in younger adults vs. middle and older adults (30), and thus PAEs might be more important to young adult health when mental illness is the outcome.

In the current study, PAEs are intended to measure a breadth of positive experiences in adulthood that acting together can lead to better health regardless of the presence of ACEs or absence of high PCEs. Like ACEs and PCEs, PAEs measure cumulative advantage but do not measure what experiences in adulthood are most important to better mental health. Instead, they provide a snapshot of the breadth of positive experiences that an adult may experience. PAEs include several items similar to those in common to PCE instruments [e.g., the Positive Childhood Experiences and the Benevolent Childhood Experiences scales (1, 2)] and some items that may be particularly important to adult wellbeing and resilience. Building off of the prior research demonstrating aspects of adult life that lead to better outcomes, PAEs examine adult relationships with family, friends, and community (e.g., having people to talk to about feelings or feeling supported in one’s relationships) as well as adult life stability and meaning (e.g., opportunities to engage in meaningful daily activities, having daily routines, and having beliefs that provide comfort).

The study had four primary aims. Aim 1 was to examine the effects of childhood experiences on PAEs. We hypothesized that those with higher ACEs would have lower PAEs and those with higher PCEs would also have more positive experiences in adulthood. In Aim 2, we examined the relationship between childhood experiences and PAEs on adult depression and anxiety. We hypothesized that PCEs and PAEs would both be linked with lower rates of anxiety and depressive symptoms and that ACEs would be associated with modestly higher rates of anxiety and depression. The purpose of aim 3 was to explore whether PAEs led to better adult mental health even when PCEs were below mean scores or ACEs were high (e.g., ≥4 ACEs). We hypothesized that PAEs could be turning points (5) that led to better adult mental health even in the presence of lower PCEs or high ACEs. Finally, for aim 4 we examined if the effects of PAEs on adult mental health varied among young adults compared to middle-aged adults. We hypothesized that PAEs would be beneficial in both age groups, but have more of a positive effect among young adults.

Data were cleaned and analyzed in Stata version 17. Multiple linear regression was used to examine the effects of childhood experiences on PAEs. To examine the relationship between childhood experiences and PAEs on adult mental health, multiple logistic regression was used, with separate models for anxiety and depression. ACEs, PCEs, and PAEs were included in these models as continuous variables. Next, a series of multiple logistic regression models were fit to examine the respective influence of ACEs and PAEs on depression and anxiety in samples with PCEs equal to or higher than the median of 12 (>11 PCEs) vs. samples with low-to-moderate (or lower than the median) PCEs (0–11 PCEs). A separate set of models were run examining high ACEs (≥ 4 ACEs) compared to low or moderate ACEs (<4 ACEs). Finally, multiple logistic regression models were run to examine differences in how childhood experiences and PAEs influenced adult depression and anxiety among younger vs. middle-aged adults by dividing the sample by those who were 18–34 years versus those who were 35 years or older. When included as independent variables in these models, ACEs, PCEs, and PAEs were included as continuous variables. All models included participant gender, age, education, race, and marital status as controls.

Table 4 includes the results for aim 1. ACEs were not associated with PAEs, but each additional PCE was associated with an increase in the PAE score of 0.53 (p < 0.001). Females and those who were married also reported higher PAEs.

PAEs were associated with lower odds of depression (0.73, p < 0.001) and anxiety (0.84; p < 0.01) while ACEs were associated with higher odds of depression (1.69, p < 0.001) and anxiety (1.66, p < 0.001). PCEs were not associated with anxiety and were modestly associated with higher odds of depression (1.15, p < 0.05) (see Table 4 for full results).

Because the data were cross-sectional, we did not examine the indirect effects of childhood experiences and adult mental health with PAEs as a mediator in our primary analyses. However, in a sensitivity analysis, we used a path model in Mplus Version 7 to examine indirect effects. Using 5,000 bootstraps to ensure robust standard errors, results indicated that PAEs mediated the relationship between PCEs and moderate-to-severe depression (standardized z-score = −4.94, p < 0.001) and between PCEs and moderate-to-severe anxiety (standardized z-score = −3.03, p < 0.01). The indirect effects of PAEs for ACEs and later adult mental health were not significant. See Table 5 for full results.

PAEs were associated with 21% lower odds of moderate-to-severe depression among those with low-to-moderate PCEs (see Table 6). However, the relationship between PAEs and depression was not significant among those with high PCEs. Similarly, PAEs were associated with 15% lower odds of moderate-to-severe anxiety among those with low-to-moderate PCEs but were not associated with anxiety with those with high PCEs. ACEs were associated with higher odds of depression and anxiety in both the high PCE sample and the low-to-moderate PCE sample.

Table 7 includes the results of models comparing participants with high vs. low-to-moderate ACEs. PAEs were similarly associated with lower odds of depression in participants with high vs. lower ACEs. However, PAEs were only associated with lower odds of anxiety among those with high ACEs (0.82, p < 0.05). PCEs were not associated with anxiety or depression in either ACEs group.

Young adults (<35 years) had 72% higher odds of having moderate-to-severe depression as compared to adults 35 years and older, but this relationship was not significant for anxiety. When the sample was split by age (see Table 8), PAEs were associated with a 33% decrease in odds for moderate-to-severe depression among young adults and a 20% decrease in odds for moderate-to-severe depression among adults ≥35 years. In anxiety models, PAEs were associated with 24% lower odds for moderate-to-severe anxiety among young adults, but the relationship was not significant among middle/older adults.

Research has established that social connection can be an important risk or protective factor for health outcomes (37). As such, programs and policies that make it easier for people to develop close connections are important in reducing risk and increasing protection and ultimately improving health outcomes. Strengthening these connections through intervention can occur at each socioecological level. For example, at the community level, community mobilization efforts that bring community members together to address challenges and increase connection include Healthy Places by Design,¹ the Blue Zones Project,² and Communities That Care.³ Community-based programming that has a theoretical basis, offers social activity and support in a group format, and fosters active participation has been shown effective at reducing social isolation among seniors (43). At the family level, programming that works to improve family communication, resolve conflict, and improve cohesiveness includes Strengthening Families⁴ for all youth and parents and Functional Family Therapy⁵ for at-risk youth and parents. Finally, at the individual/peer level, interventions include befriending (introducing clients to others), mentoring (working with clients short-term to provide skills and abilities), and gatekeeping (connecting vulnerable clients with appropriate services) (44).

Some study limitations are important to discuss. First, the data for this study were cross-sectional. As such, causality cannot be inferred. Longitudinal data are needed to better understand the relationships between PAEs and mental health and to examine potential reporter biases in reporting more positive experiences in childhood and currently. Second, data were collected in the fall of 2021 during the COVID-19 pandemic. As such, some responses and results may be affected by the pandemic and resulting trauma that some individuals and groups may have been experiencing. In particular, the relationship between PCEs and health in the current study is not consistent with prior studies using similar populations and methods (3, 45), and these inconsistencies may be due to underlying differences in daily life and mental health due to the COVID-19 pandemic. As such, it will be important to collect data after the pandemic to examine if relationships have changed, particularly as it relates to PAEs and health. Third, PAEs do not examine all possible positive adult experiences. Rather, they provide a snapshot of some key current cumulative positive experiences based on existing research relating to resilience and wellbeing in adulthood. Each experience was weighted equally although some experiences may have a greater positive impact on life and the quality of experience may vary from person to person. Participants had an average of 12.5 out of 15 PAEs and nearly 11 out of 13 PCEs, indicating a high degree of positivity. The high number of PCEs is consistent with prior studies (35), and future studies among diverse samples will demonstrate whether high positivity in adulthood is normative as well. Fourth, in future research researchers should consider using a Likert scale for response options rather than a binary (yes/no) response. This may help add more variability in responses and number of PAEs. As the PAEs scale is utilized in various samples, a next research step may be to examine different PAE conceptual groups (e.g., safety, emotional support, connection with community, and so forth) and their respective impact on health and wellbeing. Fifth, while we measured some forms of childhood adversity using an ACEs measure, we did not measure stressful life events in adulthood. Including adult stressful life events in future studies is important to understanding the degree to which PAEs may help prevent stressful life events, and when these events do occur, mitigating their effects on health and wellbeing. Finally, our sample was largely white and highly educated and the relationships observed may not be representative of low-income or other marginalized communities. Prior work on PCEs in a low-income sample showed similar results to more advantaged samples (35), therefore we would expect that PAEs will also be important in more disadvantaged groups. Items in the PAEs scale were derived from PCE scales that have been used in diverse samples (35). Nevertheless, additional work in a variety of settings and cultures is warranted and the PAEs items should be tested in other demographic groups to ensure cultural relevance.

Despite these limitations, the current study provides some insights as to how positive experiences may affect mental health even when ACEs were high and/or PCEs were low. Additionally, the new PAEs scale provides a measure of cumulative positive experiences in adulthood that had previously not been available for research. Continued refinement of the scale in other populations will be important to better examine how potential turning points (5) can help improve adult mental health even in the presence of adversity.