Examining The Mediating Role of Self-Esteem in The Relationship Between Adverse Childhood Experiences and Complex Posttraumatic Stress Disorder Among Late Adolescents in Selected Public Day High Schools in Laikipia County, Kenya

Abstract

The study aimed to explore whether self-esteem mediates the relationship between Adverse Childhood Experiences (ACEs) and the development of Complex Post-Traumatic Stress Disorder (C-PTSD). The specific objectives were to assess the prevalence of ACEs and C-PTSD, examine the relationship between them, and test the mediating role of self-esteem. It was hypothesized that exposure to ACEs would lower self-esteem, which in turn would mediate the development of C-PTSD. The study was framed within toxic stress, memory, and identity theories. A cross-sectional design was employed, targeting 300 late adolescents aged 18 to 21 in public day high schools in Laikipia East Sub-County, Laikipia County, Kenya. A census approach was taken, resulting in a final sample of 251 participants (83.7% response rate). Data collection involved structured questionnaires, and analysis utilized SPSS version 29, incorporating descriptive statistics, correlation, and mediation analysis. The findings revealed that emotional abuse and household mental illness were the most common ACEs (33.9% each), followed by domestic violence (33.5%) and parental separation (30.7%). Emotional and physical neglect were least prevalent. Gender differences were significant, with females reporting higher ACEs scores. In terms of PTSD symptoms, the "current threat" cluster was most common (67%), and for disturbances in self-organization (DSO), affect dysregulation was prevalent (53%). Overall, 51% of participants met the criteria for PTSD, 33% had no diagnosis, and 16% met criteria for C-PTSD. Gender also influenced diagnostic outcomes, with no females meeting the criteria for C-PTSD. Correlation analysis showed a strong positive link between ACEs and C-PTSD (r = .62), a moderate positive relationship between self-esteem and C-PTSD (r = .361), and a weak negative correlation between ACEs and self-esteem (r = -.196). Notably, 52% of participants exhibited low self-esteem. Mediation analysis confirmed that self-esteem partially mediated the ACEs-C-PTSD relationship, with ACEs accounting for 38.44% of the variance in C-PTSD scores. When self-esteem was included, the variance explained increased to 42.80%, with both ACEs and self-esteem as significant predictors. The study concluded that ACEs and C-PTSD are critical concerns for Kenyan adolescents, with self-esteem significantly mediating their relationship. Recommendations included implementing regular ACEs screenings and trauma-informed practices in schools, alongside interventions aimed at boosting self-esteem and mental health support for affected students.