(PS10-40) The Impact of ACEs and PTSD Symptoms Across Rural, Suburban, and Urban Parents

Abstract Text: Rural communities bear a disproportionate rate of trauma-related mental health concerns in that those in rural areas report higher rates of PTSD, depression, and suicide (CDC, 2024; Keller & Owens, 2020; Probst et al., 2006; Whealin et al., 2014). These communities, however, report comparable rates of exposure to traumatic events as that of urban settings (McCall-Hosenfeld et al., 2014). Most work has focused on these two areas, urban and rural, without much attention given to suburban areas. However, suburban areas have shown great population growth in recent years, and it is unclear how trauma exposure and mental health concerns may be distributed within this region (Fry, 2020). Understanding the differences in these areas, we can determine how geographic contexts influence trauma exposure and well-being. This research investigates the differential impact of Adverse Childhood Experiences (ACES) and Post-Traumatic Stress Disorder symptoms by location, providing valuable insights into specific community needs.
Data were collected as part of a larger randomized controlled trial (RCT) evaluating a parenting curriculum for families at risk of child welfare involvement. The sample included parents (N=91) who had completed a measure ACES (Felitti et al., 1998), and the PTSD Checklist for the DSM-5 (PCL-5; Weathers et al., 2013). Locality was measured by parents reporting their home address and then determining if it was in a rural location as determined by HRSA.gov Rural Health Analyzer.
ACEs were compared across urban, suburban, and rural areas using the Chi-square tests. Urban parents reported greater exposure to substance abuse in the home (χ2 [2, n=82] = 8.34, p=.015) and, along with suburban parents, experienced more physical assault and verbal abuse than rural parents (χ2 [2, n=90] = 6.16, p=.046; χ2 [2, n=90] = 6.43, p=.04; respectively). ACEs also significantly correlated with PTSD symptoms (r [91]=.31, p=.003) in the entire sample. Finally, a hierarchical regression (R² = .14, F[2, 88] = 7.20, p=.001) indicated that ACE score (b=1.87, t[88]=3.06, p=.003) and locality (b=8.69, t[88]=2.14, p=.035) predicted PTSD severity, with urban parents reporting the highest severity. The interaction between ACE score and locality was non-significant, suggesting ACEs impact PTSD severity similarly across locations.
The results of the present study demonstrated that parents from urban environments had consistently higher rates of exposure to substance abuse, while both urban and suburban parents experienced greater physical assault and verbal abuse than rural parents. These qualitatively different stressors may contribute to the greater PTSD severity observed in our sample of urban parents, and support the implementation of community-specific interventions. For example, urban and suburban areas might benefit from programs that address direct exposures to abuse and provide trauma-informed care, while rural communities would benefit from increased mental health care accessibility to tackle the isolation and stigma that maintains mental illness in these areas (NAMI, 2022). Such targeted strategies would not only help in mitigating the immediate effects of ACEs but also in reducing the chronic mental health issues that emerge from them.