Depression and suicidal ideation are worldwide concerns and they are the most common mental health problems (Bilsen, 2018; Perquier et al., 2021; Pozuelo et al., 2022). Existing studies indicated that 19.6–30.6% of adolescents suffered from depression (Song et al., 2008; Ibrahim et al., 2013; Gao et al., 2020), while 18–26.4% (Baiden et al., 2021; Hu et al., 2021; Mahumud et al., 2021) had suicidal ideation. In recent years, another mental problem, i.e., uncertainty stress, has attracted some attention from scholars (Holland and Wheeler, 2016), because it can arouse worse consequences and influences than life stress and study stress (Wu et al., 2020). Uncertainty stress refers to the stress caused by the condition of being unsure about someone or something (Yang et al., 2017). Since most students are confused about their own life goals and future (Wu et al., 2016; Yang et al., 2018; Peng et al., 2020), they are easily affected by the rapid socioeconomic transition, increased job competition, immature social values, and feelings of social anomie, which make them become a vulnerable population of uncertainty stress (Yang et al., 2019; Peng et al., 2020). Yang et al. (2019) found that 31.1% of Chinese university students suffered from uncertainty stress. All the depressive symptoms, suicidal ideation, and uncertainty stress could arouse negative adult outcomes, which were collectively known as psychological distress (Schneider et al., 2012).

Existing studies have confirmed that psychological distress could be aroused by negative events in the adult stage (Soares et al., 2020). However, except for the events in the adult stage, it is noteworthy that psychological distress is also linked to childhood experiences, e.g., adverse childhood experiences (ACEs) (Clements-Nolle et al., 2018; Bethell et al., 2019; Tsehay et al., 2020; Doom et al., 2021). ACEs represent a series of harmful experiences that occurred before 18 years old (Merrick et al., 2018). In comparison with those who get no exposure to ACEs, people exposed to ACEs have a higher probability of getting physical and mental health problems and even premature mortality (Chung et al., 2008; Hughes et al., 2016). A meta-analysis showed that 22–24.8% of adolescents reported at least one adverse experience (Bellis et al., 2019). Specifically, ACEs have a significant impact on stress, depressive symptoms, and suicidal ideation (Kim, 2017; Ding et al., 2019; Tracy et al., 2019; Karatekin and Ahluwalia, 2020). For instance, ACEs were attributed to 30% cases of anxiety and 40% cases of depression in North America, and more than a quarter of cases of both conditions in Europe (Bellis et al., 2019). In China, adolescents with 3–5 ACEs are over 10 times likely to be depressed and more than 20 times to have suicidal attempts (Jia et al., 2020). Finally, the stress sensitization hypothesis indicated that ACEs hinder the development of brain areas in charge of stress regulations (McLaughlin et al., 2010) which could not only lead to mental health problems but also trigger subsequent new stressors that were not previously present (Aneshensel and Mitchell, 2014).

Contrary to ACEs, benevolent childhood experiences (BCEs) represent the positive experiences before 18 years, which do not depend on higher socioeconomic status in the family of origin. BCEs can not only provide a foundation for creating better family health in adulthood (Daines et al., 2021) but are also linked to various adult mental health outcomes, such as stress, depression (Bethell et al., 2019), forgiveness, family closeness (Crandall et al., 2019), post-traumatic stress disorder (PTSD) (Narayan et al., 2017; Karatzias et al., 2020), loneliness (Doom et al., 2021), and later life cognition (Lee and Schafer, 2021). BCEs were also significantly associated with adulthood insomnia among young adults (Geng et al., 2021). Furthermore, BCEs were associated with ideal cardiovascular health in midlife (Slopen et al., 2017) and showed a better prognosis in patients with personality disorders (Skodol et al., 2007).

Crandall et al. (2019) introduced the Resiliency Theory (Cicchetti, 2016) as a theoretical framework of the relationship between ACEs and BCEs. The Resiliency Theory suggested that multiple systems (e.g., individual, family, neighborhoods, and schools) interact to affect the course of development and that resilience itself is constantly evolving within individuals and systems (Zimmerman, 2013; Crandall et al., 2019), which postulate that positive or protective factors have a direct and independent effect on an outcome separate from a risk factor. Furthermore, these positive factors can neutralize the effect of risk factors on an outcome (Zimmerman, 2013; Crandall et al., 2019). While ACEs have a negative effect on adult health, BCEs will protect health and promote wellness and may even neutralize the effects of ACEs on adult health behaviors and outcomes.

Up to date, few studies explored the effects of co-occurrence of ACEs and BCEs. On the one hand, one opinion maintained that BCEs and ACEs were only modestly negatively associated, underscoring the independence of adverse and positive early experiences (Merrick J.S. et al., 2019; Doom et al., 2021). On the other hand, Bethell considered that BCEs both co-occur with and operate independently from ACEs in their associations with the adult health outcomes (Bethell et al., 2019). BCEs can foster healthy development, overall wellness, and resilience, which develop a way to prevent and moderate ACEs through the promotion of BCEs (Sege and Harper, 2017). Existing studies have proven that BCEs can neutralize the negative impact of ACEs on adult depression, stress (Crandall et al., 2019), prenatal stress and psychopathology (Narayan et al., 2018), and adulthood PTSD symptoms (Narayan et al., 2017). However, when people suffer from ACEs too excessively, the protective effects of BCEs will be decreased (Crandall et al., 2019).

So far, few studies reported the overlap between ACEs and BCEs (Narayan et al., 2018; Bethell et al., 2019), and none of the study explored the combined effects of ACEs and BCEs toward uncertainty stress and suicidal ideation in young adults. The aim of this study was to document a percentage of overlap between ACEs and BCEs and explore the combined effects of ACEs and BCEs toward psychological distress (e.g., uncertainty stress, depressive symptoms, and suicidal ideation) from an innovative perspective. Based on the previous studies and Resiliency Theory, we hypothesized that (1) ACEs would predict worse psychological distress outcomes; (2) BCEs would predict a less risk of experiencing psychological distress; and (3) BCEs would counteract the negative effects caused by ACEs.

This study assessed the prevalence of ACEs, BCEs, and an overlap between them, as well as their association with psychological distress through a school-based investigation among undergraduates. All of the hypotheses were confirmed in this study. We have highlighted a substantially elevated risk of psychological distress among undergraduates with High-ACEs and a substantially reduced risk of psychological distress among undergraduates with High-BCEs. Moreover, BCEs could counteract the negative effects of ACEs on psychological distress, especially depressive symptoms and uncertainty stress.

In this study, about 27.1% of undergraduates experienced at least one type of ACEs, which is much lower than that of the adolescents in Brazil (85%) (Soares et al., 2016) and adults in the United States (82.9%) (Merrick et al., 2017) and China (66.2%) (Chang et al., 2019), but is similar to college students in China (35.16%) (Cheung et al., 2021). As discussed in the previous study (Butchart et al., 2006), there is a great deal of uncertainty around the estimates of the frequency and severity of ACEs worldwide due to inconsistencies in the measurement and definition of ACEs. In addition, it is worth noting that most previous studies assessed ACEs in the elder population (McLaughlin et al., 2010; Merrick et al., 2017), while few studies were conducted in young adults (Jia et al., 2020; Cheung et al., 2021). Much violence against children remains largely hidden and unreported because of fear and stigma and the societal acceptance of this type of violence (Pinheiro, 2006; Norman et al., 2012). Especially in Chinese undergraduates, Confucianism values and traditional cultures are rooted in thoughts (Ng, 1997), which may contribute to stigma formation, F., more shame toward ACEs (Mukolo et al., 2010; Purtle et al., 2021). Regarding BCEs, 65.7% of undergraduates reported more than 8 BCEs. Undergraduates reported higher BCEs in each item than homeless parents and pregnant women (Narayan et al., 2018; Merrick J.S. et al., 2019). The mean score (8.67 ± 1.78) of BCEs in this study is consistent with American adult (8.70 ± 1.68) and Chinese community people (8.63 ± 1.73) (Doom et al., 2021), and higher than the trauma-exposed sample (6.39 ± 2.66) (Karatzias et al., 2020).

Our findings suggested that BCEs were significantly correlated with lower psychological distress, while ACEs were significantly correlated with higher psychological distress. These findings verified our hypotheses 1 and 2. Similar results were found in other studies that both of them could predict the psychological distress independently (Narayan et al., 2018; Atzl et al., 2019; Bethell et al., 2019; Crandall et al., 2019; Merrick M.T. et al., 2019; Petruccelli et al., 2019; Doom et al., 2021). It is well known that ACEs are disadvantaged in the formation of secure attachment (Hill et al., 1994). In line with attachment theory, it is illustrated that secure attachment has a protective effect on psycho-social development of the children (Bretherton, 1985). Secure attachment is the major psychological resource of the children when suffering from troubles or frustrations (Violato and Arato, 2004). Therefore, children with ACEs might show less secure attachment and greater vulnerability in response to mental problems than those who experienced no obvious adversity (You et al., 2014).

In addition, the Resiliency Theory provides a theoretical framework for the effect of BCEs. Resilience includes the ability to cope when facing adversity (Cicchetti, 2016). BCEs reflect the internal and interpersonal resources from childhood (e.g., feeling comfortable with oneself, feeling safe with and close to others) which are often mentioned as aspects of resiliency and positive youth development (Klohnen, 1996; Masten et al., 1999; Skodol et al., 2007). Building BCEs for children at present could enhance their resilience to psychological distress in adulthood (Doom et al., 2021). Psychological distress could be buffered from pre-existing BCEs, resilience, and resources (Masten and Motti-Stefanidi, 2020).

Finally, as shown in Figure 1, the co-occurrence of ACEs and BCEs (High-Both group) has a protective effect on moderate psychological distress (uncertainty stress, depressive symptoms), which suggested that the positive effect of BCEs could not only counteract the negative effect of ACEs but also even reverse the negative effect of ACEs. These findings further confirmed our hypothesis 3. This can be explained by the effects of resilience, which could moderate the association between ACEs and mental problems (Poole et al., 2017). BCEs could largely counteract the negative effects of ACEs through enhancing resilience (Hornor, 2017; Poole et al., 2017; Doom et al., 2021) when suffering from moderate mental problems (uncertainty stress, depressive symptoms).

However, in suicidal ideation, the co-occurrence of ACEs and BCEs (the High-Both group) also showed a risk effect, which suggested that ACEs may have a more negative effect than the positive effect of BCEs. Although the High-Both group in Figure 1 is insignificant, the negative effect of ACEs was neutralized appropriately by BCEs. This can be explained by the challenge model (Zimmerman, 2013; Crandall et al., 2019), which posits that if the adversity is too great, then it will overwhelm the system and inhibits coping. When suffering from excessive adversities, moderate psychological distress will transfer to suicidal ideation, which is known as a serious public health problem (Bachmann, 2018). The positive effect of BCEs is weaker than the negative effect of ACEs when they co-occurred in such strong psychological distress (Felitti et al., 1998). These findings highlighted the urgent need to advocate BCEs in childhood, especially in moderate psychological distress, as well as a great need for the prevention of ACEs.

Unfortunately, events that have already occurred cannot be erased. Early screening of those at risk of ACEs and the development of effective interventions in early childhood should be encouraged to protect children from ACEs (Norman et al., 2012). It is most important to carry out widespread screening of BCEs in clinical settings, which would be beneficial for identifying those who may be at risk for current or future mental health problems (Narayan et al., 2021). Parents also play a role in shaping positive peer relationships or school and neighborhood environments to increase BCEs (Doom et al., 2021).

Several limitations should be noted in this study. First, we cannot attribute causality to the relationship between childhood experiences and distress due to the cross-sectional nature. Second, study data may be biased due to the entire self-reported questionnaire. Third, because participants were mostly collected from only three provinces of China and consisted of college students, the representativeness of the sample may be limited. As can be seen in this study, resilience has a close relationship with childhood experiences. In the future study, we would examine the role of resilience (Norman et al., 2012; Kumari, 2020) and gender (Al Shawi et al., 2019) in the association between childhood experiences and psychological distress based on a structural equation model to further explore the relationship between these factors. Future studies should also be conducted in broader populations to explore the effects of co-occurrence of ACEs and BCEs.

Our findings suggested that ACEs and BCEs could not only predict the psychological distress independently, but also BCEs could counteract the negative effect of ACEs in psychological problems. These findings pointed out an even greater need to identify and support the victims of ACEs and an urgent need to increase BCEs in early childhood.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the Medical Ethics Committee of Xuzhou Medical University. The patients/participants provided their written informed consent to participate in this study.

HH contributed to data curation, formal analysis, investigation, methodology, project administration, resources, software, visualization, writing—original draft, reviewing, and editing. WW contributed to formal analysis, investigation, methodology, validation, writing, reviewing, editing, and funding acquisition. CZ, JT, JX, and JW contributed to validation, writing, reviewing, and editing. QZ, WY, and XG contributed to conceptualization, funding acquisition, supervision, writing, reviewing, and editing. All authors contributed to the article and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.