1 Introduction

A substantial body of literature has consistently linked adverse childhood experiences (ACEs) to poor wellbeing (Oshio et al. 2013; Hughes et al. 2017; Mosley-Johnson et al. 2019) and lifetime and recent depressive disorders (Chapman et al. 2004). The World Mental Health Survey reported that childhood adversities accounted for 29.8% of all mental health disorders worldwide (Kessler et al. 2010). Additionally, according to the Global Burden of Disease Study, depressive disorders rank as the second-highest attributable cause of years lost to disability in young people (Mokdad et al. 2016), showing the widespread prevalence and impact of depression.

The mental health of young adults in Eritrea is of particular research interest due to the impact of war and postwar challenges on families and communities. War or postwar trauma is highly prevalent among Eritreans (Graf 2018; Akresh et al. 2012), as Eritrea has only enjoyed 7 years (1991–1997) of complete peace since the end of World War II. The Ethiopian war of 1998–2000 marked the beginning of a no-peace no-war situation in Eritrea. Studies show that, in addition to the evident consequences of war, including broken family structures, displacement, and exposure to violence, the economic burden and psychological traumas, though primarily faced by parental figures, result in higher risks for ACEs among children (Nurius et al. 2012). Research has also documented the possibility of intergenerational transmission of trauma (Yehuda and Lehrner 2018), emphasizing the longstanding impact of war on communities. Young adults in Eritrea have grown up in the aftermath of the war, with many born during a time of active warfare, making this population an important and unique cohort to study depression and wellbeing. Besides the exposure to potential external and societal adversities, college students have additional unique stressors, including adapting to new college environments (Alonso et al. 2018), academic pressures, and developmental turbulences associated with the transition to adulthood (Arnett 2012; Newcomb-Anjo et al. 2017). Moreover, nearly three-quarters of all lifetime mental health problems first occur during this developmental period of young adulthood (Auerbach et al. 2018). Further, the wellbeing of college students is seen to decline after joining college (Ratanasiripong et al. 2018), and college students are more vulnerable to depression compared to the general population (Ibrahim et al. 2013).

The mental health and wellbeing of young people in Eritrea face additional challenges due to the deep-rooted stigma and unavailability of mental health services. Mental health is viewed categorically as the presence or absence of psychological symptoms. A shift from this pathological perspective to promoting positive mental health resources such as resilience and subjective wellbeing seems more crucial in this context. It has been widely recognized that enhancing positive mental health resources and reducing risks help people thrive and/or flourish in the face of adversity ( Luthar et al. 2014). Therefore, to help break the generational cycle of wartime adversities in the resource-limited setting of Eritrea, it is essential to identify modifiable risk and protective factors affecting the mental health and wellbeing of young people.

1.1 The Link of ACEs to Subjective Wellbeing and Depression

Wellbeing as a general concept is an integral part of the WHO definition of health—“not merely the absence of disease or infirmity” but “a state of wellbeing” (Vik and Carlquist 2018). There are several definitions and measures around the concept of subjective wellbeing (Diener et al. 2018). Nonetheless, based on the judgment model of subjective wellbeing, it could be described as an individual’s cognitive and affective global judgment of his/her life (Schwarz and Strack 1991). Subjective wellbeing is becoming an important measure of the health and wellbeing of individuals and societies (Diener 2006). Due to poverty and structural barriers to health services, subjective wellbeing could be more related to health in the least developed countries such as Eritrea (Ngamaba et al. 2017).

While a large base of evidence has indicated the link of ACEs to later mental and physical health problems, the focus is also growing to look into the association of ACEs and positive aspects of mental health including subjective wellbeing. Adults with a history of childhood adversity were more likely to report significantly low adulthood subjective wellbeing as compared to those with lesser negative experiences (Bellis et al. 2013). Corcoran and McNulty (2017), for example, found that childhood adversities indirectly reduced subjective wellbeing through attachment mechanisms among university students. Likewise, Oshio et al. (2013) indicated that ACEs had considerably reduced subjective wellbeing during adulthood. More so, several childhood bullying experiences were associated with a significant reduction of the subjective wellbeing of undergraduates in Spain (Víllora et al. 2020). Further, ACEs substantially impacted general wellbeing through early-onset depression and other health-harming behaviors (Giovanelli et al. 2016; Scott et al. 2011). ACEs negatively affect subjective wellbeing by several mechanisms. The neurobiological perspective highlights that ACEs over-activate brain structures in charge of emotion-laden memories, while at the same time disrupting neutral memories (Payne et al. 2007). ACEs are also related to alterations of the mesolimbic dopamine system and over stimulation of the hypothalamus–pituitary–adrenal axis (HPA), structures involved in reward processes and the regulation of stress respectively (Koss and Gunnar 2018). Reduced mesolimbic dopamine neurotransmission is associated with depressed mood (Pizzagalli et al. 2008), while its activation is related to resilient attributes (Dutcher and Creswell 2018). Moreover, ACEs have been shown to threaten one’s capacity to cope with stress through the disruption of neurobiological mechanisms and the alteration of psychological and epigenetic circuitries (Shonkoff et al. 2009). These changes may consequently inhibit the development of cognitive foundations of resilience, including attachment ( Luthar et al. 2015; Fergusson and Horwood 2003), positive emotions (Tugade and Fredrickson 2004), and sense of purpose (Sagone and De Caroli 2014). Research found that children with secure-attachments to significant others showed less sensitivity to stress and higher resilience capacity (Marriner et al. 2014). Likewise, children with adaptive emotion regulation strategies following ACEs showed reduced negative psychological outcomes (McLafferty et al. 2020). Liang et al. (2018) also revealed that college students in China who were left behind by parents during childhood reported much lower scores of hope, optimism and self-efficacy. After relief from ACEs, altered cognitive functions tend to improve. However, structures related to emotion regulation, reward execution, and affective functioning hardly show improvement, even decades after the experience of adversity (Herzog and Schmahl 2018; Pechtel and Pizzagalli 2011). This could be one reason why affective disorders and reduced level of wellbeing are commonly seen among adults with a history of ACEs (Chapman et al. 2004). Likewise, not only do ACEs strongly predict later depressive symptoms (Blum et al. 2019), but they also increase the vulnerability of experiencing further stressors later in life (Mc Elroy and Hevey 2014). Indirect pathways through which ACEs proliferate stress to compromise later mental health outcomes included lack of social support, low income and adversity during adulthood (Jones et al. 2018). On the other hand, in a sample of Japanese adults, Oshio et al. (2013) found that a large proportion of the impact of ACEs on subjective wellbeing remained unexplained by the mediated or moderated effects of social support and low socioeconomic status. Hence, potential conduits through which ACEs lead to poor subjective wellbeing later in life may be through mental health problems such as depression or through personal attributes like psychological resilience.

1.2 Protective Role of Resilience

Not all people with a history of ACEs suffer depression and poor wellbeing later in life. One important protective factor against the toxic stress of ACEs is resilience (Werner 2009). Resilience is defined as the dynamic ability of an individual to “bounce back” in the face of adversity (Connor and Davidson 2003). Resilient individuals have better wellbeing and lower risk of developing psychopathology (Meng et al. 2018). Studies showed that resilience was negatively correlated with depression (Min et al. 2013) and positively with wellbeing (Satici 2016). Individuals with resilient characteristics tend to rely on efficient utilization and mobilization of personal coping resources to overcome adversities, which leads to the feeling of wellbeing. They also show better-coping skills and affect regulation than their non-resilient counterparts (Agaibi and Wilson 2005). Further, people with resilient capacities have a positive orientation towards themselves the environment and the future (Mak et al. 2011). This perception may help them buffer any negative biological and psycho-emotional stress responses which may increase their wellbeing and reduce depression (Southwick and Charney 2012).

Recent studies have pointed out the importance of examining pathways by which resilience provides an advantage to students at institutions of higher education, specifically in regard to withstanding ACEs (Oehme et al. 2019). For example, researchers have implicated that resilience enhances wellbeing and protects against the effects of ACEs among college students (Mello 2016; Theron and Theron 2014). Moreover, among Chinese university students, Chen (2016) found that resilience had a direct and positive effect on subjective wellbeing. Hartley (2012) also documented that college students who sought help from university counseling centers had lower resilience and greater psychological disturbance. Available evidence has guided many researchers to advocate the value of resilience as key for the wellbeing of college students (Holdsworth et al. 2018; Johnson et al. 2015; Hartley 2011, 2012). Yet, most previous studies have not explored the cumulative effect of ACEs on subjective wellbeing and the underlying mediating factors (both risk and protective) in youth emerging from a long-standing war.

In summary, the relationships between ACEs, resilience, depression and wellbeing appear quite intermingled. That is, bidirectional influence and causation are possible in the relationship of these constructs (Diener et al. 2017; Fredrickson and Joiner 2002). Their relationship is further complicated, as they are all confounded by genetic and personality traits (Migliorini et al. 2013). However, it is quite convincing that ACEs are critical factors to lay the ground for and impact later wellbeing (Felitti and Anda 2009).

1.3 The Current Study

With a global increase in the prevalence of common mental health problems among the youth (Eisenberg et al. 2016; Evans-Lacko and Thornicroft 2019; Castillo and Schwartz 2013), a significant decline in resilience among college undergraduates is also detected (Gray 2015; Oehme et al. 2019). Early adulthood is a developmental period when new risks like depression appear (Shapero et al. 2019). Hence, this period gives a crucial window for understanding mental health risks and protective factors. Although mental health has received substantial attention in high-income countries, specifically among young adults, the same is not true for the low-income (Atilola 2015). Eritrean youth are an under-researched population, and they live in a socio-politically complex culture accompanying political unrest. Therefore, identifying contextual factors affecting the subjective wellbeing of young people is essential to inform practice and lay the ground for future studies. Existing literature suggested that the effect of ACEs on psychological adjustment (i.e., depression and wellbeing) could be moderated or mediated by resilience (Hoppen and Chalder 2018). Youssef et al. (2017), for instance, found that higher resilience moderated the effect of ACEs on depression among young adults. Similarly, Poole et al. (2017) have shown that the negative impact of ACEs on depression is moderated by psychological resilience in primary care adults. Moreover, resilience resources moderated ACEs’ effect on perceived wellbeing in a large sample of American adults (Nurius et al. 2015). While the above-mentioned studies have documented that resilience appears to moderate the associations between ACEs and mental health outcomes, others indicated both moderating and mediating effects of resilience in the relationship between childhood adversities and depression (Ding et al. 2017). The effect of childhood abuse among socio-economically disadvantaged women was mediated by resilience on post-traumatic stress symptoms (Hong et al. 2018). A longitudinal cohort study indicated that the mediation role of resilience reduced the relationship between ACEs and wellbeing among adolescents and emerging young adults (Giovanelli et al. 2016). Several longitudinal research also linked the significant mitigating role of resilience to ACEs and later positive mental health outcomes of young adults (Werner 1989; Masten et al. 2004, 2006; Fergusson and Horwood 2003). More so, Fossion et al. (2013) found that the effects of traumas on depression and anxiety among children who have survived the Nazi holocaust were mediated by resilience. Depression, on the other hand, is also shown to mediate the effects of childhood adversities on multiple health-harming behaviors including risk-taking and drug abuse (Solakoglu et al. 2018; Guo et al. 2018; Smith et al. 2018), which may subsequently compromise subjective wellbeing in the long term. Consistent with prior inquiry (Chen 2016; Lu et al. 2017; Karatzias et al. 2017), we hypothesize (1) ACEs, depression and resilience predict subjective wellbeing, (2) Resilience and depression moderate or mediate the effects of ACEs on subjective wellbeing.

2 Methods

2.1 Participants

There are seven colleges in the Eritrean institute of higher education and research. The total number of undergraduate degree students in these colleges was 5740. Paper–Pencil based questionnaires were self-administered among undergraduate students from all seven colleges in November 2018. This study applied a stratified systematic sampling to obtain a representative sample of undergraduate degree students. First, the sampling frame was stratified based on students’ year of study (Year 1–6). Next, students were selected through a systematic sampling from an alphabetically arranged name list, with a sample interval of 10. Selected participants were approached through their teachers and head departments in a classroom. A total of 564 students participated in this survey, and data for 507 respondents were eligible for analysis, indicating a response rate of 89.9%. The study was approved by the respective Institutional Review Boards. All participants provided written informed consent.

2.2 Measures

Demographic characteristics including gender, age, college, department, year of study, growing up with both parents, setting of residence before college (urban, rural), ethnicity (Tigrigna, others) and parental college education were also collected.

2.2.1 Subjective Wellbeing

The World Health Organization’s five wellbeing index (WHO-5) was used to measure subjective wellbeing (WHO 1998). WHO-5 index mainly reflects basic subjective states of wellbeing such as positive mood, vitality and general interests (Hochberg et al. 2012). It measures subjective wellbeing as a unidimensional construct in a 6-point Likert scale ranging from “at no time” (0) to “all of the time” (5). Higher scores represented better subjective wellbeing. The composite reliability in current study was 0.82, with a 95% confidence interval (0.79, 0.85).

2.2.2 ACEs

The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was utilized to assess adverse childhood experiences (WHO 2018). It contains 29 questions regarding exposures to 13 categories of ACEs: emotional abuse; physical abuse; sexual abuse; emotional neglect; physical neglect; domestic violence; living with household members who were substance abusers; living with household members who were mentally ill or suicidal; living with household members who were imprisoned; one or no parents, parental separation or divorce; bullying; community violence; and collective violence. The summary score of ACEs ranged from 0 to 13, with higher scores indicating greater exposure to ACEs. In this study, we employed the frequency scoring approach to estimate ACE exposure. According to the guidance for ACE-IQ (WHO 2018), only 5.5% of college students reported physical neglect or physical abuse. However, child physical abuse and neglect are quite common and widely complicated by structural and deeply rooted sociocultural norms. For instance, parents have the right to disciplining the child and corporal punishment is widely prevalent in families and schools (Plastow 2007; Terhune 1997). Therefore, we modified the scoring of physical neglect and physical abuse. Specifically, responses of “A Few Times” or “Many Times” were recoded as exposure to physical neglect and physical abuse.

2.2.3 Resilience

Resilience was assessed using the 10-item Connor–Davidson Resilience Scale (Connor and Davidson 2003; Campbell-Sills and Stein 2007). It is a unidimensional and self-administered scale that measures core attributes of resilience, including the ability to quickly “bounce back” in the face of stress or illness, focus under pressure, manage negative and painful affects, and problem solve (Campbell-Sills and Stein 2007). Items were rated on a 5-point Likert scale ranging from “not true at all” (0) to “true nearly all the time” (4). The total score ranged from 0–40, with higher scores suggesting higher resilience capacity. The composite reliability in current study was 0.82, with a 95% confidence interval (0.79, 0.84).

2.2.4 Depression

The Self-Reporting-Questionnaire (SRQ-20) developed by the World Health Organization for screening depression in low income settings was utilized (Beusenberg et al. 1994). Recently, it was validated among adults in the primary health care setting in Eritrea (Netsereab et al. 2018). College students reported if they had symptoms of depression (E.g. Do you feel unhappy? No = 0; Yes = 1). A composite score ranged from 0 to 20, with higher scores indicating more symptoms of depression.

2.3 Data Analysis

The completed questionnaires were entered into CSPro version 6.3.2 (census and survey processing system) software. Tetrachoric correlations, composite reliability, and structural equation modeling (SEM) were utilized using Mplus 8.0, whereas all other analyses were performed using SPSS 23.0. ACEs and depression were modeled as observed continuous variables, while resilience and subjective wellbeing were modeled as latent variables. A bootstrap sample of 1000 and 95% confidence interval (95% CI) tested the mediating effect. A series of indicators were used to evaluate the goodness of model fit, including the Comparative Fit Index (CFI), Tucker–Lewis Fit Index (TLI), chi-square to degrees-of-freedom ratio (χ2/df), the Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR).

3 Results

As shown in Table 1, the mean age of the participants was 19.69 ± 1.50 years (range 18–25), and 50.49% of the sample was male. The majority were Tigrigna in ethnicity (87.38%) and lived in urban settings before college (81.66%). Only 36.69% of respondents either or both parents graduated from college. 86.4% (438/507) of participants reported at least one category of childhood adversity. Table 1 summarizes the means and standard deviations of ACEs, depression, resilience, and subjective wellbeing.

Table 1 Description of study variables (N = 507)
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Tetrachoric correlations between ACEs categories ranged from − 0.01 to 0.64, depression items from 0.06 to 0.63, see Tables 5 and 6. The bivariate correlations for the variables are displayed in Table 2. All correlation coefficients were statistically significant at p < 0.001.

Table 2 Correlations between study variables
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To test the hypothesized moderated mediation model, we first examined the overall effect of ACEs on subjective wellbeing (β = − 0.18, p < 0.001). Next, depression was considered as a mediator to investigate the relation between ACEs and subjective wellbeing. The finding showed that depression fully mediated the effect of ACEs on subjective wellbeing. Then, resilience was examined as a moderator, see Fig. 1. Results indicated that the interaction between resilience and ACEs regressed on depression (p = 0.606) and subjective wellbeing (p = 0.281) were non-significant.

Fig. 1
figure 1

Hypothesized moderated mediation model

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Finally, we tested whether resilience mediates the effect of ACEs on subjective wellbeing. The direct link between ACEs and wellbeing became non-significant (β = − 0.01; p = 0.890), hence this path was eliminated from the final model for parsimony. Figure 2 depicts the final model, with standardized path coefficients adjusting for year of study, growing up with both parents, gender, ethnicity, setting of residence before college, and parental college education. The final model demonstrated a very good fit (χ2 = 393.736, df = 206, χ2/df < 3, CFI = 0.92, TLI = 0.91, SRMR = 0.06, and RMSEA = 0.04, 90% CI: 0.04–0.05), explaining 37.2% of the variance in wellbeing. ACEs were negatively associated with resilience (β = − 0.18, p < 0.001). In turn, resilience was correlated with lower depression (β = − 0.26, p < 0.001) and higher subjective wellbeing (β = 0.24, p < 0.001). ACEs had a positive association with depression (β = 0.22, p < 0.001), which in turn was negatively related to subjective wellbeing (β = − 0.49, p < 0.001), see Table 3.

Fig. 2
figure 2

Standardized coefficients of the final mediation model

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Table 3 Standardized estimate effects of final structural models
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As presented in Table 4, ACEs had significant indirect effects on subjective wellbeing through resilience (β = − 0.04, p = 0.006) and depression (β = − 0.11, p < 0.001). Resilience together with depression mediated the relationship between ACEs and subjective wellbeing (β = − 0.02, p = 0.005).

Table 4 Standardized effects of ACEs on wellbeing
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4 Discussion

This is the first study from Eritrea to report the effect of ACEs on the subjective wellbeing of college students. ACEs are estimated to be more prevalent in Low and Middle Income Countries (LMICs) with a prevalence of 46% for violence, 52% for emotional maltreatment, and 43% for household dysfunction among adolescents (Blum et al. 2019). 86.40% of respondents reported at least one category of childhood adversity in the current study, which is higher as compared to university students from Tunisia (74.8%), Germany (23.0%) and South Korea (49.9%) (El Mhamdi et al. 2017; Wiehn et al. 2018; Kim 2017). In our study, the average ACE score was 2.70, also higher than similar studies in other countries like China (1.83), East Asia (1.51), and the Philippines (2.37) (Ho et al. 2019, 2020; Reyes et al. 2018).

Previous studies indicated that the subjective wellbeing of college students declines relative to its pre-college level. Though it improves gradually through the undergraduate years, it hardly returns to its previous level (Bewick et al. 2010; Sarmento 2015). This observation is expected to be pronounced among college students with depression or a history of ACEs (Sciolla et al. 2019).

Our data do not support the hypothesized moderated mediation model, with resilience as a moderator. Conversely, the current study showed that resilience, depression, and joint resilience-depression fully mediated the effects of ACEs on subjective wellbeing. Previous studies have reported a link between ACEs and negative mental health outcomes in universities around the world (Mall et al. 2018; Peng et al. 2012; Kalmakis et al. 2019; Robinson et al. 2019; Sokratous et al. 2013). For example, Karatekin and Hill (2018) found that college students with a history of high exposure to ACEs were far more likely to report depression. Another research also found that ACEs had cumulative effects on the subjective wellbeing of college students (Brogden and Gregory 2019). Research on developmental pathways from ACEs through depression (Merrick et al. 2017; LaNoue et al. 2012) further support our finding. The far reaching impact of ACEs can be explained by the indication that during childhood, when brain development is active, ACEs hyper-sensitize stress and emotion regulating brain circuitries such as the HPA, amygdala and the hippocampus (Herzog and Schmahl 2018). These potential neurobiological repercussions from ACEs and the prolonged toxic stress expose children to become highly sensitive, hyper-vigilant and over-reactive to threat stimuli later in life (Tottenham and Sheridan 2010; Teicher et al. 2016). Individuals with these behaviors will have problems regulating their emotions and building healthy interpersonal relationships, which negatively affect their wellbeing (Mc Elroy and Hevey 2014). Not only do ACEs alter neurobiological systems, they also dysregulate other epigenetic and psychosocial stress pathways that lead to lowered stress threshold and exhausted coping mechanisms (Shonkoff 2010; Nurius et al. 2015), which increase vulnerability to depression. These impacts might be visible during this transitional developmental period when young adults move towards independence and salient biological and psychosocial developmental changes occur. Therefore, it is high time to identify high-risk individuals and protective factors.

Compared to the contributions of other variables included in the model, depression exerted the strongest negative effect on subject wellbeing. Additionally, depression alone has mediated more proportion in the relationship than the joint depression-resilience and resilience. This is not a surprising finding inasmuch as several studies have indicated that depression exacerbates subjective wellbeing by several means, including the dominance of negative affect and reduction of positive affect (Cummins 2013), rumination (Sun et al. 2014), loss of hope (Mascaro and Rosen 2005), and increased activity of the HPA axis (Kalmakis et al. 2015).

Risk accumulation is another way ACEs sustain their enduring negative impact on wellbeing through depression. Experiencing one type of ACEs potentially increases the probability of being exposed to another (Garrido et al. 2018). In communities and families with multiple risks related to war, socio-economic, and political challenges, multiple stressors intermingle in a complex mechanism, exposing children to an array of adversities and subsequent psychopathology (Shonkoff et al. 2012). The absence of formal targeted mental health services in our setting may make these risks perpetuate. Therefore, it is crucial to identify and prevent ACEs as early as possible to prevent the accumulation of exposures. Recognizing and treating depression is also essential to prevent the sustained impact of ACEs on subjective wellbeing (Giovanelli et al. 2016). However, investing in the promotion of resilience and subjective wellbeing would be more acceptable than preventing negative mental health, as mental illness literacy is low and stigma is prevalent in this context. Despite the presence of mental illness, nurturing personal assets like psychological resilience helps sustain wellbeing (Bos et al. 2016). Evidence shows that mechanisms that promote positive mental health are effective and sustainable in reducing future mental ill-health (Keyes 2005).

Further, in line with studies among Eritrean youth (Melamed et al. 2019; Farwell 2003), resilience is negatively correlated with both ACEs and depression and positively with subjective wellbeing. Likewise, our results corroborate previous findings (Mehta et al. 2019; Tugade and Fredrickson 2004; Mak et al. 2011; Howell et al. 2017), in which resilience enhances wellbeing and reduces depressive symptoms through positive emotions and positive cognitive schemas. Several studies reiterated the substantial impact of resilience on wellbeing; people with higher resilience capacity are more tenacious when faced with adversity, handle stressful and threatening situations more positively, and have a higher capacity of coping with life’s challenges (Werner 2009; Luthar et al. 2015). Our result is also supported by Turner’s (Turner et al. 2017) finding, indicating resilience as a precursor to the wellbeing of university students. However, research conducted by Kaloeti et al. (2019) has shown that resilience did not mediate the effect of ACEs on depression among university students.

Our study recognizes the significant mediating role of resilience in the relationships between ACEs, depression, and subjective wellbeing, which implies that, though distant risks such as ACEs perpetrate enduring disruptions on subjective wellbeing, they can still be ameliorated by jointly enhancing wellbeing through building resilience and reducing depression (Peng et al. 2012). Our model’s joint risk and protective factor examination also align with the two continua model of mental health and psychological wellbeing (Kinderman et al. 2018).

5 Limitations

Several limitations should be mentioned in the current study. First, this study is prone to systematic bias as the sample consists only of college students; therefore, findings are not generalizable to other populations. Second, causal relationships could not be made from this cross-sectional study. Third, self-reports of study variables may be subject to recall and social desirability biases. Likewise, it is worth noting that the CD-RISC-10 measures only self-perceived individual attributes of resilience. Further, the magnitude of the relationship between ACEs, wellbeing, and resilience are significant but small. The contribution of variables on the explained variance of resilience and depression are very low, as several important constructs such as social supports (Jones et al. 2018) were not examined. Finally, caution should also be used in extrapolating the findings, allowing for sociocultural differences and the meaning ascribed to ACEs, resilience, depression, and subjective wellbeing in the local context.

6 Implications

This study presents potential practical implications. In accordance with the global call by the Sustainable Development Goals to reduce the life-course effects of ACEs on health (Hughes et al. 2017), our study underscores that school psychologists, counselors and other mental health professionals should consider ACEs as key risks to the wellbeing of young people in this particular context. In line with findings from similar war and post war settings, our study confirms that depression and prevalent multiple risks are key intervention targets to improve the wellbeing of youth (Okello et al. 2013). Hence, our research presents an insight into contextualized interventions that might offset the immediate harms of ACEs, protect against depression, and enhance subjective wellbeing. This may help youth to undergo successful transition to college and adulthood. It is particularly relevant to Eritrea, where mental health services are being decentralized and integrated into the primary health care system. For instance, trauma-informed programs could be integrated and streamlined into medical education and other existing primary health care programs. Colleges could be key partners in providing coordinated mental health services. Furthermore, recognizing the limited research on these significant risks in settings affected by political unrest (Kabiru et al. 2013; Akresh et al. 2012) and extensive stigma towards mental illness, our research has the potential to stimulate future studies. The literature on vulnerability in resource limited-settings largely focus on the deficits with little or no attention to assets that may promote the health and wellbeing of people. Investing and harnessing resilience may provide alternatives.

7 Conclusions

Our study further supports the notion that ACEs are prevalent in resource-limited settings and their negative mental health impacts are far-reaching. ACEs affect the subjective wellbeing of young adults emerging from war hardships indirectly via resilience, depression and joint resilience-depression pathways with depression playing a major role. Innovative and contextually suitable interventions targeting youth with history of ACEs may help mitigate the cycle of risk proliferation.