PT - JOURNAL ARTICLE AU - Stock, Sarah AU - Lacey, Rebecca AU - Fisher, Helen AU - Baldwin, Jessie TI - OP147 Can a warm and supportive adult protect against mental health problems amongst children with experience of adversity? A twin difference study AID - 10.1136/jech-2023-SSMabstracts.277 DP - 2023 Aug 01 TA - Journal of Epidemiology and Community Health PG - A133--A133 VI - 77 IP - Suppl 1 4099 - http://jech.bmj.com/content/77/Suppl_1/A133.1.short 4100 - http://jech.bmj.com/content/77/Suppl_1/A133.1.full SO - J Epidemiol Community Health2023 Aug 01; 77 AB - Background Adverse childhood experiences (ACEs) are associated with mental health difficulties at the population level, however there are individual differences and many exposed children do not develop mental health problems. A warm and supportive adult presence in childhood is associated with a lower likelihood of developing mental health problems after exposure to ACEs. However, it is not clear whether the presence of a warm and supportive adult can causally protect against mental health problems, as previous research has not accounted for genetic confounding.Methods We studied data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a representative cohort of 2,232 same-sex twins from the UK. We examined associations between maternal warmth and adult support and emotional and behavioural problems at age 12 and a general measure of psychopathology (p-factor) at age 18. ACEs were measured prospectively from ages 5 to 12 through repeated observations and interviews with parents. Maternal warmth was assessed through mothers’ speech-samples at ages 5 and 10, and adult support was assessed through child self-reports at age 12. Mental health problems were assessed through interviews with parents and teachers at age 12 and participants at age 18. First, associations were studied amongst all E-Risk participants with experience of ACEs (phenotypic level). Then twin difference models examined whether a warm and supportive adult presence is protective independent of familial confounding.Results Among children exposed to ACEs, those who experienced greater maternal warmth and adult support had lower levels of mental health problems at ages 12 and 18. In monozygotic twin difference analyses, the protective effects of maternal warmth and adult support on mental health were largely attenuated (on average by 70% for maternal warmth, and 79% for adult support). MZ twins who experienced greater maternal warmth and adult support had minimal or no difference in mental health outcomes compared to their co-twins, concordant for ACE exposure.Conclusion Our findings suggest that the protective effect of adult warmth and support is largely explained by familial confounding and thus may not causally protect against mental health difficulties following adversity. Our study suggests that programmes aiming to boost maternal warmth and adult support may not prevent children exposed to adversity from developing mental health problems. Instead, interventions addressing heritable psychiatric vulnerabilities and family environmental risks in children exposed to ACEs may be better able to boost resilience.