From Childhood Adversity to Workplace Stress: A Mediation Analysis of Resilience and Social Support Among Nurses Using the Transactional Model of Stress and Coping

Background Adverse Childhood Experiences(ACEs)are particularly common among nurses compared with the general population, posing higher risks for workplace strain. Guided by the Transactional Model of Stress and Coping, this study examined the relationships of ACEs, perceived stress, resilience and social support. Method Between December 2023 and January 2024, 715 nurses (97.5% female) from hospitals in Shanghai, China, were recruited using convenience sampling. Participants completed online surveys, including Simplified Chinese version of the ACE-International Questionnaire, the 10-item Connor–Davidson Resilience Scale, Perceived Stress Scale, Perceived Social Support Scale. Descriptive statistics, ANOVA tests and multiple regression analysis were performed to identify the influencing factors, while mediation analyses to examine whether resilience and social support mediated the relationship between ACEs and perceived stress. Results 57.3% of nurses reported experiencing at least one ACEs, with family abuse, emotional neglect and abuse being the most reported types. Multivariate linear regression analysis showed that resilience, social support and ACEs were all associated with perceived stress. Furthermore, resilience and social support served as parallel mediators in the relationship between ACEs and perceived stress, with resilience showing a more significant mediation effect. Conclusions This study highlights the high prevalence of ACEs among nurses and need for early, systematic screening. ACEs directly and indirectly influence perceived stress. These insights deepen the understanding of ACEs’ impact on stress perception among nurses and provide valuable guidance in developing a comprehensive, multi-level approach focused on enhancing resilience to mitigate the impact of ACEs and reduce perceived stress among nurses.