Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being
Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences - a retrospective study on adult health-harming behaviours and mental well-being
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DOI：
10.1186/s12888-017-1260-z
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发表时间：
2017-03-23
期刊：
影响因子：
4.4
通讯作者：
Butler, Nadia
中科院分区：
文献类型：
--
作者：
Bellis, Mark A.;Hardcastle, Katie;Butler, Nadia
背景：包括虐待儿童和家庭问题（如家庭暴力）在内的不良童年经历增加了成年后健康和精神状况不佳的风险。诸如小时候能接触到值得信任的成年人等因素，可能会赋予孩子抵御这种负面结果的韧性。这种韧性在多大程度上减轻了童年的逆境，目前很难量化。在这里，我们测试了童年时期获得可信任的成年人是否与ace对采取危害健康行为的影响降低和成人心理幸福感降低有关。方法：在英国四个地区进行横断面面对面家庭调查（年龄18-69岁，2015年2月至9月），检查童年遭受的不良经历，从你信任的人那里获得的成人（AAA）支持，以及目前的饮食、吸烟、饮酒和心理健康状况。抽样采用分层随机概率法（n = 7047）。分析使用卡方、二元和多项逻辑回归。结果：不良饮食、日常吸烟和重度饮酒的成人患病率随着ACE计数的增加而增加，而在儿童期接受AAA支持后则下降。有这两种行为的患病率从1.8%（0次ace， AAA支持，居住最富裕的五分之一）增加到21.5%（>= 4次ace，缺乏AAA支持，最贫困的五分之一）。然而，在AAA支持下，增幅降至7.1%（>= 4个ace，最贫困的五分之一）。心理幸福感较低的人在童年时期从你信任的人那里获得AAA支持的可能性为3.27 （95% Cls, 2.16-4.96）倍（与0 ACE相比，有AAA支持），在童年时期获得= 4 ACE但没有AAA支持的可能性为8.32 （95% Cls, 6.53-10.61）倍。儿童期ACE计数和缺乏AAA支持时，多种健康危害行为合并较低的心理幸福感显著增加（校正优势比32.01,95% Cls 18.31-55）。98, >= 4张王牌，没有AAA支持vs. 0张王牌，有AAA支持)。结论：不良的童年经历会对一生的身心健康产生负面影响。这种影响可以通过在童年时期得到你信任的成年人的支持而得到实质性的缓解。如果要减少心理健康低下、危害健康的行为及其对非传染性疾病的综合影响，培养儿童的复原力和减少童年逆境至关重要。
Background: Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. Here we test if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviours and lower mental well-being in adults.Methods: Cross-sectional, face-to-face household surveys (aged 18-69 years, February-September 2015) examining ACEs suffered, always available adult (AAA) support from someone you trust in childhood and current diet, smoking, alcohol consumption and mental well-being were undertaken in four UK regions. Sampling used stratified random probability methods (n = 7,047). Analyses used chi squared, binary and multinomial logistic regression.Results: Adult prevalence of poor diet, daily smoking and heavier alcohol consumption increased with ACE count and decreased with AAA support in childhood. Prevalence of having any two such behaviours increased from 1.8% (0 ACEs, AAA support, most affluent quintile of residence) to 21.5% (>= 4 ACEs, lacking AAA support, most deprived quintile). However, the increase was reduced to 7.1% with AAA support (>= 4 ACEs, most deprived quintile). Lower mental well-being was 3.27 (95% Cls, 2.16-4.96) times more likely with >= 4 ACEs and AAA support from someone you trust in childhood (vs. 0 ACE, with AAA support) increasing to 8.32 (95% Cls, 6.53-10.61) times more likely with = 4 ACEs but without AAA support in childhood. Multiple health-harming behaviours combined with lower mental well-being rose dramatically with ACE count and lack of AAA support in childhood (adjusted odds ratio 32.01, 95% Cls 18.31-55. 98, >= 4 ACEs, without AAA support vs. 0 ACEs, with AAA support).Conclusions: Adverse childhood experiences negatively impact mental and physical health across the life-course. Such impacts may be substantively mitigated by always having support from an adult you trust in childhood. Developing resilience in children as well as reducing childhood adversity are critical if low mental well-being, health-harming behaviours and their combined contribution to non-communicable disease are to be reduced.