Resilience and vulnerability to childhood maltreatment in an 18-year longitudinal study of British children

背景：平均而言，与未受虐待的儿童相比，受虐待的儿童在以后的生活中健康和功能更差。然而，这些群体差异未能体现出许多受虐待的儿童在面对逆境时所表现出的非凡韧性。事实上，在受虐待的儿童群体中，健康和功能方面存在显著差异。认识和理解是什么使一些儿童更有弹性，而另一些儿童更容易受到虐待的影响，这在几个方面都很重要。至关重要的是，协助从业者和临床医生识别风险较大的儿童，从而以有针对性和具有成本效益的方式分配可用资源。同样重要的是，帮助确定从业者和临床医生可以针对的潜在可修改因素，以减少虐待的有害影响。方法：作为环境风险E-Risk纵向双胞胎研究的一部分，我们将在1994-95年对2232名英国儿童进行跟踪调查，从出生到18岁，对造成虐待时韧性和脆弱性的因素进行全面调查。当研究成员的年龄分别为5岁、7岁、10岁、12岁和18岁时，通过重复家访进行评估。值得注意的是，最初队列中93%的儿童在18岁时仍参加了最新的评估阶段，样本在社会经济地位方面仍然代表着英国家庭。随着研究成员的成长，对12岁以下的儿童虐待行为的评估是通过对母亲和儿童的反复验证访谈进行的。之前的几篇同行评议的出版物已经表明，这种虐待程度预示着更差的健康和晚年生活功能。在12岁和18岁的家访中，我们收集了关于健康的全面信息，包括半结构化的精神病学访谈，并建立了身体健康状况较差的指标，如身体质量指数(BMI)和炎症性血液生物标志物。我们还收集了有关功能的信息，如主观生活质量、教育程度，以及研究成员是否没有接受教育、就业或培训(NEET)的信息。至关重要的是，20年来积累的关于研究成员的特征、家庭环境特征和对社区的评估的丰富数据集，将给我们一个前所未有的机会，全面测试为什么一些被虐待的儿童在以后的生活中健康和功能不佳，而另一些则更具弹性。通过对2000多名儿童进行这一项目18年的跟踪调查，获得这一庞大的信息数据集，将为NSPCC/ESRC在此申请的投资提供巨大的资金价值。创新和成果：拟议的研究为研究受虐待儿童的复原力和脆弱性带来了几个方法学上的进步。简而言之，拟议的研究具有独特的地位，可以全面调查在同一个人身上评估的个人、家庭和社区因素作为复原力和脆弱性的决定因素的作用；测试这些因素是否对受虐待儿童的心理和身体健康和功能不良的广泛指标产生类似的影响；并确保结果反映英国社区受虐待儿童的现实，并可用于预测这些环境中的风险。这项研究将产生两组与临床相关的结果。首先，它将为从业者和临床医生提供风险计算器，这是一种基于证据的工具，可以帮助他们识别最有可能出现不利结果的受虐待儿童。其次，它将确定潜在的可修改因素，促进受虐待儿童的复原力，从业者和临床医生可以利用这些因素进行预防性干预。

Background: Maltreated children have, on average, poorer health and functioning in later life compared to non-maltreated children. However, these group differences fail to capture the remarkable resilience that many maltreated children display in the face of adversity. Indeed, there is significant variation in health and functioning within groups of maltreated children. Recognising and understanding what makes some children more resilient and others more vulnerable to the effects of maltreatment is important in several ways. It is crucial to assist practitioners and clinicians in identifying children at greater risk and, thus, in allocating the available resources in a targeted and cost-effective fashion. It is also important to help identify potentially modifiable factors that practitioners and clinicians can target to reduce the detrimental impact of maltreatment. Approach: We will undertake a comprehensive investigation of factors contributing to resilience and vulnerability in the face of maltreatment among a cohort of 2,232 British children followed up from birth, in 1994-95, to age 18 years as part of the Environmental Risk E-Risk Longitudinal Twin Study. Assessments were undertaken through repeated home visits when study members were aged 5, 7, 10, 12, and 18 years. Remarkably, 93% of the children in the original cohort still took part in the latest assessment phase at age 18 years and the sample remains representative of UK families in terms of socioeconomic status. Child maltreatment up to 12 years of age has been assessed through repeated validated interviews with mothers and children as the Study members grew up. Several previous peer reviewed publications have shown that this measure of maltreatment predicts poorer health and functioning in later life. During home visits at ages 12 and 18 we collected comprehensive information about health including semi-structured psychiatric interviews and established measures of poor physical health, such as body-mass index (BMI) and inflammatory blood biomarkers. We also collected information about functioning, such as subjective quality of life, educational attainment, and information on whether Study members were not in education, employment, or training (NEET). Crucially, the rich dataset accumulated over two decades on the Study members’ characteristics, features of their family environments, and assessment of their communities, will give us an unprecedented opportunity to comprehensively test why some maltreated children develop poor health and functioning later in life while others are more resilient. Access to this extensive dataset of information on over 2000 children followed for 18 years to conduct this project will provide great value for money for the NSPCC/ESRC investment requested here. Innovation and output: The proposed research brings several methodological advances to the study of resilience and vulnerability in maltreated children. Briefly, the proposed research is uniquely placed to comprehensively investigate the role of individual, family, and community factors assessed in the same individuals as determinants of resilience and vulnerability; to test whether these factors have similar effects on a broad range of measures of poor mental and physical health and functioning in maltreated children; and to ensure that results reflect the reality of maltreated children in UK communities and can be used to predict risk in those settings. This research will generate two sets of clinically-relevant outputs. First, it will provide practitioners and clinicians with a risk calculator, an evidence-based instrument that can assist them in identifying maltreated children at greatest risk of developing unfavourable outcomes. Second, it will identify potentially modifiable factors that promote resilience in maltreated children, which could be utilised by practitioners and clinicians for preventative interventions.