What is it about ACE's? Understanding the relationship between adversity and mental health

ACE 到底是什么？

• 批准号: 2625989
• 金额: --
• 依托单位: University of Bristol
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2625989
• 关键词: What; about; ACE; Understanding; relationship

Adverse childhood experiences (ACEs) such as abuse, bullying or family disruption are increasingly recognised as one of the most potent determinants of later mental health problems. Estimates suggest that mental health problems, including depression and self-harm are at least double among those who have been exposed to ACEs. Despite the recognised importance of ACEs to later mental health outcomes, relatively little is known about the characteristics of ACEs that have the greatest impact. Firstly, many studies have relied on cumulative scores, whereby ACEs are simply dichotomised and summed. This approach assumes that each ACE contributes equitably to the outcome of interest and that they operate via the same mechanisms. Other research has focused on the relationship between individual ACEs and mental health. Although such studies have provided useful insights, it is known that ACEs often co-occur and most have failed to take account of this clustering. Secondly, little attention has been paid to the role of timing, chronicity, or recency of exposure in relation to mental health, and findings from existing studies have been inconclusive. Disentangling these effects is challenging as it may be that those who have been exposed earlier in childhood have also been exposed for longer. Person centred approaches such as Latent Class Analysis (LCA) have been used to identify variability in ACE profiles between individuals, however it is not currently known whether ACE profiles differ during different stages of the life-course. This PhD will address these limitations and generate valuable new insights into the relationship between ACEs and two mental health outcomes - depression and self-harm. Both depression and self-harm are major public health concerns which have been rising over recent years. The proposed study will use data from the Avon Longitudinal Study of Parents and Children (ALSPAC); a UK birth cohort study of over 14,000 participants born in 1991-1992. ALSPAC has unrivalled data on ACEs, with over 500 questions asked prospectively across childhood and adolescence, as well as repeated measures data on depression and self-harm into adulthood. The study also includes rich information on biological (e.g. inflammation), social (e.g. educational outcomes), and cognitive (e.g. emotion recognition) factors that could be explored as potential mechanisms linking ACEs with later mental health outcomes.Research questions What is the relationship between specific ACEs and mental health outcomes (depression and self-harm) in adolescence and adulthood? How do ACEs cluster together during different stages of the life course, and how do different ACE profiles relate to mental health? How do timing, chronicity, and recency of exposure to ACEs impact on risk for mental health problems? What are the mechanisms through which ACEs have an impact on mental health? Key Methods: structural equation modelling, mediation analysis, strategies for dealing with missing data (such as multiple imputation) and causal analysis methods.

虐待、欺凌或家庭破裂等不良童年经历 (ACE) 越来越被认为是日后心理健康问题的最有力决定因素之一。据估计，接触过 ACE 的人中，包括抑郁和自残在内的心理健康问题至少增加了一倍。尽管 ACE 对以后的心理健康结果的重要性已得到公认，但人们对影响最大的 ACE 的特征知之甚少。首先，许多研究依赖于累积分数，即 ACE 被简单地二分和求和。这种方法假设每个 ACE 对感兴趣的结果做出公平的贡献，并且它们通过相同的机制运作。其他研究重点关注个体 ACE 与心理健康之间的关系。尽管此类研究提供了有用的见解，但众所周知，ACE 经常同时出现，而且大多数研究都未能考虑到这种聚类。其次，很少有人关注暴露时间、长期性或近期性与心理健康的关系，现有研究的结果尚无定论。理清这些影响具有挑战性，因为那些在童年早期接触过的人可能接触的时间也更长。以人为中心的方法，如潜在类别分析 (LCA)，已被用来识别个体之间 ACE 概况的变异性，但目前尚不清楚 ACE 概况在生命历程的不同阶段是否存在差异。该博士将解决这些局限性，并就 ACE 与两种心理健康结果（抑郁和自残）之间的关系产生有价值的新见解。抑郁症和自残都是近年来不断上升的主要公共卫生问题。拟议的研究将使用雅芳父母和儿童纵向研究（ALSPAC）的数据；英国出生队列研究，对 1991 年至 1992 年间出生的 14,000 多名参与者进行了研究。 ALSPAC 拥有无与伦比的 ACE 数据，其中包括 500 多个儿童期和青少年期前瞻性问题，以及成年期抑郁和自残的重复测量数据。该研究还包括有关生物（例如炎症）、社会（例如教育成果）和认知（例如情绪识别）因素的丰富信息，这些因素可以作为将 ACE 与后期心理健康结果联系起来的潜在机制进行探索。研究问题特定 ACE 与青春期和成年期的心理健康结果（抑郁和自残）之间有什么关系？ ACE 在生命历程的不同阶段如何聚集在一起，不同的 ACE 特征与心理健康有何关系？接触 ACE 的时间、长期性和近期性如何影响心理健康问题的风险？ ACE 通过哪些机制影响心理健康？关键方法：结构方程模型、中介分析、处理缺失数据的策略（如多重插补）和因果分析方法。