Poor Individual Risk Classification From Adverse Childhood Experiences Screening
Poor Individual Risk Classification From Adverse Childhood Experiences Screening
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DOI：
10.1016/j.amepre.2021.08.008
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发表时间：
2022-02-18
影响因子：
5.5
通讯作者：
Danese, Andrea
中科院分区：
文献类型：
--
作者：
Meehan, Alan J.;Baldwin, Jessie R.;Danese, Andrea
简介：不良童年经历会增加人群出现身心健康问题的风险，促使人们呼吁根据报告的不良童年经历暴露情况进行常规临床筛查。然而，最近的纵向研究质疑不良童年经历是否可以准确地识别个人层面的健康状况不佳。方法：回顾 1995 年至 1997 年间不良童年经历研究收集的数据，本研究得出了曲线下的近似面积估计值，以测试回顾性报告的不良童年经历评分区分具有和不具有一系列常见健康风险因素和疾病状况的成年人的能力。此外，根据敏感性、特异性、阳性和阴性预测值以及阳性似然比，评估了高风险暴露（>= 4 与 0-3 不良童年经历）的推荐临床定义的分类准确性。 结果：在所有健康结果中，连续不良童年经历评分的歧视程度从非常差到一般（曲线下面积 = 0.50-0.76）。 >= 4 与 0-3 不良童年经历的二元分类产生了高特异性（真阴性检测）和阴性预测值（低风险不良童年经历组中不存在健康不良）。然而，敏感性（真阳性检测）和阳性预测值（高风险不良童年经历群体中存在健康状况不佳）较低，而阳性似然比表明，与报告 0-3 次不良童年经历的个体相比，报告 >= 4 次不良童年经历的个体的健康风险仅略有增加。结论：这些发现表明，基于不良童年经历评分的筛查并不能准确识别那些健康问题高风险的个体。这可能导致分配不必要的干预措施和缺乏必要的支持。 (C) 2021 年美国预防医学杂志。由爱思唯尔公司出版
Introduction: Adverse childhood experiences confer an increased risk for physical and mental health problems across the population, prompting calls for routine clinical screening based on reported adverse childhood experience exposure. However, recent longitudinal research has questioned whether adverse childhood experiences can accurately identify ill health at an individual level.Methods: Revisiting data collected for the Adverse Childhood Experience Study between 1995 and 1997, this study derived approximate area under the curve estimates to test the ability of the retrospectively reported adverse childhood experience score to discriminate between adults with and without a range of common health risk factors and disease conditions. Furthermore, the classification accuracy of a recommended clinical definition for high-risk exposure (>= 4 versus 0-3 adverse childhood experiences) was evaluated on the basis of sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios.Results: Across all health outcomes, the levels of discrimination for the continuous adverse childhood experience score ranged from very poor to fair (area under the curve=0.50-0.76). The binary classification of >= 4 versus 0-3 adverse childhood experiences yielded high specificity (true-negative detection) and negative predictive values (absence of ill health among low-risk adverse childhood experience groups). However, sensitivity (true-positive detection) and positive predictive values (presence of ill health among high-risk adverse childhood experience groups) were low, whereas positive likelihood ratios suggested only minimal-to-moderate increases in health risks among individuals reporting >= 4 adverse childhood experiences versus that among those reporting 0-3.Conclusions: These findings suggest that screening based on the adverse childhood experience score does not accurately identify those individuals at high risk of health problems. This can lead to both allocation of unnecessary interventions and lack of provision of necessary support. (C) 2021 American Journal of Preventive Medicine. Published by Elsevier Inc.