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

背景：与未受虐待的儿童相比，受虐待儿童的健康和晚年功能平均较差。然而，这些群体差异未能体现出许多受虐待儿童在面对逆境时所表现出的非凡适应力。事实上，受虐待儿童群体内的健康和功能有很大差异。从几个方面来看，认识和理解是什么使一些儿童更有韧性，而另一些儿童更容易受到虐待的影响是很重要的。至关重要的是，要协助从业人员和临床医生确定面临更大风险的儿童，从而以有针对性和具有成本效益的方式分配现有资源。同样重要的是，帮助确定潜在的可改变的因素，从业人员和临床医生可以针对减少虐待的有害影响。方法：作为环境风险e -风险纵向双胞胎研究的一部分，我们将在2232名英国儿童中进行一项全面的调查，以确定在面对虐待时影响恢复力和脆弱性的因素，这些儿童从1994-95年出生到18岁。当研究对象的年龄分别为5岁、7岁、10岁、12岁和18岁时，通过反复家访进行评估。值得注意的是，原始队列中93%的孩子在18岁时仍然参加了最新的评估阶段，样本在社会经济地位方面仍然具有英国家庭的代表性。随着研究成员的成长，通过对母亲和儿童的反复有效访谈，评估了12岁以下儿童的虐待情况。之前一些同行评议的出版物已经表明，这种虐待的衡量标准预示着以后生活中更差的健康和功能。在12岁和18岁的家访期间，我们收集了全面的健康信息，包括半结构化的精神病学访谈和身体健康状况不佳的既定指标，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、受教育程度以及研究成员是否在接受教育、就业或培训（NEET）的信息。至关重要的是，20多年来积累的关于研究成员特征、家庭环境特征和社区评估的丰富数据集，将为我们提供一个前所未有的机会，全面测试为什么一些受虐待的儿童在以后的生活中健康状况和功能不佳，而另一些儿童则更有弹性。为了开展这个项目，对2000多名儿童进行了18年的跟踪调查，访问这个广泛的数据集将为NSPCC/ESRC在这里要求的投资提供巨大的价值。创新和产出：拟议的研究为受虐待儿童的复原力和脆弱性研究带来了几项方法上的进步。简而言之，拟议的研究具有独特的优势，可以全面调查个人、家庭和社区因素在同一个体中作为恢复力和脆弱性决定因素的作用；测试这些因素是否对受虐待儿童的精神和身体健康状况不佳和功能不佳的广泛衡量指标产生类似影响；并确保结果反映了英国社区受虐待儿童的现实情况，并可用于预测这些环境中的风险。这项研究将产生两组临床相关的产出。首先，它将为从业人员和临床医生提供风险计算器，这是一种以证据为基础的工具，可以帮助他们识别受虐待的儿童，这些儿童面临着发展不利结果的最大风险。其次，它将确定潜在的可修改因素，促进受虐待儿童的恢复力，这可以被从业人员和临床医生用于预防性干预。

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.