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

不良童年经历（ACE），如虐待，欺凌或家庭破裂，越来越多地被认为是后来心理健康问题的最有力的决定因素之一。估计表明，精神健康问题，包括抑郁和自我伤害，在接触过ACE的人中至少增加了一倍。尽管ACE对以后的心理健康结果的重要性已得到公认，但对ACE的影响最大的特征知之甚少。首先，许多研究都依赖于累积分数，其中ACE简单地二分法和总结。这种方法假设每个ACE都公平地对利益结果做出贡献，并且它们通过相同的机制运作。其他研究集中在个体ACE与心理健康之间的关系。虽然这些研究提供了有用的见解，但已知ACE通常共同出现，并且大多数未能考虑到这种聚类。其次，很少有人注意到与心理健康有关的暴露时间、慢性或新近的作用，现有研究的结果也没有定论。解开这些影响是具有挑战性的，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）已被用于确定个体之间的ACE谱的变异性，但目前尚不清楚ACE谱是否在生命过程的不同阶段有所不同。这个博士学位将解决这些局限性，并对ACE与两种心理健康结果-抑郁症和自我伤害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。这项拟议的研究将使用来自雅芳父母和儿童纵向研究（ALSPAC）的数据;这是一项英国出生队列研究，涉及1991-1992年出生的14，000多名参与者。ALSPAC拥有关于ACE的无与伦比的数据，在童年和青春期前瞻性地询问了500多个问题，以及关于抑郁和自我伤害的重复测量数据。这项研究还包括丰富的信息，生物（如炎症），社会（如教育成果），和认知（如情绪识别）的因素，可以探索潜在的机制，连接ACE与以后的心理健康outcomes.Research问题之间的关系是什么具体的ACE和心理健康结果（抑郁症和自我伤害）在青春期和成年期？ACE如何在生命历程的不同阶段聚集在一起，不同的ACE特征如何与心理健康相关？ACE暴露的时间、慢性程度和近期程度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。

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.