Surtees Paul G, Wainwright Nicholas W J
University of Cambridge, Cambridge, UK.
Soc Sci Med. 2007 Jan;64(1):95-111. doi: 10.1016/j.socscimed.2006.08.013. Epub 2006 Sep 25.
Research evidence is accumulating to support an association between social adversity and the development of predisease processes and physical disease outcomes. While methodological advances have been achieved in the assessment of social adversity, significant barriers remain to their adoption in chronic disease epidemiological settings consequent upon the need to limit participant burden and restrictions imposed by cohort size and cost. A large-scale population-based cohort study, as part of the European Prospective Investigation into Cancer, Norfolk, UK, provided an opportunity to include a comprehensive postal assessment of social adversity. A total of 20,921 participants reported details of 16,031 adverse circumstances during childhood, 119,056 life events and 106,170 person-years of difficulties experienced during adulthood. Impact and adaptation indices were constructed from responses to questions regarding specific life events experienced. There was no evidence that younger participants reported more difficulties in childhood than those who were older, and no evidence of clustering of loss events involving the death of first degree relatives according to their recency. However, there was evidence of recall bias for events not involving loss with increased event rates observed in the few years immediately prior to questionnaire completion. Women reported similar events as more upsetting, and that they took longer to get over their effects, than men. Difficulties experienced in childhood, life events and difficulties in adulthood, event impact and adaptation were all associated with worse physical functional health. Reported slow adaptation to the effects of life events was associated with the largest decrement in physical functional health. These findings strengthen the rationale for including a collection of comprehensive social adversity data within chronic disease epidemiological settings and offer promise for aiding understanding of individual differences in physical disease aetiology.
越来越多的研究证据支持社会逆境与疾病前期过程及身体疾病结局发展之间存在关联。虽然在社会逆境评估方面已取得方法学进展，但由于需要限制参与者负担以及队列规模和成本所带来的限制，在慢性病流行病学研究中采用这些方法仍存在重大障碍。作为英国诺福克郡欧洲癌症前瞻性调查的一部分，一项基于大规模人群的队列研究提供了一个机会，可对社会逆境进行全面的邮政评估。共有20921名参与者报告了童年时期16031起逆境事件、119056起生活事件以及成年时期经历的106170人年的困难情况。根据对特定生活事件相关问题的回答构建了影响和适应指数。没有证据表明年轻参与者在童年时期比年长参与者报告更多困难，也没有证据表明涉及一级亲属死亡的损失事件根据其发生时间存在聚集现象。然而，有证据表明对于不涉及损失的事件存在回忆偏差，在问卷完成前的几年中观察到事件发生率有所增加。女性报告类似事件比男性更令人苦恼，且她们克服这些事件影响所需的时间更长。童年时期经历的困难、生活事件以及成年时期的困难、事件影响和适应均与较差的身体功能健康相关。报告显示对生活事件影响适应缓慢与身体功能健康下降幅度最大有关。这些发现强化了在慢性病流行病学研究中收集全面社会逆境数据的理论依据，并有望有助于理解身体疾病病因的个体差异。
