Raposo Sarah M, Mackenzie Corey S, Henriksen Christine A, Afifi Tracie O
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, Mount Royal University, Calgary, Alberta, Canada.
Am J Geriatr Psychiatry. 2014 Nov;22(11):1241-50. doi: 10.1016/j.jagp.2013.04.009. Epub 2013 Sep 5.
We aimed to examine the prevalence of several types of childhood adversity across adult cohorts, whether age moderates the effect of childhood adversity on mental health, the relationship between childhood adversity and psychopathology among older adults, the dose-response relationship between number of types of childhood adversities and mental disorders in later life, and whether lifetime mental health treatment reduces the odds of psychopathology among older survivors of childhood adversity.
In a population-based, cross-sectional study on a nationally representative U.S. sample, we studied 34,653 community-dwelling Americans 20 years and older, including 7,080 adults 65 years and older from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Trained lay interviewers assessed past-year mood and anxiety disorders and lifetime personality disorders. Participants self-reported childhood adversity based on questions from the Adverse Childhood Experiences Study.
Childhood adversity was prevalent across five age cohorts. In our adjusted models, age did not moderate the effect of childhood adversity on mental disorders. Older adults who experienced childhood adversity had higher odds of having mood (odds ratio: 1.73; 95% confidence interval: 1.32-2.28), anxiety (odds ratio: 1.48; 95% confidence interval: 1.20-1.83), and personality disorders (odds ratio: 2.11; 95% confidence interval: 1.75-2.54) after adjusting for covariates. An increasing number of types of childhood adversities was associated with higher odds of personality disorders and somewhat higher odds of anxiety disorders. Treatment-seeking was associated with a reduced likelihood of anxiety and, especially, mood disorders in older adult childhood adversity survivors.
These results emphasize the importance of preventing childhood adversity and intervening once it occurs to avoid the negative mental health effects that can last into old age.
我们旨在研究不同成年人群体中几种童年逆境的患病率，年龄是否会调节童年逆境对心理健康的影响，老年人中童年逆境与精神病理学之间的关系，童年逆境类型数量与晚年精神障碍之间的剂量反应关系，以及终生心理健康治疗是否会降低童年逆境老年幸存者患精神病理学的几率。
在一项基于全国代表性美国样本的横断面研究中，我们对34653名20岁及以上的美国社区居民进行了研究，其中包括来自全国酒精及相关疾病流行病学调查第二轮的7080名65岁及以上的成年人。经过培训的非专业访谈员评估了过去一年的情绪和焦虑障碍以及终生人格障碍。参与者根据童年不良经历研究中的问题自我报告童年逆境情况。
童年逆境在五个年龄组中普遍存在。在我们的校正模型中，年龄并未调节童年逆境对精神障碍的影响。经历过童年逆境的老年人在调整协变量后，患情绪障碍（优势比：1.73；95%置信区间：1.32 - 2.28）、焦虑障碍（优势比：1.48；95%置信区间：1.20 - 1.83）和人格障碍（优势比：2.11；95%置信区间：1.75 - 2.54）的几率更高。童年逆境类型数量的增加与患人格障碍的几率增加以及焦虑障碍的几率略有增加相关。寻求治疗与老年童年逆境幸存者患焦虑障碍尤其是情绪障碍的可能性降低相关。
这些结果强调了预防童年逆境以及在逆境发生后进行干预以避免可能持续到老年的负面心理健康影响的重要性。
