Smith M, Williamson A E, Walsh D, McCartney G
NHS Greater Glasgow and Clyde, Commonwealth House, 32 Albion Street, Glasgow, G1 1LH, UK.
General Practice and Primary Care, School of Medicine, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, UK.
BMC Public Health. 2016 Jul 28;16:655. doi: 10.1186/s12889-016-3201-z.
Scotland has a persistently high mortality rate that is not solely due to the effects of socio-economic deprivation. This "excess" mortality is observed across the entire country, but is greatest in and around the post-industrial conurbation of West Central Scotland. Despite systematic investigation, the causes of the excess mortality remain the subject of ongoing debate.
Attachment processes are a fundamental part of human development, and have a profound influence on adult personality and behaviour, especially in response to stressors. Many studies have also shown that childhood adversity is correlated with adult morbidity and mortality. The interplay between childhood adversity and attachment is complex and not fully elucidated, but will include socio-economic, intergenerational and psychological factors. Importantly, some adverse health outcomes for parents (such as problem substance use or suicide) will simultaneously act as risk factors for their children. Data show that some forms of "household dysfunction" relating to childhood adversity are more prevalent in Scotland: such problems include parental problem substance use, rates of imprisonment, rates of suicide and rates of children being taken into care. However other measures of childhood or family wellbeing have not been found to be substantially different in Scotland compared to England. We suggest in this paper that the role of childhood adversity and attachment experience merits further investigation as a plausible mechanism influencing health in Scotland. A model is proposed which sets out some of the interactions between the factors of interest, and we propose parameters for the types of study which would be required to evaluate the validity of the model.
苏格兰的死亡率一直居高不下，这并非完全是社会经济剥夺造成的。这种“超额”死亡率在全国范围内都有体现，但在苏格兰中西部的后工业化城市及其周边地区最为严重。尽管进行了系统调查，但超额死亡率的原因仍在持续争论中。
依恋过程是人类发展的基本组成部分，对成年人的性格和行为有深远影响，尤其是在应对压力源时。许多研究还表明，童年逆境与成年人的发病率和死亡率相关。童年逆境与依恋之间的相互作用很复杂，尚未完全阐明，但将包括社会经济、代际和心理因素。重要的是，父母的一些不良健康结果（如药物滥用问题或自杀）同时会成为其子女的风险因素。数据显示，与童年逆境相关的某些形式的“家庭功能失调”在苏格兰更为普遍：这些问题包括父母药物滥用问题、监禁率、自杀率以及儿童被送入福利院的比例。然而，与英格兰相比，尚未发现苏格兰在童年或家庭幸福的其他衡量标准上有显著差异。我们在本文中提出，童年逆境和依恋经历的作用作为影响苏格兰健康的一个合理机制值得进一步研究。本文提出了一个模型，阐述了相关因素之间的一些相互作用，并提出了评估该模型有效性所需的研究类型的参数。
