Bellis Mark A, Hardcastle Katie, Ford Kat, Hughes Karen, Ashton Kathryn, Quigg Zara, Butler Nadia
College of Health and Behavioural Sciences, Normal Site, Bangor University, Bangor, LL57 2PZ, UK.
Directorate of Policy, Research and International Development, Public Health Wales, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK.
BMC Psychiatry. 2017 Mar 23;17(1):110. doi: 10.1186/s12888-017-1260-z.
Adverse childhood experiences (ACEs) including child abuse and household problems (e.g. domestic violence) increase risks of poor health and mental well-being in adulthood. Factors such as having access to a trusted adult as a child may impart resilience against developing such negative outcomes. How much childhood adversity is mitigated by such resilience is poorly quantified. Here we test if access to a trusted adult in childhood is associated with reduced impacts of ACEs on adoption of health-harming behaviours and lower mental well-being in adults.
Cross-sectional, face-to-face household surveys (aged 18-69 years, February-September 2015) examining ACEs suffered, always available adult (AAA) support from someone you trust in childhood and current diet, smoking, alcohol consumption and mental well-being were undertaken in four UK regions. Sampling used stratified random probability methods (n = 7,047). Analyses used chi squared, binary and multinomial logistic regression.
Adult prevalence of poor diet, daily smoking and heavier alcohol consumption increased with ACE count and decreased with AAA support in childhood. Prevalence of having any two such behaviours increased from 1.8% (0 ACEs, AAA support, most affluent quintile of residence) to 21.5% (≥4 ACEs, lacking AAA support, most deprived quintile). However, the increase was reduced to 7.1% with AAA support (≥4 ACEs, most deprived quintile). Lower mental well-being was 3.27 (95% CIs, 2.16-4.96) times more likely with ≥4 ACEs and AAA support from someone you trust in childhood (vs. 0 ACE, with AAA support) increasing to 8.32 (95% CIs, 6.53-10.61) times more likely with ≥4 ACEs but without AAA support in childhood. Multiple health-harming behaviours combined with lower mental well-being rose dramatically with ACE count and lack of AAA support in childhood (adjusted odds ratio 32.01, 95% CIs 18.31-55.98, ≥4 ACEs, without AAA support vs. 0 ACEs, with AAA support).
Adverse childhood experiences negatively impact mental and physical health across the life-course. Such impacts may be substantively mitigated by always having support from an adult you trust in childhood. Developing resilience in children as well as reducing childhood adversity are critical if low mental well-being, health-harming behaviours and their combined contribution to non-communicable disease are to be reduced.
童年不良经历（ACEs），包括儿童虐待和家庭问题（如家庭暴力），会增加成年后健康状况不佳和心理健康问题的风险。童年时能接触到一位值得信赖的成年人等因素可能会增强抵御这些负面后果的能力。这种抵御能力能减轻多少童年逆境的影响，目前还缺乏量化。在此，我们测试童年时能接触到一位值得信赖的成年人是否与ACEs对成年人采取有害健康行为的影响降低以及较低的心理健康水平有关。
2015年2月至9月，在英国四个地区开展了横断面面对面家庭调查（年龄在18 - 69岁），调查童年遭受的ACEs、童年时能随时获得你信任的成年人（AAA）的支持以及当前的饮食、吸烟、饮酒和心理健康状况。抽样采用分层随机概率方法（n = 7,047）。分析使用卡方检验、二元和多项逻辑回归。
不良饮食、每日吸烟和重度饮酒在成年人中的患病率随ACEs数量增加而上升，随童年时获得AAA支持而下降。同时出现任意两种此类行为的患病率从1.8%（0个ACEs，有AAA支持，居住在最富裕五分位数）增至21.5%（≥4个ACEs，缺乏AAA支持，居住在最贫困五分位数）。然而，在有AAA支持的情况下（≥4个ACEs，最贫困五分位数），这一增幅降至7.1%。心理健康水平较低在有≥4个ACEs且童年时获得你信任的人的AAA支持的情况下发生的可能性是（与0个ACEs且有AAA支持相比）3.27倍（95%置信区间，2.16 - 4.96），而在有≥4个ACEs但童年时没有AAA支持的情况下增至8.32倍（95%置信区间，6.53 - 10.61）。多种有害健康行为与较低的心理健康水平随着ACEs数量增加以及童年时缺乏AAA支持而急剧上升（调整后的优势比为32.01，95%置信区间18.31 - 55.98，≥4个ACEs，无AAA支持与0个ACEs，有AAA支持相比）。
童年不良经历会对一生的身心健康产生负面影响。童年时始终获得你信任的成年人的支持可能会大幅减轻这种影响。如果要降低心理健康水平低、有害健康行为及其对非传染性疾病的综合影响，培养儿童的复原力以及减少童年逆境至关重要。
