Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania.
Am J Prev Med. 2017 Dec;53(6):882-891. doi: 10.1016/j.amepre.2017.07.015. Epub 2017 Sep 14.
This study examined how mothers' Adverse Childhood Experiences (ACEs) relate to their children's developmental risk and assessed how the association is mediated through mothers' depressive symptoms and fair/poor health.
Mothers of children aged between 4 months and 4 years were recruited from the emergency department of a children's hospital between March 2012 and June 2015 and interviewed about ACEs, mothers' depressive symptoms and health status, and children's developmental risk (screened via Parents' Evaluations of Developmental Status [PEDS]). Between August and November 2016 a Cochran-Armitage test assessed trend of PEDS by ACEs. Multinomial regression models examined differences in PEDS by ACEs severity. Mediation by mothers' depressive symptoms and self-rated health was also assessed.
Of 1,293 mothers, 56.7% reported one or more ACEs. Mothers also reported developmental risk (20.4% overall): 120 (9.2%) reported one concern and 144 (11.2%) reported two or more concerns on the PEDS. Mothers who reported household substance use, mental illness, or an incarcerated household member during childhood were more likely to report at least one child developmental concern on the PEDS. After controlling for covariates, odds of one PEDS concern were 1.86 (95% CI=1.16, 3.00) for ACEs, one to three versus none, and 2.21 (95% CI=1.26, 3.87) for ACEs four or more versus none. Adjusted odds of two or more concerns were 1.70 (95% CI=1.07, 2.72) for ACEs, one to three versus none, and 1.76 (95% CI=1.02, 3.05) for ACEs, four or more versus none. Mothers' depressive symptoms and self-rated health were potential mediators.
Mothers' ACEs are significantly associated with their children's developmental risk. If replicated, findings suggest that addressing intergenerational trauma through focus on childhood adversity among young children's caregivers may promote child development.
本研究探讨了母亲的不良童年经历 (ACEs) 如何与子女的发育风险相关，并评估了这种关联如何通过母亲的抑郁症状和健康状况（一般/较差）来中介。
2012 年 3 月至 2015 年 6 月期间，我们从一家儿童医院的急诊室招募了 4 个月至 4 岁儿童的母亲，并对她们进行 ACEs、母亲的抑郁症状和健康状况以及儿童发育风险（通过父母对发育状况的评估[PEDS]进行筛查）的访谈。2016 年 8 月至 11 月， Cochran-Armitage 检验评估了 PEDS 按 ACEs 的趋势。多项回归模型检验了 ACEs 严重程度对 PEDS 的差异。还评估了母亲抑郁症状和自我评估健康状况的中介作用。
在 1293 名母亲中，56.7%报告了一个或多个 ACEs。母亲还报告了发育风险（总体 20.4%）：120 名（9.2%）报告了一个关注点，144 名（11.2%）报告了 PEDS 上的两个或更多关注点。报告儿童期家庭中有物质滥用、精神疾病或监禁家庭成员的母亲更有可能在 PEDS 上报告至少一个儿童发育问题。在控制了协变量后，ACEs（1-3 项与无 ACEs 相比，OR=1.86，95%CI=1.16，3.00）和 ACEs（4 项及以上与无 ACEs 相比，OR=2.21，95%CI=1.26，3.87）与一个 PEDS 关注点的可能性分别增加了 1.86 和 2.21 倍。调整后两个或更多关注点的优势比为 ACEs（1-3 项与无 ACEs 相比，OR=1.70，95%CI=1.07，2.72）和 ACEs（4 项及以上与无 ACEs 相比，OR=1.76，95%CI=1.02，3.05）。母亲的抑郁症状和自我评估健康状况是潜在的中介因素。
母亲的 ACEs 与子女的发育风险显著相关。如果得到复制，研究结果表明，通过关注幼儿照顾者的儿童期逆境来解决代际创伤，可能会促进儿童的发展。
