Department of Psychology, Georgia State University, Atlanta, Georgia; Ross University School of Medicine, Dominica, West Indies.
National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
Am J Prev Med. 2018 Dec;55(6):803-811. doi: 10.1016/j.amepre.2018.06.029.
Adverse childhood experiences are associated with poor health outcomes in adulthood, such as depression, suicidal behavior, and post-traumatic stress disorder. Subsequent military service may continue trajectories of childhood adversity and contribute to cumulative disadvantage over the life span. This study examines distinct patterns of adversity from childhood through military service and their relationships with adult health and mental health outcomes.
The study used data from a nationally representative survey (conducted in 2012, analysis in 2016) with >6,000 women primary care users in the Veterans Health Administration, and linked to data from electronic medical records. Latent class analysis was used to derive qualitatively distinct patterns of adverse experiences and logistic regression to model odds of past-year health conditions, comparing effect sizes across classes.
Prevalence of both childhood and military adverse events was high. Five meaningful classes of adversity were observed, characterized by low adversity across all events, high adversity across all events, extreme high adversity across all events, adverse family context, and a class characterized primarily by adverse military experiences. Odds of past-year diagnoses of depression, anxiety, post-traumatic stress disorder, substance use disorder, and comorbid mental health and chronic health conditions significantly differed across classes.
Among women Veterans Health Administration users, examination of qualitatively distinct patterns of adversity yielded more meaningful results than counting the number of adverse events. Given the high incidence of adverse experiences, Veterans Health Administration is positioned to respond with secondary prevention and a universal trauma precautions approach to all care for women Veterans.
童年逆境与成年后健康状况不佳有关，例如抑郁、自杀行为和创伤后应激障碍。随后的兵役可能会延续童年逆境的轨迹，并导致整个生命周期的累积劣势。本研究考察了从童年到兵役期间不同的逆境模式及其与成年健康和心理健康结果的关系。
该研究使用了退伍军人事务部（VA）超过 6000 名女性初级保健使用者的全国代表性调查（2012 年进行，2016 年分析）的数据，并与电子病历数据相关联。采用潜在类别分析得出不良经历的定性不同模式，并采用逻辑回归模型比较各类别之间的过去一年健康状况的几率。
童年和兵役逆境的发生率均很高。观察到五种有意义的逆境类别，其特点是所有事件的逆境程度都较低、所有事件的逆境程度都较高、所有事件的极端高逆境、不良家庭环境以及主要以不良兵役经历为特征的类别。过去一年被诊断为抑郁、焦虑、创伤后应激障碍、物质使用障碍以及合并精神和慢性健康状况的几率在各类别之间存在显著差异。
在 VA 女性使用者中，对定性不同的逆境模式进行检查比计算不良事件的数量产生了更有意义的结果。鉴于不良经历的高发生率，VA 有能力通过二级预防和对所有女性退伍军人的普遍创伤预防措施来应对。
