Cosco Theodore D, Hardy Rebecca, Howe Laura D, Richards Marcus
Gerontology Research Center, Department of Gerontology, Simon Fraser University, Vancouver, Canada.
Oxford Institute of Population Ageing, University of Oxford, Oxford, UK.
Int Psychogeriatr. 2019 Sep;31(9):1249-1258. doi: 10.1017/S1041610218001795. Epub 2018 Nov 23.
Robust and persistent links between early-life adversities and later-life mental distress have previously been observed. Individual and social resources are associated with greater mental health and resilience. This study aimed to test these resources as moderators and mediators of the association between childhood psychosocial adversity and later-life mental distress.
Participant data came from the Medical Research Council National Survey of Health and Development, a nationally-representative birth cohort study. The General Health Questionnaire-28 (GHQ-28) captured mental distress at ages 53, 60-64, and 68-69. An eight-item cumulative psychosocial adversity score was created (0, 1, 2, ≥3 adversities). Individual (i.e., education, occupational status, physical activity) and social (i.e., social support, neighborhood cohesion) resources were examined as mediators and moderators of CPA and GHQ-28 in longitudinal multilevel models.
Greater adversity was associated with an average GHQ-28 score increase of 0.017, per unit adversity (β = 0·017, < 0·001, 95% CI 0·011, 0·022). Lower mental distress was associated with higher levels of physical activity, occupational status, education, social support, and neighborhood cohesion. There was no evidence that resources moderated the relationship between GHQ-28 and adversity. All resources, save for physical activity and occupational status, partly mediated this relationship.
Individual and social resources were associated with lower mental distress. They did not modify, but partly mediated the association between childhood adversity and adult mental distress. Social support was the most important mediator, suggesting that interventions to promote greater social support may offset psychosocial adversities experienced in childhood to foster better mental health in older adults.
此前已观察到早年逆境与晚年精神困扰之间存在稳固且持久的联系。个人和社会资源与更好的心理健康及恢复力相关。本研究旨在检验这些资源作为童年期心理社会逆境与晚年精神困扰之间关联的调节因素和中介因素。
参与者数据来自医学研究理事会全国健康与发展调查，这是一项具有全国代表性的出生队列研究。一般健康问卷28项版（GHQ - 28）用于评估53岁、60 - 64岁和68 - 69岁时的精神困扰情况。创建了一个包含八项的累积心理社会逆境得分（0、1、2、≥3种逆境）。在纵向多层次模型中，将个人资源（即教育程度、职业地位、身体活动）和社会资源（即社会支持、社区凝聚力）作为童年期心理社会逆境（CPA）与GHQ - 28之间关联的中介因素和调节因素进行检验。
每增加一个单位的逆境，平均GHQ - 28得分增加0.017（β = 0·017，P < 0·001，95%置信区间0·011，0·022）。较低的精神困扰与较高水平的身体活动、职业地位、教育程度、社会支持和社区凝聚力相关。没有证据表明资源可调节GHQ - 28与逆境之间的关系。除身体活动和职业地位外，所有资源均部分介导了这种关系。
个人和社会资源与较低的精神困扰相关。它们并未改变，但部分介导了童年逆境与成人精神困扰之间的关联。社会支持是最重要的中介因素，这表明促进更多社会支持的干预措施可能抵消童年期经历的心理社会逆境，从而促进老年人更好的心理健康。
