Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, New York.
Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland.
Depress Anxiety. 2019 Jul;36(7):596-606. doi: 10.1002/da.22887. Epub 2019 Mar 18.
The significance of the timing and chronicity of childhood adversity for depression outcomes later in life is unclear. Identifying trajectories of adversity throughout childhood would allow classification of children according to the accumulation, timing, and persistence of adversity, and may provide unique insights into the risk of subsequent depression.
Using data from the Avon Longitudinal Study of Parents and Children, we created a composite adversity score comprised of 10 prospectively assessed domains (e.g., violent victimization, inter-parental conflict, and financial hardship) for each of eight time points from birth through age 11.5 years. We used semiparametric group-based trajectory modeling to derive childhood adversity trajectories and examined the association between childhood adversity and depression outcomes at the age of 18 years.
Among 9,665 participants, five adversity trajectories were identified, representing stable-low levels (46.3%), stable-mild levels (37.1%), decreasing levels (8.9%), increasing levels (5.3%), and stable-high levels of adversity (2.5%) from birth through late childhood. Approximately 8% of the sample met criteria for probable depression at 18 years and the mean depression severity score was 3.20 (standard deviation = 3.95, range 0-21). The risk of depression in young adulthood was elevated in the decreasing (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.19-2.48), increasing (OR = 1.81, 95% CI = 1.15-2.86), and stable-high (OR = 1.80, 95% CI = 1.00-3.23) adversity groups, compared to those with stable-low adversity, when adjusting for potential confounders.
Children in trajectory groups characterized by moderate or high levels of adversity at some point in childhood exhibited consistently greater depression risk and depression severity, regardless of the timing of adversity.
儿童期逆境的发生时间和持续时间对成年后患抑郁症的影响尚不清楚。识别整个儿童期的逆境轨迹可以根据逆境的积累、发生时间和持续时间对儿童进行分类，并且可能为随后发生抑郁症的风险提供独特的见解。
我们利用阿冯纵向研究父母与子女的数据，为从出生到 11.5 岁的 8 个时间点的 10 个前瞻性评估领域（例如，暴力受害、父母间冲突和经济困难）创建了一个综合逆境评分。我们使用半参数基于群组的轨迹建模来得出儿童期逆境轨迹，并研究了儿童期逆境与 18 岁时抑郁结果之间的关联。
在 9665 名参与者中，确定了五种逆境轨迹，代表了从出生到儿童晚期的稳定低水平（46.3%）、稳定轻度水平（37.1%）、下降水平（8.9%）、上升水平（5.3%）和稳定高水平的逆境（2.5%）。大约 8%的样本在 18 岁时符合可能患有抑郁症的标准，平均抑郁严重程度评分为 3.20（标准差=3.95，范围 0-21）。在年轻成年期，抑郁的风险在下降（比值比[OR] = 1.72，95%置信区间[CI] = 1.19-2.48）、上升（OR = 1.81，95% CI = 1.15-2.86）和稳定高（OR = 1.80，95% CI = 1.00-3.23）逆境组中升高，与稳定低逆境组相比，在调整了潜在混杂因素后。
在儿童期某个时间点具有中等到高水平逆境的轨迹组中的儿童，无论逆境发生的时间如何，抑郁风险和抑郁严重程度都始终更高。
