Johns Hopkins University, Department of International Health, Bloomberg School of Public Health, Center for American Indian Health, Great Lakes Hub, Duluth, MN, USA.
J Racial Ethn Health Disparities. 2020 Oct;7(5):958-966. doi: 10.1007/s40615-020-00720-y. Epub 2020 Feb 24.
Decades of evidence link adverse childhood experiences (ACEs) to worse health. Despite disproportionate rates of ACEs and health disparities in tribal communities, a gap exists in understanding the effects of ACEs on American Indian (AI) health. The purpose of this study is to estimate frequencies of eight categories of ACEs, assess the risk for internalizing symptoms by each ACE category, and determine if moderate and high levels of ACEs exposures have differential, increasing risk associated with internalizing symptoms for a sample of AI adults with T2D.
Five tribal communities participated in a community-based participatory research study. Data from AI adults with T2D were analyzed (N = 192). Frequencies of eight childhood events and situations were assessed, and exposure levels of low (0-1), moderate (2-3), and high levels (4 +) of ACEs were calculated. Odds of screening positive for depression and generalized anxiety disorder (GAD) by each ACE type and moderate and high levels of ACEs were estimated using regression analyses.
Relative to other studies, exposure estimates for each of the eight ACE categories and moderate and high levels of ACEs were high. Sexual and physical abuse, neglect, and household mental illness were positively associated with depressive symptoms, and physical abuse was positively associated with anxiety symptoms. Exposures to moderate and high levels of ACEs were associated with increased odds of screening positive for current depression in a dose-response fashion. A high level of ACEs exposure was also associated with an increased odds of a positive GAD screening.
This research extends limited knowledge about ACEs and health among AIs. More research is needed to understand the health consequences of ACEs for a population exhibiting health inequities. Components of strategies for addressing ACEs, mental health, T2D complications, and comorbidities are proposed for AIs generally and AI adults with T2D specifically.
几十年来的证据表明，不良的童年经历（ACEs）与健康状况恶化有关。尽管部落社区的 ACE 发生率和健康差距不成比例，但人们对 ACE 对美国印第安人（AI）健康的影响仍存在理解上的差距。本研究的目的是估计 8 类 ACE 的发生频率，评估每个 ACE 类别与内化症状的风险，并确定在有 T2D 的 AI 成人样本中，中高强度 ACE 暴露是否与内化症状的关联存在差异且呈递增趋势。
五个部落社区参与了一项基于社区的参与式研究。分析了有 T2D 的 AI 成人的数据（N=192）。评估了 8 种童年事件和情况的发生频率，并计算了低（0-1）、中（2-3）和高（4+）水平 ACE 的暴露水平。使用回归分析估计每种 ACE 类型和中高强度 ACE 暴露与抑郁和广泛性焦虑障碍（GAD）筛查阳性的几率。
与其他研究相比，八种 ACE 类别和中高强度 ACE 暴露的估计值都很高。性虐待、身体虐待、忽视和家庭精神疾病与抑郁症状呈正相关，身体虐待与焦虑症状呈正相关。中高强度 ACE 暴露与当前抑郁筛查阳性的几率呈剂量反应关系增加。高水平 ACE 暴露也与 GAD 筛查阳性的几率增加有关。
本研究扩展了关于 ACEs 和 AI 健康的有限知识。需要进一步研究以了解 ACEs 对存在健康不平等的人群的健康后果。提出了针对 ACEs、心理健康、T2D 并发症和合并症的策略的组成部分，适用于一般的 AI 和特定的有 T2D 的 AI 成人。
