Mental Health Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
Mental Health Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
J Adolesc Health. 2020 Jul;67(1):93-100. doi: 10.1016/j.jadohealth.2020.01.005. Epub 2020 Mar 16.
The impact of adverse childhood experiences (ACEs) on various health outcomes is a major public health concern. This study aimed to provide a comprehensive overview of direct and indirect effects of ACEs on young adult mental and physical health-related quality of life (HRQoL) and to identify protective factors that could be addressed by public health interventions.
We used structural equation modeling to investigate associations between ACE exposure and mental and physical HRQoL in 3,704 young adults (44.5% male) who participated at baseline (2003-2006; mean age = 12.2 years, 95% confidence interval = 12.1-12.3) and at the second follow-up (2014-2017; mean age = 25.0 years, 95% confidence interval = 24.9-25.1) of the KiGGS cohort study, a population-based study of children and adolescents in Germany. We investigated the mediating role of protective factors in associations between ACEs and adult HRQoL while controlling for child/adolescent HRQoL.
A substantial proportion of young adults (65.6%) reported an ACE. Emotional abuse, neglect, depression/suicide of a household member, and ACE co-occurrence affected HRQoL negatively. Some of the negative effects of ACEs on HRQoL were attenuated, and cumulative effects from ACE co-occurrence were buffered by protective factors.
Self-efficacy and emotional stability seem to play a key role in buffering the effects of ACEs on mental and physical HRQoL. To reduce the negative impact of ACEs, public health measures should pay additional attention to emotional abuse and promote coping and adaption competencies in children and adolescents with ACE and in general.
不良童年经历（ACEs）对各种健康结果的影响是一个主要的公共卫生关注点。本研究旨在提供 ACEs 对年轻成年人心理健康和身体健康相关生活质量（HRQoL）的直接和间接影响的综合概述，并确定可以通过公共卫生干预措施解决的保护因素。
我们使用结构方程模型调查了在德国儿童和青少年的基于人群的 KiGGS 队列研究中，3704 名年轻成年人（44.5%为男性）的 ACE 暴露与心理健康和身体健康 HRQoL 之间的关联，这些参与者在基线（2003-2006 年；平均年龄为 12.2 岁，95%置信区间为 12.1-12.3）和第二次随访（2014-2017 年；平均年龄为 25.0 岁，95%置信区间为 24.9-25.1）时参与了研究。我们在控制儿童/青少年 HRQoL 的情况下，调查了保护因素在 ACEs 和成人 HRQoL 之间关联中的中介作用。
相当一部分年轻成年人（65.6%）报告有 ACE。情感虐待、忽视、家庭成员的抑郁/自杀和 ACE 共同发生对 HRQoL 产生负面影响。ACEs 对 HRQoL 的一些负面影响被削弱，而 ACE 共同发生的累积效应则被保护因素缓冲。
自我效能感和情绪稳定性似乎在缓冲 ACEs 对心理健康和身体健康 HRQoL 的影响方面起着关键作用。为了减少 ACEs 的负面影响，公共卫生措施应额外关注情感虐待，并在儿童和青少年中促进 ACE 和一般情况下的应对和适应能力。
