Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario.
Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario.
Perm J. 2020;24. doi: 10.7812/TPP/19.079. Epub 2020 Mar 18.
Adverse childhood experiences (ACEs) are often operationalized as a cumulative score, treating all forms of adversity as equivalent despite fundamental differences in the type of exposure.
To explore the suitability of this approach, we examined the independent, cumulative, and multiplicative effects of physical abuse, sexual abuse, and/or family violence on the occurrence of mental disorders in adults.
Data from the 2012 Canadian Community Health Survey-Mental Health were used to derive a series of logistic regression models. A set of interaction terms was included to model the multiplicative effects of ACEs on mental disorders and suicidality.
The independent effects of physical abuse and sexual abuse were stronger than the effects of family violence. The cumulative effects represent nearly a 2-fold increase in disorder for each additional form of adversity. The multiplicative effects suggested that the clustering of physical abuse and sexual abuse had the greatest effect on mental disorders and suicidality.
These findings highlight the need to examine the nuanced effects of clustering of adversity in an individual, rather than relying on a single cumulative score.
Future work should examine a comprehensive set of ACEs to identify which ACE combinations contribute to greater mental health burden, thereby informing the development of specific interventions.
不良的童年经历（ACEs）通常以累积分数的形式进行操作，尽管暴露的类型存在根本差异，但将所有形式的逆境视为同等对待。
为了探讨这种方法的适用性，我们研究了身体虐待、性虐待和/或家庭暴力对成年人精神障碍发生的独立、累积和乘法效应。
使用 2012 年加拿大社区健康调查-心理健康的数据得出了一系列逻辑回归模型。纳入了一组交互项，以对 ACE 对精神障碍和自杀倾向的乘法效应进行建模。
身体虐待和性虐待的独立效应强于家庭暴力的效应。累积效应表明，每增加一种逆境形式，障碍的发生率就会增加近两倍。乘法效应表明，身体虐待和性虐待的聚类对精神障碍和自杀倾向的影响最大。
这些发现强调了需要在个体中检查逆境聚类的细微影响，而不是依赖单一的累积分数。
未来的工作应该检查一整套 ACE，以确定哪些 ACE 组合对更大的心理健康负担有贡献，从而为特定干预措施的制定提供信息。
