Elmore Amanda L, Crouch Elizabeth, Kabir Chowdhury Mohiuddin Ahsanul
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA.
Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, USA.
Child Abuse Negl. 2020 Sep;107:104616. doi: 10.1016/j.chiabu.2020.104616. Epub 2020 Jul 6.
Adverse childhood experiences (ACEs) are common among children. Little is known on how resilience factors and positive childhood experiences (PCEs) may moderate the relationship between ACEs and childhood depression.
Our study fills this gap by providing recent, nationally representative estimates of ACE and PCE exposure for ages 8-17 and examines the associations between ACE exposure and PCEs on the outcome of depression.
Data were drawn from the nationally representative 2016-2017 National Survey of Children's Health (NSCH) and included a total sample of 40,302 children and adolescents.
Chi square analysis and multivariate logistic regressions were performed to assess associations of depression with 9 ACE and 6 PCE exposures. Additive and multiplicative interactions were examined between ACE exposure and PCEs (resiliency measures) on depression. Survey sampling weights and SAS survey procedures were used.
Our study found that 4% of children had current depression and those with an ACE count greater than four had increased odds (aOR: 2.29; CI: 1.74-3.02). Multivariate regressions demonstrated associations between depression and low resiliency as well as significant interactions between ACE exposure and three PCEs. Children who were exposed to greater than four ACEs and did not exhibit resilience had 8.75 higher odds of depression (CI: 5.23-14.65) compared to those with less than four ACEs and some resilience.
These findings illustrate the need for the promotion of PCEs and the building of resiliency for combatting depression and reducing the impact of trauma in children and adolescents.
童年不良经历（ACEs）在儿童中很常见。关于复原力因素和积极童年经历（PCEs）如何调节ACEs与儿童抑郁症之间的关系，我们知之甚少。
我们的研究通过提供近期具有全国代表性的8至17岁儿童ACE和PCE暴露估计数据填补了这一空白，并研究了ACE暴露和PCEs与抑郁症结局之间的关联。
数据来自具有全国代表性的2016 - 2017年全国儿童健康调查（NSCH），共纳入40302名儿童和青少年样本。
进行卡方分析和多变量逻辑回归，以评估抑郁症与9种ACE和6种PCE暴露之间的关联。研究了ACE暴露与PCEs（复原力指标）之间对抑郁症的相加和相乘交互作用。使用了调查抽样权重和SAS调查程序。
我们的研究发现，4%的儿童目前患有抑郁症，ACE计数大于4的儿童患抑郁症的几率增加（调整后比值比：2.29；置信区间：1.74 - 3.02）。多变量回归显示抑郁症与低复原力之间存在关联，以及ACE暴露与三种PCEs之间存在显著交互作用。与ACEs少于4种且具有一定复原力的儿童相比，ACEs大于4种且未表现出复原力的儿童患抑郁症的几率高8.75倍（置信区间：5.23 - 14.65）。
这些发现表明，需要促进PCEs并培养复原力，以对抗抑郁症并减少创伤对儿童和青少年的影响。
