School of Public Health, Cheeloo Collage of Medicine, Shandong University, Jinan, China.
Institute for Medical Dataology, Cheeloo Collage of Medicine, Shandong University, Jinan, China.
JAMA Netw Open. 2020 Aug 3;3(8):e2012557. doi: 10.1001/jamanetworkopen.2020.12557.
Childhood intrafamilial aggression, a series of aggressive behaviors inflicted by family members, and adulthood mental health are associated with childhood peer bullying (eg, in the neighborhood or in school). However, few studies have been able to identify the contribution of childhood peer bullying to the association between childhood intrafamilial aggression and adult depression.
To examine the mediating role of childhood peer bullying in the association between childhood intrafamilial aggression and depression in adulthood.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS). Middle-aged and older adults (≥45 years) participated in a CHARLS wave from July 1 to September 30, 2015, and the CHARLS life history survey from June 1 to December 31, 2014, with complete data. A 4-step mediation model with logistic regression was run to test the mediating role of peer bullying. Data analysis was performed from October 1 to 30, 2019.
Childhood intrafamilial aggression, including parental physical maltreatment and sibling aggression, and peer bullying.
Depressive symptoms measured by a categorical variable derived from the Center for Epidemiologic Studies Depression Scale, based on a cutoff score of 12.
Among the 15 450 respondents (mean [SD] age, 59.5 [9.9] years; 7987 women [51.7%]), 4422 (28.6%) were exposed to parental physical maltreatment; 986 (6.4%), to sibling aggression; and 2504 (16.2%), to peer bullying in childhood. Respondents experiencing intrafamilial aggression were more likely to be bullied by peers (parental physical maltreatment odds ratio [OR], 2.53 [95% CI, 2.25-2.83]; sibling aggression OR, 3.05 [95% CI, 2.46-3.78]). Children with these adverse experiences were at a higher risk of adult depression symptoms (parental physical maltreatment OR, 1.28 [95% CI, 1.15-1.42]; sibling aggression OR, 1.40 [95% CI, 1.13-1.74]; peer bullying OR, 1.78 [95% CI, 1.56-2.01]). Peer bullying mediated 30% (95% CI, 19%-42%) of the association between childhood parental maltreatment and adult depression and 35% (95% CI, 15%-54%) of the association between sibling aggression and depression symptoms in adulthood.
This study found that being bullied by peers was a mediator of the association between childhood intrafamilial aggression and depression in adulthood. The findings have important implications to mitigate the effect of early-life stress and promote life-course mental health through dealing with childhood intrafamilial aggression and peer bullying experiences coordinately.
童年期家庭内攻击行为，即家庭成员之间实施的一系列攻击行为，以及成年后的心理健康与儿童期同伴欺凌（如在邻里或学校）有关。然而，很少有研究能够确定儿童期同伴欺凌对童年期家庭内攻击行为与成年期抑郁之间关联的贡献。
检验儿童期同伴欺凌在童年期家庭内攻击行为与成年期抑郁之间关联中的中介作用。
设计、地点和参与者：本基于人群的横断面研究使用了中国健康与退休纵向研究（CHARLS）的数据。中年和老年人（≥45 岁）参加了 2015 年 7 月 1 日至 9 月 30 日的 CHARLS 波次，并于 2014 年 6 月 1 日至 12 月 31 日完成了 CHARLS 生活史调查。采用 logistic 回归的四步中介模型检验了同伴欺凌的中介作用。数据分析于 2019 年 10 月 1 日至 30 日进行。
童年期家庭内攻击行为，包括父母身体虐待和兄弟姐妹攻击行为，以及同伴欺凌。
抑郁症状采用基于中心流行病学研究抑郁量表的分类变量来衡量，基于 12 分的截断得分。
在 15450 名应答者中（平均[标准差]年龄，59.5[9.9]岁；7987 名女性[51.7%]），4422 名（28.6%）经历过父母身体虐待；986 名（6.4%）经历过兄弟姐妹攻击；2504 名（16.2%）经历过儿童期同伴欺凌。经历家庭内攻击行为的应答者更有可能受到同伴欺凌（父母身体虐待比值比[OR]，2.53[95% CI，2.25-2.83]；兄弟姐妹攻击 OR，3.05[95% CI，2.46-3.78]）。有这些不良经历的儿童更有可能出现成年期抑郁症状（父母身体虐待 OR，1.28[95% CI，1.15-1.42]；兄弟姐妹攻击 OR，1.40[95% CI，1.13-1.74]；同伴欺凌 OR，1.78[95% CI，1.56-2.01]）。同伴欺凌介导了 30%（95% CI，19%-42%）的父母虐待与成年期抑郁之间的关联，以及 35%（95% CI，15%-54%）的兄弟姐妹攻击与成年期抑郁症状之间的关联。
本研究发现，被同伴欺凌是童年期家庭内攻击行为与成年期抑郁之间关联的一个中介因素。研究结果具有重要意义，可以通过协调处理儿童期家庭内攻击行为和同伴欺凌经历来减轻早期生活压力的影响，促进整个生命周期的心理健康。
