Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA; Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA.
Center for Advancing Population Science (CAPS), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226 USA.
J Affect Disord. 2020 Dec 1;277:999-1004. doi: 10.1016/j.jad.2020.09.023. Epub 2020 Sep 11.
Adverse Childhood Experiences (ACEs) and perceived discrimination impact health overtime, however little is known about their association.
Data for 6,325 participants in the Midlife in the US (MIDUS) study were analyzed across three waves of data. ACEs included emotional or physical abuse, household dysfunction, or financial strain in childhood. Generalized Linear Models with Generalized Estimating Equation approach was used to test the unadjusted and adjusted associations for ACEs and perceived discrimination and perceived inequality.
Individuals with ACEs reported significantly higher perceived inequality in work (β=0.05, 95%CI 0.02-0.07), in home (β=0.06, 95%CI 0.04-0.09), in family relationships (β=0.09, 95%CI 0.06-0.11), perceived daily discrimination (β=0.77, 95%CI 0.58-0.96), and perceived lifetime discrimination (β=0.24, 95%CI 0.18-0.30). ACE types were significantly associated with more perceived inequality and perceived discrimination. . Abuse was independently associated with all outcomes after adjusting for household dysfunction, financial strain, age, sex, race/ethnicity, education, marital status, and income.
Findings cannot speak to the temporal relationship between ACEs and discrimination. It should not be assumed that ACEs cause perceived discrimination, but rather that there is an important association that warrants further investigation.
These findings represent the first step in better understanding the relationship between ACEs and perceived discrimination. As both influence health across the lifespan, understanding the relationship, mechanisms, and pathways for intervening are of great importance from a population health perspective. Efforts to incorporate discussions on experiences with discrimination and inequality may be warranted as a part of treatment for ACEs to address psychosocial stressors across the lifespan.
不良的童年经历（ACEs）和感知歧视会随着时间的推移影响健康，但人们对它们之间的关系知之甚少。
对美国中年生活（MIDUS）研究的 6325 名参与者的三波数据进行了分析。ACEs 包括童年时期的情感或身体虐待、家庭功能障碍或经济压力。使用广义线性模型和广义估计方程方法，测试 ACEs 和感知歧视以及感知不平等之间的未经调整和调整后的关联。
有 ACEs 的个体报告在工作（β=0.05，95%CI 0.02-0.07）、家庭（β=0.06，95%CI 0.04-0.09）、家庭关系（β=0.09，95%CI 0.06-0.11）、日常感知歧视（β=0.77，95%CI 0.58-0.96）和终生感知歧视（β=0.24，95%CI 0.18-0.30）方面感知到的不平等程度明显更高。ACE 类型与更多的感知不平等和感知歧视显著相关。在调整家庭功能障碍、经济压力、年龄、性别、种族/民族、教育、婚姻状况和收入后，虐待与所有结果独立相关。
研究结果不能说明 ACEs 和歧视之间的时间关系。不能假设 ACEs 导致感知歧视，而只是存在一个重要的关联，这需要进一步研究。
这些发现代表了更好地理解 ACEs 和感知歧视之间关系的第一步。由于两者都会在整个生命周期中影响健康，因此从人口健康的角度来看，了解这种关系、机制和干预途径非常重要。为了应对整个生命周期中的心理社会压力源，作为 ACE 治疗的一部分，将讨论感知歧视和不平等的经历纳入治疗可能是合理的。
