Harvard Medical School, Boston, MA, USA.
MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
Can J Psychiatry. 2021 Oct;66(10):906-917. doi: 10.1177/0706743721989158. Epub 2021 Jan 27.
The associations between adverse childhood experiences (ACEs) and psychopathology have been well-established in the general population. Research on ACEs in the homeless population has been limited. This study examined whether ACE exposure is associated with specific mental health outcomes among a national sample of homeless adults with mental illness and whether this association varies according to ACE dimension and gender.
This cross-sectional study utilized data from a national sample of 2,235 homeless adults with mental illness in Canada to evaluate their sociodemographic characteristics, exposure to ACEs, and mental health outcomes. Exploratory and confirmatory factor analyses were conducted to identify and confirm ACE dimensions (maltreatment, sexual abuse, neglect, divorce, and household dysfunction) from individual ACE items. Multivariable logistic regression was used to examine the associations between total ACE score and ACE dimensions with mental illness diagnoses and psychopathology severity.
The mean total ACE score among all study participants was 4.44 (standard deviation []: 2.99). Total ACE score was positively associated with several mental illness diagnoses and psychopathology severity. Unique associations were found between specific ACE dimensions and poor mental health outcomes. The prevalence of almost all ACEs was significantly higher among women. Yet, associations between several ACE dimensions and poor mental health outcomes existed uniquely among men.
There are unique and gender-specific associations between specific ACE dimensions and mental health outcomes among homeless adults. Better understanding of the mechanisms underlying these associations is needed to inform screening, prevention, and treatment efforts, particularly given the very high prevalence of ACEs among this vulnerable and marginalized population.
在普通人群中，不良童年经历（ACE）与精神病理学之间的关联已得到充分证实。针对无家可归人群中的 ACE 的研究有限。本研究考察了在患有精神疾病的全国性无家可归成年人样本中，ACE 暴露是否与特定的心理健康结果相关，以及这种关联是否因 ACE 维度和性别而异。
本横断面研究利用加拿大 2235 名患有精神疾病的无家可归成年人的全国性样本数据，评估他们的社会人口统计学特征、ACE 暴露情况以及心理健康结果。进行了探索性和验证性因素分析，以从个体 ACE 项目中确定和确认 ACE 维度（虐待、性虐待、忽视、离婚和家庭功能障碍）。多变量逻辑回归用于检查 ACE 总分和 ACE 维度与精神疾病诊断和精神病理学严重程度之间的关联。
所有研究参与者的 ACE 总分平均值为 4.44（标准差 []：2.99）。ACE 总分与多种精神疾病诊断和精神病理学严重程度呈正相关。特定 ACE 维度与不良心理健康结果之间存在独特的关联。几乎所有 ACE 的发生率在女性中明显更高。然而，在男性中，某些 ACE 维度与不良心理健康结果之间存在独特的关联。
在无家可归的成年人中，特定 ACE 维度与心理健康结果之间存在独特且具有性别特异性的关联。需要更好地了解这些关联背后的机制，以便为筛查、预防和治疗工作提供信息，特别是考虑到这个脆弱和边缘化的人群中 ACE 的发生率非常高。
