School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Children and Young People's Mental Health Research Collaboration, College of Medicine and Health, University of Exeter, Exeter, UK.
J Child Psychol Psychiatry. 2021 Sep;62(9):1100-1109. doi: 10.1111/jcpp.13379. Epub 2021 Feb 22.
Childhood adversity strongly predicts adolescent multiple health risk behaviours (MRBs) such as alcohol/tobacco use, self-harm and physical inactivity, and both adversities and MRBs are associated with premature mortality and several chronic health conditions that are among the leading causes of death in adults. It is therefore important to understand the relationship between adversities and MRBs and what could mediate any association. The aim of this study was to explore whether childhood psychopathology mediates associations between adversities and MRBs.
Participants were young people in the Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 5,799). Using structural equation modelling, we explored the associations between adversities before 9 years and MRBs at age 16 years. We also explored potential mediating pathways through dimensional psychopathology measured by the Strength and Difficulties Questionnaire subscales at age 12 years.
There were strong positive associations between adversities and MRBs (β .25, 95% CI 0.20, 0.31, p < .001) suggesting that each additional adversity is associated with a 0.25 increase in number of MRBs out of 13 total risk behaviours. We found robust evidence of mediating pathways from adversities through conduct problems (β .05, 95% CI 0.03, 0.06, p < .001), hyperactivity/inattention (β .02, 95% CI 0.01, 0.03, p < .001) and peer relationship problems (β -.02, 95% CI -0.03, -0.02, p < .001) to MRBs.
Increased conduct problems and hyperactivity/inattention appear to partially explain the relationship between adversities and MRBs. Peer relationship problems also appear to reduce the association between adversities and MRBs, and further research is needed to understand how to encourage peer connectivity without increasing risk of MRBs. These results suggest that interventions aimed at reducing MRBs among those exposed to childhood adversities could focus on prevention of behavioural problems.
童年逆境强烈预测青少年多种健康风险行为（MRB），如饮酒/吸烟、自残和身体活动不足，而逆境和 MRB 都与过早死亡和几种慢性健康状况有关，这些健康状况是成年人死亡的主要原因之一。因此，了解逆境与 MRB 之间的关系以及可能介导任何关联的因素非常重要。本研究旨在探讨儿童期精神病理学是否在逆境与 MRB 之间的关联中起中介作用。
参与者为阿冯纵向研究父母和儿童（ALSPAC）中的年轻人（N=5799）。使用结构方程模型，我们探讨了 9 岁前的逆境与 16 岁时的 MRB 之间的关联。我们还通过在 12 岁时使用困难问卷子量表测量的维度精神病理学，探讨了潜在的中介途径。
逆境与 MRB 之间存在强烈的正相关关系（β.25，95%置信区间 0.20，0.31，p<0.001），这表明每增加一种逆境与 13 种总风险行为中的 0.25 种 MRB 增加相关。我们发现有强有力的证据表明，从逆境到行为问题（β.05，95%置信区间 0.03，0.06，p<0.001）、多动/注意力不集中（β.02，95%置信区间 0.01，0.03，p<0.001）和同伴关系问题（β -.02，95%置信区间 -0.03，-0.02，p<0.001）的中介途径存在稳健证据，导致 MRB。
增加的行为问题和多动/注意力不集中似乎部分解释了逆境与 MRB 之间的关系。同伴关系问题似乎也降低了逆境与 MRB 之间的关联，需要进一步研究如何在不增加 MRB 风险的情况下鼓励同伴联系。这些结果表明，针对暴露于童年逆境的个体减少 MRB 的干预措施可能侧重于预防行为问题。
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