Department of Psychology, University of the South.
Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University.
Am Psychol. 2021 Feb-Mar;76(2):230-242. doi: 10.1037/amp0000763.
The Adverse Childhood Experiences (ACEs) studies transformed our understanding of the true burden of trauma. Notable elements of Felitti and colleagues' findings include the influence of adversity on many physical as well as psychological problems and the persistence of impacts decades after the traumas occurred. In this article, we make the case that the most revolutionary finding was the discovery of a strong dose-response effect, with marked increases in risk observed for individuals who reported four or more adversities. Over the past two decades, our understanding of the cumulative burden of trauma has expanded further, with recognition that experiences outside the family, including peer victimization, community violence, and racism, also contribute to trauma dose. Recent research has provided evidence for the pervasiveness of trauma, which we now realize affects most people, even by the end of adolescence. Extensive scientific evidence has documented that more than 40 biopsychosocial outcomes, including leading causes of adult morbidity and mortality, are associated with adverse childhood experiences, measured by dose. We summarize the state of science and explain how ACEs built a movement for uncovering mechanisms responsible for these relationships. Perhaps unexpectedly, the pervasiveness of trauma also expands our understanding of resilience, which is likewise more common than previously recognized. Emerging research on positive childhood experiences and poly-strengths suggests that individual, family, and community strengths may also contribute to outcomes in a dose-response relationship. We close with an agenda for research, intervention, and policy to reduce the societal burden of adversity and promote resilience. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
创伤后不良经历（ACE）研究改变了我们对创伤真实负担的理解。费利蒂及其同事研究结果的显著特点包括逆境对许多身体和心理问题的影响，以及创伤发生几十年后仍存在影响。在本文中，我们认为最具革命性的发现是发现了强烈的剂量反应效应，即报告遭受 4 种或更多逆境的个体风险显著增加。在过去的二十年中，我们对创伤累积负担的理解进一步扩展，人们认识到家庭以外的经历，包括同伴受害、社区暴力和种族主义，也会增加创伤剂量。最近的研究提供了创伤普遍存在的证据，我们现在意识到，即使在青春期结束时，创伤也会影响大多数人。大量科学证据表明，超过 40 种生物心理社会结果，包括成年人发病率和死亡率的主要原因，与通过剂量测量的不良儿童经历有关。我们总结了科学现状，并解释了 ACE 如何建立一个揭示这些关系背后机制的运动。也许出人意料的是，创伤的普遍性也扩大了我们对弹性的理解，而弹性比以前认识到的更为普遍。关于积极的儿童经历和多元优势的新兴研究表明，个体、家庭和社区优势也可能以剂量反应关系对结果产生影响。最后我们提出了一个研究、干预和政策议程，以减轻社会逆境负担，促进弹性。（PsycInfo 数据库记录（c）2021 APA，保留所有权利）。
