Meehan Alan J, Baldwin Jessie R, Lewis Stephanie J, MacLeod Jelena G, Danese Andrea
Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Child Study Center, Yale School of Medicine, New Haven, Connecticut.
Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Clinical, Educational and Health Psychology, UCL Psychology and Language Sciences, University College London, London, United Kingdom.
Am J Prev Med. 2022 Mar;62(3):427-432. doi: 10.1016/j.amepre.2021.08.008. Epub 2021 Oct 9.
Adverse childhood experiences confer an increased risk for physical and mental health problems across the population, prompting calls for routine clinical screening based on reported adverse childhood experience exposure. However, recent longitudinal research has questioned whether adverse childhood experiences can accurately identify ill health at an individual level.
Revisiting data collected for the Adverse Childhood Experience Study between 1995 and 1997, this study derived approximate area under the curve estimates to test the ability of the retrospectively reported adverse childhood experience score to discriminate between adults with and without a range of common health risk factors and disease conditions. Furthermore, the classification accuracy of a recommended clinical definition for high-risk exposure (≥4 versus 0-3 adverse childhood experiences) was evaluated on the basis of sensitivity, specificity, positive and negative predictive values, and positive likelihood ratios.
Across all health outcomes, the levels of discrimination for the continuous adverse childhood experience score ranged from very poor to fair (area under the curve=0.50-0.76). The binary classification of ≥4 versus 0-3 adverse childhood experiences yielded high specificity (true-negative detection) and negative predictive values (absence of ill health among low-risk adverse childhood experience groups). However, sensitivity (true-positive detection) and positive predictive values (presence of ill health among high-risk adverse childhood experience groups) were low, whereas positive likelihood ratios suggested only minimal-to-moderate increases in health risks among individuals reporting ≥4 adverse childhood experiences versus that among those reporting 0-3.
These findings suggest that screening based on the adverse childhood experience score does not accurately identify those individuals at high risk of health problems. This can lead to both allocation of unnecessary interventions and lack of provision of necessary support.
童年不良经历会增加整个人口群体出现身心健康问题的风险，这促使人们呼吁基于所报告的童年不良经历暴露情况进行常规临床筛查。然而，最近的纵向研究对童年不良经历能否在个体层面准确识别健康问题提出了质疑。
本研究回顾了1995年至1997年期间为童年不良经历研究收集的数据，得出曲线下面积近似估计值，以测试回顾性报告的童年不良经历得分区分有无一系列常见健康风险因素和疾病状况的成年人的能力。此外，根据敏感性、特异性、阳性和阴性预测值以及阳性似然比，评估了推荐的高风险暴露临床定义（≥4次与0 - 3次童年不良经历）的分类准确性。
在所有健康结局中，连续童年不良经历得分的区分水平从非常差到一般（曲线下面积 = 0.50 - 0.76）。≥4次与0 - 3次童年不良经历的二元分类产生了高特异性（真阴性检测）和阴性预测值（低风险童年不良经历组中无健康问题）。然而，敏感性（真阳性检测）和阳性预测值（高风险童年不良经历组中存在健康问题）较低，而阳性似然比表明，报告≥4次童年不良经历的个体与报告0 - 3次童年不良经历的个体相比，健康风险仅略有至中度增加。
这些发现表明，基于童年不良经历得分进行筛查并不能准确识别那些有高健康问题风险的个体。这可能导致不必要干预措施的分配以及必要支持的缺乏。
