Department of Psychology, Yale University, New Haven, Conn.
Am J Psychiatry. 2021 Nov;178(11):998-1013. doi: 10.1176/appi.ajp.2021.21090944.
Adversity early in life is common and is a major risk factor for the onset of psychopathology. Delineating the neurodevelopmental pathways by which early adversity affects mental health is critical for early risk identification and targeted treatment approaches. A rapidly growing cross-species literature has facilitated advances in identifying the mechanisms linking adversity with psychopathology, specific dimensions of adversity and timing-related factors that differentially relate to outcomes, and protective factors that buffer against the effects of adversity. Yet, vast complexity and heterogeneity in early environments and neurodevelopmental trajectories contribute to the challenges of understanding risk and resilience in the context of early adversity. In this overview, the author highlights progress in four major areas-mechanisms, heterogeneity, developmental timing, and protective factors; synthesizes key challenges; and provides recommendations for future research that can facilitate progress in the field. Translation across species and ongoing refinement of conceptual models have strong potential to inform prevention and intervention strategies that can reduce the immense burden of psychopathology associated with early adversity.
人生早期的逆境很常见,是精神病理学发病的主要风险因素。描绘早期逆境影响心理健康的神经发育途径对于早期风险识别和有针对性的治疗方法至关重要。大量跨物种的文献促进了确定将逆境与精神病理学、逆境的具体维度以及与结果相关的时间相关因素联系起来的机制的进展,以及缓冲逆境影响的保护因素。然而,早期环境和神经发育轨迹的巨大复杂性和异质性导致了在早期逆境背景下理解风险和复原力的挑战。在这篇综述中,作者强调了四个主要领域的进展——机制、异质性、发展时间和保护因素;综合了关键挑战;并为未来的研究提供了建议,这将有助于该领域的进展。跨物种的翻译和概念模型的不断完善具有很大的潜力,可以为预防和干预策略提供信息,这些策略可以减轻与早期逆境相关的巨大精神病理学负担。