Am J Epidemiol. 2022 Mar 24;191(4):655-664. doi: 10.1093/aje/kwab275.
Toxic stress caused by child maltreatment can lead to adverse mental health outcomes in later life, yet unmeasured confounding has been a major issue in many previous studies. To examine the association between child maltreatment and resilience and behavior problems among early elementary school-age children, we used data from a population-based longitudinal survey targeting all first-grade children in 2015 in Adachi City, a ward in Tokyo, Japan. Children whose caregivers provided valid responses during the 2015 (first grade; ages 6-7 years), 2016 (second grade; ages 7-8 years), and 2018 (fourth grade; ages 9-10 years) waves of the study were included in the analysis (n = 2,920). Fixed-effects regression models revealed that child maltreatment was inversely associated with resilience (β = -0.89, 95% confidence interval (CI): -1.05, -0.72) and prosocial behavior (β = -0.03, 95% CI: -0.05, -0.003) and positively associated with behavior problems (β = 0.32, 95% CI: 0.27, 0.37) over 4 years of follow-up (2015-2018), after controlling for all time-invariant confounders and measured time-varying confounders and survey year. These associations were consistent across sex. Child maltreatment may hamper the development of resilience and prosocial behavior and induce behavior problems in early elementary school children over time. Future researchers should identify modifiable protective factors for better mental health among maltreated children.
儿童虐待导致的毒性应激可能会导致日后出现不良心理健康结局，但在许多先前的研究中，未测量的混杂因素一直是一个主要问题。为了研究儿童虐待与小学低年级儿童的适应力和行为问题之间的关联，我们使用了 2015 年在日本东京足立区针对所有一年级儿童进行的一项基于人群的纵向调查的数据。在研究的 2015 年（一年级；年龄 6-7 岁）、2016 年（二年级；年龄 7-8 岁）和 2018 年（四年级；年龄 9-10 岁）这三个波次中，有有效回复的儿童照料者的数据被纳入分析（n=2920）。固定效应回归模型显示，儿童虐待与适应力（β=-0.89，95%置信区间（CI）：-1.05，-0.72）和亲社会行为（β=-0.03，95%CI：-0.05，-0.003）呈负相关，与行为问题呈正相关（β=0.32，95%CI：0.27，0.37），随访时间为 4 年（2015-2018 年），在控制所有时间不变的混杂因素和测量的时变混杂因素以及调查年份后。这些关联在性别之间是一致的。儿童虐待可能会阻碍小学低年级儿童适应力和亲社会行为的发展，并随着时间的推移导致行为问题。未来的研究人员应该确定可改变的保护因素，以改善受虐待儿童的心理健康。
