San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92120, USA.
VA San Diego Healthcare System, San Diego, CA 92161, USA.
Mil Med. 2022 Mar 28;187(3-4):304-312. doi: 10.1093/milmed/usab536.
Adverse childhood experiences (ACEs) are associated with poor psychosocial and health outcomes in adulthood. Veterans and females experience ACEs disproportionately. A greater understanding of this disparity may be achieved by examining the relationship between distinct ACE patterns and these demographic characteristics. Therefore, this study examined distinct ACE patterns and their association with Veteran status, sex, and other demographics in a nationally representative sample of U.S. adults to inform interventions tailored to ACE patterns experienced by specific groups.
Latent class analysis (LCA) was conducted with data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative structured diagnostic interview conducted from 2012-2013. The target population was the noninstitutionalized adult population living in the USA. The analytic sample was 36,190 (mean age 46.5 years; 48.1% male). Of these participants, 3,111 were Veterans. Data were analyzed between September 2020 and January 2021.
Latent class analysis revealed a four-class solution: (1) "Low adversity" (75.3%); (2) "Primarily household dysfunction" (9.0%); (3) "Primarily maltreatment" (10.7%); and (4) "Multiple adversity types" (5.1%). Compared to "Low adversity," members in the other classes were more likely to be Veterans (odds ratio (OR)C2vC1 = 1.33, ORC3vC1 = 1.55, ORC4vC1 = 1.98) and female (ORC2vC1 = 1.58, ORC3vC1 = 1.22, ORC4vC1 = 1.65). While lower education and income were also related to higher adversity class membership, Veteran status and sex were the strongest predictors, even when controlling for education and income.
Distinct and meaningful patterns of ACEs identified in this study highlight the need for routine ACE screenings in Veterans and females. As in the current study, operationalizing and clustering ACEs can inform screening measures and trauma-informed interventions in line with personalized medicine. Future work can test if classes are differentially associated with health outcomes.
不良的儿童经历（ACEs）与成年人的心理健康和社会结果不佳有关。退伍军人和女性不成比例地经历 ACEs。通过检查不同 ACE 模式与这些人口统计学特征之间的关系，可以更好地了解这种差异。因此，本研究在全国代表性的美国成年人样本中，通过检查不同 ACE 模式及其与退伍军人身份、性别和其他人口统计学特征之间的关系，来研究不同 ACE 模式及其与退伍军人身份、性别和其他人口统计学特征之间的关系，以便为特定群体经历的 ACE 模式提供有针对性的干预措施。
采用来自全国酒精相关情况流行病学调查-III 的数据进行潜在类别分析（LCA），这是一项全国代表性的结构诊断访谈，于 2012-2013 年进行。目标人群是居住在美国的非机构化成年人口。分析样本为 36190 人（平均年龄 46.5 岁；48.1%为男性）。其中 3111 人为退伍军人。数据于 2020 年 9 月至 2021 年 1 月进行分析。
潜在类别分析显示出四种模式：（1）“低逆境”（75.3%）；（2）“主要家庭功能障碍”（9.0%）；（3）“主要虐待”（10.7%）；（4）“多种逆境类型”（5.1%）。与“低逆境”相比，其他类别的成员更有可能是退伍军人（优势比（OR）C2vC1=1.33，ORC3vC1=1.55，ORC4vC1=1.98）和女性（ORC2vC1=1.58，ORC3vC1=1.22，ORC4vC1=1.65）。虽然较低的教育和收入也与更高的逆境类别的成员有关，但退伍军人身份和性别是最强的预测因素，即使在控制了教育和收入的情况下也是如此。
本研究中确定的不同且有意义的 ACE 模式突出表明，需要对退伍军人和女性进行常规 ACE 筛查。就像在当前的研究中一样，操作化和聚类 ACE 可以根据个性化医疗提供筛查措施和以创伤为中心的干预措施。未来的工作可以测试类是否与健康结果存在差异。
