Liu Jianlin, Abdin Edimansyah, Vaingankar Janhavi Ajit, Verma Swapna, Tang Charmaine, Subramaniam Mythily
Research Division, Institute of Mental Health, Singapore.
Research Division, Institute of Mental Health, Singapore.
J Affect Disord. 2022 Apr 15;303:24-30. doi: 10.1016/j.jad.2022.01.112. Epub 2022 Feb 1.
Adverse childhood experiences (ACE) vary across culture and their heterogenous impact on health outcomes is understudied. The present population-based study determined latent classes of adverse childhood experiences, examined socio-demographic variations between identified classes, and elucidated the interactions between class membership and protective resources (i.e., positive mental health and perceived social support) on high-risk behaviors (i.e., smoking, binge drinking, and suicidality), chronic physical disorders, and mental disorders.
A total of 4441 adult Singapore residents were recruited from the community. Lifetime mental disorders and suicidality were assessed on structured clinical interviews by trained interviewers, while chronic physical disorders, smoking, binge drinking, ACE, perceived social support, and positive mental health were self-reported.
Latent class analysis identified three distinct profiles; a multiple adversities class endorsing elevated levels of abuse and violence (6.1%), an emotionally neglected and bullied class (7.6%), and a low adversities class (86.2%). The multiple adversities class was associated with younger age, female gender, lower education status, more high-risk behaviors (e.g. binge drinking and suicidality), and physical/mental disorders. A three-way interaction was observed between ACE profiles, social support, and positive mental health on suicidality; high social support and positive mental health reduced the risk of suicidality in the multiple adversities class.
Results may not be generalizable beyond the Singapore population due to cultural factors.
Clinical assessment should adopt a person-centered approach to identify profiles of ACE and determine their interactions with protective resources on high-risk behaviors and physical/mental disorders; patient-tailored treatment may subsequently build upon these profiles.
童年不良经历（ACE）在不同文化中存在差异，且其对健康结果的异质性影响尚未得到充分研究。本基于人群的研究确定了童年不良经历的潜在类别，研究了已识别类别之间的社会人口统计学差异，并阐明了类别归属与保护资源（即积极的心理健康和感知到的社会支持）在高危行为（即吸烟、暴饮和自杀倾向）、慢性身体疾病和精神障碍方面的相互作用。
从社区招募了总共4441名成年新加坡居民。由训练有素的访谈员通过结构化临床访谈评估终生精神障碍和自杀倾向，而慢性身体疾病、吸烟、暴饮、ACE、感知到的社会支持和积极的心理健康则通过自我报告。
潜在类别分析确定了三种不同的类型；一个多重逆境类型，认可较高水平的虐待和暴力（6.1%），一个情感上被忽视和受欺凌的类型（7.6%），以及一个低逆境类型（86.2%）。多重逆境类型与较年轻的年龄、女性、较低的教育程度、更多的高危行为（如暴饮和自杀倾向）以及身体/精神障碍相关。在ACE类型、社会支持和积极的心理健康对自杀倾向的影响方面观察到三方相互作用；高社会支持和积极的心理健康降低了多重逆境类型中的自杀倾向风险。
由于文化因素，结果可能不适用于新加坡人群之外的其他人群。
临床评估应采用以患者为中心的方法来识别ACE类型，并确定它们在高危行为和身体/精神障碍方面与保护资源的相互作用；随后可基于这些类型进行针对患者的治疗。
