Adjei Nicholas Kofi, Schlüter Daniela K, Straatmann Viviane S, Melis Gabriella, Fleming Kate M, McGovern Ruth, Howard Louise M, Kaner Eileen, Wolfe Ingrid, Taylor-Robinson David C
Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom.
Department of Public Health Sciences, Stockholm University, Stockholm Sweden.
Lancet Reg Health Eur. 2021 Nov 30;13:100279. doi: 10.1016/j.lanepe.2021.100279. eCollection 2022 Feb.
Children exposed to poverty and family adversities including domestic violence, parental mental ill health and parental alcohol misuse may experience poor outcomes across the life course. However, the complex interrelationships between these exposures in childhood are unclear. We therefore assessed the clustering of trajectories of household poverty and family adversities and their impacts on adolescent health outcomes.
We used longitudinal data from the UK Millennium Cohort study on 11564 children followed to age 14 years. Family adversities included parent reported domestic violence and abuse, poor mental health and frequent alcohol use. We used a group-based multi-trajectory cluster model to identify trajectories of poverty and family adversity for children. We assessed associations of these trajectories with child physical, mental and behavioural outcomes at age 14 years using multivariable logistic regression, adjusting for confounders.
Six trajectories were identified: low poverty and family adversity (43·2%), persistent parental alcohol use (7·7%), persistent domestic violence and abuse (3·4%), persistent poor parental mental health (11·9%), persistent poverty (22·6%) and persistent poverty and poor parental mental health (11·1%). Compared with children exposed to low poverty and adversity, children in the persistent adversity trajectory groups experienced worse outcomes; those exposed to persistent poor parental mental health and poverty were particularly at increased risk of socioemotional behavioural problems (adjusted odds ratio 6·4; 95% CI 5·0 - 8·3), cognitive disability (aOR 2·1; CI 1·5 - 2·8), drug experimentation (aOR 2·8; CI 1·8 - 4·2) and obesity (aOR 1·8; CI 1·3 - 2·5).
In a contemporary UK cohort, persistent poverty and/or persistent poor parental mental health affects over four in ten children. The combination of both affects one in ten children and is strongly associated with adverse child outcomes, particularly poor child mental health.
The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London (ARC South London) at King's College Hospital NHS Foundation Trust and the Medical Research Council (MRC).
经历贫困以及包括家庭暴力、父母心理健康问题和父母酗酒在内的家庭困境的儿童，在其一生可能会有不良后果。然而，童年时期这些经历之间复杂的相互关系尚不清楚。因此，我们评估了家庭贫困轨迹和家庭困境的聚类情况及其对青少年健康结果的影响。
我们使用了英国千禧队列研究的纵向数据，该研究跟踪了11564名儿童至14岁。家庭困境包括家长报告的家庭暴力和虐待、心理健康不佳以及频繁饮酒。我们使用基于群体的多轨迹聚类模型来确定儿童的贫困轨迹和家庭困境轨迹。我们使用多变量逻辑回归评估这些轨迹与14岁儿童的身体、心理和行为结果之间的关联，并对混杂因素进行了调整。
确定了六种轨迹：低贫困和家庭困境（43.2%）、父母持续酗酒（7.7%）、持续的家庭暴力和虐待（3.4%）、父母持续心理健康不佳（11.9%）、持续贫困（22.6%）以及持续贫困和父母心理健康不佳（11.1%）。与经历低贫困和困境的儿童相比，处于持续困境轨迹组的儿童有更差的结果；那些经历父母持续心理健康不佳和贫困的儿童尤其面临社会情感行为问题（调整后的优势比为6.4；95%置信区间5.0 - 8.3）、认知残疾（aOR 2.1；CI 1.5 - 2.8）、药物试验（aOR 2.8；CI 1.8 - 4.2）和肥胖（aOR 1.8；CI 1.3 - 2.5）风险的增加。
在当代英国队列中，持续贫困和/或父母持续心理健康不佳影响超过十分之四的儿童。两者的结合影响十分之一的儿童，并与不良儿童结果密切相关，尤其是儿童心理健康不佳。
国家卫生研究院（NIHR）政策研究计划、国王学院医院国民保健服务信托基金的NIHR南伦敦应用研究合作组织（ARC南伦敦）以及医学研究理事会（MRC）。
