The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Am J Prev Med. 2022 Sep;63(3):331-340. doi: 10.1016/j.amepre.2022.03.016. Epub 2022 May 4.
Childhood adversities are risk factors for subsequent mental health problems. Research commonly focuses on adverse childhood experiences, despite evidence that other exposures, such as neighborhood violence or peer victimization, co-occur with adverse childhood experiences and are associated with similar mental health outcomes. This study explored the clustering of these exposures and examined the associations with mental health.
Data were a nationally representative sample of U.S. children aged 10-17 years (N=1,959), collected in 2013-2014. Latent class analysis was conducted on 22 types of childhood adversity. Regression models examined associations with mental health and substance use. These secondary analyses were conducted in 2021.
A total of 5 classes were identified: Low all (59% of the sample), Abuse (29%), High multiple adversities (5%), Peer adversity (4%), and Neighborhood violence (4%). All classes had poorer mental health and a higher prevalence of substance use than Low all, with particularly harmful levels in High multiple adversities. Neighborhood violence was not significantly different from High multiple adversities on mental health symptoms and showed a greater proportion of past-year substance use than all other classes except High multiple adversities. Peer adversity and Abuse classes did not differ significantly in any outcomes.
Findings highlight the particularly deleterious impact of neighborhood violence and highly co-occurring adversity types on mental health and substance use. It is important to extend our conceptualization of adverse childhood experiences to include peer adversity and neighborhood violence and shift from a siloed approach to examining all these exposures.
童年逆境是随后心理健康问题的风险因素。尽管有证据表明，其他暴露因素，如邻里暴力或同伴受害，与不良的童年经历同时发生，并与类似的心理健康结果相关，但研究通常侧重于不良的童年经历。本研究探讨了这些暴露因素的聚类，并研究了它们与心理健康的关联。
数据来自 2013-2014 年美国年龄在 10-17 岁的儿童（n=1959）的全国代表性样本。对 22 种儿童逆境进行潜在类别分析。回归模型检验了与心理健康和物质使用的关联。这些二次分析于 2021 年进行。
共确定了 5 个类别：低所有（样本的 59%）、虐待（29%）、高多种逆境（5%）、同伴逆境（4%）和邻里暴力（4%）。所有类别都比低所有类别表现出更差的心理健康状况和更高的物质使用发生率，其中高多种逆境类别尤为严重。邻里暴力在心理健康症状方面与高多种逆境没有显著差异，在过去一年的物质使用比例方面，除了高多种逆境之外，与其他所有类别都有显著差异。同伴逆境和虐待类别在任何结果上都没有显著差异。
研究结果强调了邻里暴力和高度共同发生的逆境类型对心理健康和物质使用的特别有害影响。重要的是要将我们对不良童年经历的概念扩展到包括同伴逆境和邻里暴力，并从检查所有这些暴露因素的孤立方法转变。
