College of Public Health, University of South Florida, Tampa, FL, USA.
Child Abuse Negl. 2023 Mar;137:106034. doi: 10.1016/j.chiabu.2023.106034. Epub 2023 Jan 25.
Adverse childhood experiences (ACEs) are potentially traumatic experiences that occur before age 18. ACEs are linked to depression in adulthood, but little is known about the association between ACEs and depression trajectories across the lifespan.
To examine the association between specific types of ACEs, cumulative ACE scores, and depression trajectories from adolescence to adulthood.
Waves 1-4 of the National Longitudinal Study of Adolescent to Adult Health (N = 12,888), spanning ages 12 years to 43 years.
We constructed trajectories of depression scores using a modified 9-item Center for Epidemiologic Studies Depression Scale (CES-D-9). We used weighted logistic regression to calculate odds ratios and confidence intervals for each ACE and ACE score and depression trajectories after adjusting for confounders.
We found 75.3 % experienced at least one ACE and 14.7 % experienced 4+ ACEs. We identified three CES-D-9 trajectories: consistently low (Group 1), decreasing (Group 2), and increasing (Group 3) depression scores. All types of abuse, neglect, and community violence were significantly associated with trajectory Groups 2 and 3 vs 1 (p < .05). Foster home placement, poverty, and parental incarceration were associated with Group 2 vs 1. ACE scores showed a dose-response association with Group 3 vs 1 [aORs for 1ACE = 1.43 (0.93-2.20); 2-3ACEs = 1.97 (1.30-3.00); 4+ACEs = 3.08 (1.86-5.09)], and Group 2 vs 1 [aORs for 1ACE = 1.26 (0.87-1.83); 2-3ACEs = 1.93 (1.36-2.74); 4+ACES = 2.70 (1.90-3.84)].
ACEs can have a lasting impact on depression through adulthood, highlighting the need to mitigate their impact to prevent depression-associated morbidity and mortality.
不良的童年经历（ACEs）是指 18 岁之前发生的潜在创伤性经历。ACEs 与成年人的抑郁有关，但人们对 ACEs 与整个生命周期的抑郁轨迹之间的关系知之甚少。
研究特定类型的 ACEs、累积 ACE 评分与青少年至成年期抑郁轨迹之间的关系。
国家青少年至成人健康纵向研究（N=12888）的第 1-4 波次，年龄在 12 岁至 43 岁之间。
我们使用改良的 9 项中心流行病学研究抑郁量表（CES-D-9）构建抑郁评分轨迹。我们使用加权逻辑回归来计算每个 ACE 和 ACE 评分以及调整混杂因素后的抑郁轨迹的优势比和置信区间。
我们发现 75.3%的人经历过至少一种 ACE，14.7%的人经历过 4 种以上 ACE。我们确定了三种 CES-D-9 轨迹：持续低度（第 1 组）、逐渐下降（第 2 组）和逐渐升高（第 3 组）的抑郁评分。所有类型的虐待、忽视和社区暴力与第 2 组和第 3 组与第 1 组相比均显著相关（p<.05）。寄养家庭安置、贫困和父母监禁与第 2 组与第 1 组相关。ACE 评分与第 3 组与第 1 组呈剂量反应关系[aOR 为 1ACE=1.43（0.93-2.20）；2-3ACEs=1.97（1.30-3.00）；4+ACEs=3.08（1.86-5.09）]，与第 2 组与第 1 组相比[aOR 为 1ACE=1.26（0.87-1.83）；2-3ACEs=1.93（1.36-2.74）；4+ACES=2.70（1.90-3.84）]。
ACEs 可以对成年后的抑郁产生持久影响，这突出表明需要减轻其影响以预防与抑郁相关的发病率和死亡率。
