Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Public Health, Guangzhou Huangpu District Center for Disease Control and Prevention, Guangzhou, People's Republic of China.
Eur J Psychotraumatol. 2023;14(2):2218248. doi: 10.1080/20008066.2023.2218248.
The influence of adverse childhood experiences (ACEs) on an individual's health is substantial. However, the associations between ACEs, problematic internet use (PIU), and health-related quality of life (HRQOL) in adolescents remain underexplored. To assess the association between ACEs and HRQOL in Chinese adolescents and to evaluate the mediating role of PIU in this association. A sample of 6,639 adolescents (3,457 boys and 3,182 girls) aged between 11-20 years (mean [SD] age: 14.5 [1.6] years) were recruited from 6 junior and senior middle schools using a proportional sampling approach in a cross-sectional study. Data on ACE exposure was collected through the short form of Childhood Trauma Questionnaire, the ACE-International Questionnaire, and two additional questions. HRQOL was assessed by the Pediatric Quality of Life Inventory version 4.0. The associations between ACEs and HRQOL were estimated using linear regression models. Mediation analysis was further conducted to explore the possible mediating role of PIU in the association between ACEs and HRQOL. Our study collected 13 different ACEs. We found that adolescents exposed to any ACE had significantly lower scores in all HRQOL dimensions, psychosocial health summary scale, and total scale, than those without such exposure. Specifically, adolescents with ≥ 3 ACE exposure had a total scale score that was 14.70 (95%CI: 15.53 to 13.87) points lower than their non-exposed counterparts. Mediation analysis identified PIU as a significant mediator, with the proportion of the total effect attributable to PIU ranging from 14.38% for social functioning to 17.44% for physical functioning. Exposure to ACEs was associated with poorer HRQOL in Chinese adolescents, underscoring the importance to prevent ACEs and their negative impacts on adolescent well-being. These findings also highlighted the need of promoting appropriate internet use among adolescents exposed to ACEs, in order to avert potential impairment in their HRQOL.Adolescents with adverse childhood experiences have poorer health-related quality of life.The association between adverse childhood experiences and health-related quality of life shows a dose-response pattern.Problematic internet use partially mediates the associations between adverse childhood experiences and health-related quality of life in adolescents.
童年逆境（ACE）对个体健康的影响是巨大的。然而，ACE、网络成瘾（PIU）与青少年健康相关生活质量（HRQOL）之间的关联在青少年群体中仍未得到充分探索。本研究旨在评估 ACE 与中国青少年 HRQOL 之间的关联，并评估 PIU 在这种关联中的中介作用。采用横断面研究，采用比例抽样法，从 6 所初中和高中招募了 6639 名 11-20 岁（平均[标准差]年龄：14.5[1.6]岁）的青少年。通过简短的童年创伤问卷、ACE-国际问卷和另外两个问题收集 ACE 暴露数据。采用儿科生活质量量表 4.0 评估 HRQOL。采用线性回归模型估计 ACE 与 HRQOL 之间的关联。进一步进行中介分析，以探讨 PIU 在 ACE 与 HRQOL 之间关联中的可能中介作用。本研究共收集了 13 种 ACE。我们发现，暴露于任何 ACE 的青少年在所有 HRQOL 维度、心理社会健康综合量表和总分上的得分均显著低于无 ACE 暴露的青少年。具体而言，暴露于≥3 种 ACE 的青少年总分比无 ACE 暴露的青少年低 14.70（95%CI：15.53 至 13.87）分。中介分析确定 PIU 为显著的中介变量，PIU 对总效应的归因比例范围从社会功能的 14.38%到身体功能的 17.44%。在中国青少年中，ACE 暴露与较差的 HRQOL 相关，这突显了预防 ACE 及其对青少年幸福感的负面影响的重要性。这些发现还强调了在 ACE 暴露的青少年中促进适当使用互联网的必要性，以避免潜在的 HRQOL 受损。
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