David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Pediatrics. 2023 Jul 1;152(1). doi: 10.1542/peds.2022-060951.
Adverse childhood experiences (ACEs) can drive poor adult mental and physical health, but the impact of early life protective factors should not be overlooked. Positive childhood experiences (PCEs) measures quantify protective factors, but evidence is lacking on their link to health conditions independent of ACEs in nationally representative studies. This study examines associations between composite PCE score and adult health, adjusting for ACEs.
The most recent 2017 wave of the Panel Study of Income Dynamics, a nationally representative study and its 2014 Childhood Retrospective Circumstances supplement (n = 7496) collected adult health outcomes, PCEs, and ACEs. Multivariable logistic regression assessed associations between PCE score and adult self-rated health or condition diagnosis, with and without ACEs adjustment. Cox proportional hazards models examined relationships between PCEs, ACEs, and annual risk of diagnosis.
Adults with 5 to 6 PCEs had 75% (95% confidence interval [CI], 0.58-0.93) of the risk of fair/poor overall health and 74% of the risk of any psychiatric diagnosis (CI, 0.59-0.89) compared with those with 0 to 2 PCEs, independent of ACEs. In survival analysis models accounting for PCEs and ACEs, reporting 5 to 6 PCEs was associated with a 16% lower annual hazard of developing any adult psychiatric or physical condition (hazard ratio, 0.84; CI, 0.75-0.94); reporting 3+ ACEs was associated with a 42% higher annual hazard (CI, 1.27-1.59).
PCEs were independently associated with lower risks of fair or poor adult health, adult mental health problems, and developing any physical or mental health condition at any given age after adjusting for ACEs.
童年逆境经历（ACEs）可能导致成年人心理健康和身体健康状况不佳，但不应忽视早期生活保护因素的影响。积极的童年经历（PCEs）测量量化了保护因素，但在全国代表性研究中，缺乏关于它们与 ACEs 无关的健康状况之间关联的证据。本研究通过调整 ACEs，检验了综合 PCE 评分与成年人健康之间的关联。
收入动态面板研究（Panel Study of Income Dynamics）的最新 2017 年波次及其 2014 年儿童回溯情况补充调查（n=7496）收集了成年人健康结果、PCEs 和 ACEs。多变量逻辑回归评估了 PCE 评分与成年人自评健康或疾病诊断之间的关联，同时调整和不调整 ACEs。Cox 比例风险模型检验了 PCEs、ACEs 与每年诊断风险之间的关系。
与拥有 0 至 2 个 PCEs 的成年人相比，拥有 5 至 6 个 PCEs 的成年人总体健康状况为“差/差”的风险降低了 75%（95%置信区间[CI]，0.58-0.93），任何精神科诊断的风险降低了 74%（CI，0.59-0.89），独立于 ACEs。在考虑了 PCEs 和 ACEs 的生存分析模型中，报告拥有 5 至 6 个 PCEs 与每年发生任何成年精神或身体疾病的风险降低 16%相关（风险比，0.84；CI，0.75-0.94）；报告 3 个以上 ACEs 与每年发生的风险增加 42%相关（CI，1.27-1.59）。
在调整 ACEs 后，PCEs 与较差的成年健康、成年心理健康问题以及在任何特定年龄发生任何身体或心理健康状况的风险降低独立相关。
