Department of Global Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, M&D Tower 16F 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8510, Japan.
Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage Ward, Chiba 263-8522, Japan; Department of Gerontological Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Obu City, Aichi 474-8511, Japan.
Child Abuse Negl. 2023 Oct;144:106340. doi: 10.1016/j.chiabu.2023.106340. Epub 2023 Jul 17.
Marital status is a well-known social determinant of health. Adverse childhood experiences (ACEs) affect attachment, critical to establishing and maintaining intimate relationships, such as marital status.
This study examined the association between ACEs and marital status among older Japanese adults.
This research used data from a nationwide population-based study among functionally independent people aged 65 and above in Japan.
ACEs were assessed by self-reported questionnaires on the following experiences before 18 years old: parental death, parental divorce, parental mental disease, exposure to intimate partner violence, physical abuse, psychological neglect, psychological abuse, and poverty. Marital status was asked as currently having a spouse (including common-law marriage), widowed, divorced, or unmarried. Associations between the total number of ACEs and marital status were analyzed by multinomial logistic regression.
Three or more ACEs showed higher risks of being widowed, divorced, or unmarried. Psychological neglect led to higher divorce risks among males (RRR, 95%CI = 1.41, 1.13-1.76) and females (RRR, 95%CI = 1.56, 1.28-1.89). Childhood poverty showed higher risks of unmarried among males (RRR, 95%CI = 1.25, 1.02-1.53) and females (RRR, 95%CI = 1.41, 1.18-1.69). Association between ACEs and divorce risks showed gender differences (RRR, 95%CI of having three or more ACEs in males: 2.19, 1.66-2.90; in females: 3.45, 2.71-4.38; p for interaction = 0.034).
ACEs showed higher risks of being widowed, divorced, and unmarried among older Japanese people. Policy to tackle ACEs and research investigating how ACEs, attachment, and relationship quality influence marital status are required to promote well-being in later life.
婚姻状况是健康的一个众所周知的社会决定因素。不良的童年经历（ACEs）会影响依恋，而依恋对建立和维持亲密关系至关重要，如婚姻状况。
本研究调查了 ACEs 与日本老年成年人婚姻状况之间的关系。
本研究使用了一项全国性的基于人群的研究数据，该研究对象为日本功能独立的 65 岁及以上老年人。
通过自我报告问卷评估 ACEs，内容包括 18 岁前的以下经历：父母死亡、父母离婚、父母精神疾病、亲密伴侣暴力、身体虐待、心理忽视、心理虐待和贫困。婚姻状况的询问方式为目前是否有配偶（包括事实婚姻）、丧偶、离婚或未婚。通过多项逻辑回归分析 ACEs 总数与婚姻状况之间的关系。
有 3 项或更多 ACEs 的人丧偶、离婚或未婚的风险较高。心理忽视导致男性（RRR，95%CI=1.41，1.13-1.76）和女性（RRR，95%CI=1.56，1.28-1.89）离婚风险增加。童年贫困导致男性（RRR，95%CI=1.25，1.02-1.53）和女性（RRR，95%CI=1.41，1.18-1.69）未婚风险增加。ACEs 与离婚风险之间的关系存在性别差异（RRR，男性有 3 项或更多 ACEs 的 95%CI：2.19，1.66-2.90；女性：3.45，2.71-4.38；交互作用 p 值=0.034）。
ACEs 使日本老年人丧偶、离婚和未婚的风险增加。需要制定解决 ACEs 的政策，并研究 ACEs、依恋和关系质量如何影响婚姻状况，以促进晚年的幸福感。
