Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm, Ulm, Germany; University Psychiatric Hospitals, Child and Adolescent Psychiatric Research Department (UPKKJ), University of Basel, Basel, Switzerland.
Department of Child and Adolescent Psychiatry/Psychotherapy, University Ulm, Ulm, Germany.
Child Abuse Negl. 2023 Oct;144:106382. doi: 10.1016/j.chiabu.2023.106382. Epub 2023 Jul 30.
Adverse childhood experiences (ACEs) are highly prevalent and increase the risk for long-term adverse health outcomes. Next to well-known ACE-associated risks for morbidity, recent research is increasingly invested in exploring pathways towards health, overall functioning, and partaking in society following early adversity.
Thus, this study aims to assess the association between latent classes of ACEs with perceived social participation and health-related Quality of Life (QoL) in a large population-based sample and to explore potential moderators of these associations.
A representative sample of the German population (N = 2531; M = 48.7; 51 % women) was cross-sectionally investigated for ACEs, social participation (KsT-5), and health-related QoL (EuroQol-5D-5L). Latent Class Analysis (LCA) was performed to derive groups with similar ACE patterns. Multiple regression analyses were used to investigate the association of latent classes of ACEs with social participation and health-related QoL and to explore potential moderators.
Four distinct latent classes of ACEs were identified; "no/low ACEs" (N = 1968, 77.8 %); "household-dysfunction" (N = 259, 10.2 %), "child abuse and neglect" (N = 188, 7.4 %), and "polyadversity" (N = 116, 4.6 %). Compared to participants in the no/low ACE class, those in the ACE-exposed classes showed overall lower levels of perceived social participation and health-related QoL. The polyadversity class showed lower levels of social participation compared to the two other ACE-exposed classes. Chronic stress, living with a partner, education, current job/educational involvement, and gender were found to moderate these associations in exploratory analyses.
This study shows people exposed to ACEs to have a higher risk for lower perceived social participation and lower health-related QoL - an increased risk, however, is not a deterministic uninventable fortune. Reduction of chronic stress, fostering of social support, and educational and vocational paths as interventional targets are discussed to enable those with precarious starting conditions to partake in society.
不良的童年经历（ACEs）普遍存在，并增加了长期不良健康后果的风险。除了众所周知的与发病风险相关的 ACE 之外，最近的研究越来越多地致力于探索在早期逆境之后，健康、整体功能和参与社会的途径。
因此，本研究旨在评估在一个大型基于人群的样本中，ACEs 的潜在类别与感知社会参与和健康相关生活质量（QoL）之间的关联，并探讨这些关联的潜在调节因素。
对德国人群的代表性样本（N=2531；M=48.7；51%为女性）进行横断面调查，以了解 ACEs、社会参与（KsT-5）和健康相关 QoL（EuroQol-5D-5L）。进行潜在类别分析（LCA）以得出具有相似 ACE 模式的组。使用多元回归分析来研究 ACE 潜在类别与社会参与和健康相关 QoL 的关联，并探讨潜在的调节因素。
确定了四个不同的 ACE 潜在类别；“无/低 ACEs”（N=1968，77.8%）；“家庭功能障碍”（N=259，10.2%），“儿童虐待和忽视”（N=188，7.4%）和“多逆境”（N=116，4.6%）。与无/低 ACE 类别的参与者相比，暴露于 ACE 的参与者的感知社会参与度和健康相关 QoL 总体较低。与其他两个 ACE 暴露类别的参与者相比，多逆境类别的社会参与度较低。在探索性分析中，发现慢性应激、与伴侣同住、教育程度、当前工作/教育参与以及性别调节了这些关联。
本研究表明，暴露于 ACE 的人面临着较低的感知社会参与度和较低的健康相关 QoL 的更高风险——但这种风险并不是不可避免的命中注定。讨论减少慢性应激、培养社会支持以及教育和职业途径作为干预目标，以帮助那些处于不稳定起点的人参与社会。
