School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
Harvard T.H. Chan School of Public Health, Boston, MA, USA.
BMC Psychiatry. 2023 Aug 10;23(1):581. doi: 10.1186/s12888-023-05085-0.
Adverse childhood experiences and adult trauma, including sexual abuse, physical abuse, neglect, and interpersonal violence, are highly prevalent in low-resource settings and associated with adverse psychological outcomes. However, there is limited focus on the impact of ACEs and trauma on mental health in sub-Saharan Africa. Therefore, this study examines the impact of traumatic events and ACEs on depression, anxiety, and stress scores among outpatients receiving psychiatric care at two public mental health treatment facilities in Johannesburg, South Africa.
A sample of 309 participants were recruited between January and June 2022 at Helen Joseph Hospital and Alexandra 18th Avenue Clinic. Participants completed screening measures for mental health outcomes, including the 9-item Patient Health Questionnaire (PHQ-9), the 7-item General Anxiety Disorder scale (GAD-7) and the 10-item Perceived Stress Scale. We fitted modified Poisson and linear regression models to estimate the impact of ACEs and adult experiences of trauma on depression, anxiety, and stress scale scores.
47.57% (n = 147) of participants screened positive for anxiety, 44.66% (n = 138) for depression, and 17% (n = 54) for severe stress. More females screened positive for anxiety (65.31%), depression (65.94%), and stress (77.78%). Each ACE was associated with a 12% increased risk of depression, a 10% increased risk of anxiety, and a 17% increased risk of stress. In separately estimated models, each additional traumatic event during adulthood was associated with a 16% increased risk for depression, an 8% increased risk of anxiety, and a 26% increased risk of stress. Across all models, being male and self-reported physical health were consistently associated with a reduced risk for depression, anxiety, and stress.
ACEs and experiences of traumatic events as adults were associated with significantly increased risks of anxiety, depression, and severe stress. Given high exposure to ACEs and trauma and the associated impact on the mental health of individuals, families, and communities, there is a need to strengthen and scale innovative combination interventions that address multiple stressors impacting people in low-resource settings.
在资源匮乏的环境中，儿童时期的不良经历和成人创伤（包括性虐待、身体虐待、忽视和人际暴力）非常普遍，并且与不良心理后果相关。然而，针对撒哈拉以南非洲地区 ACE 与创伤对心理健康的影响，关注程度有限。因此，本研究旨在探讨创伤事件和 ACE 对南非约翰内斯堡两家公立精神卫生治疗机构的门诊患者的抑郁、焦虑和压力评分的影响。
本研究于 2022 年 1 月至 6 月在海伦·约瑟夫医院和亚历山德拉 18 号大街诊所招募了 309 名参与者。参与者完成了心理健康结果的筛查措施，包括 9 项患者健康问卷（PHQ-9）、7 项广泛性焦虑障碍量表（GAD-7）和 10 项感知压力量表。我们使用修正泊松回归和线性回归模型来估计 ACE 和成人创伤经历对抑郁、焦虑和压力评分的影响。
47.57%（n=147）的参与者筛查出焦虑阳性，44.66%（n=138）的参与者筛查出抑郁阳性，17%（n=54）的参与者筛查出严重压力阳性。女性在焦虑（65.31%）、抑郁（65.94%）和压力（77.78%）方面的筛查阳性率更高。每一项 ACE 都与抑郁风险增加 12%、焦虑风险增加 10%和压力风险增加 17%相关。在单独估计的模型中，成年期每增加一次创伤性事件，抑郁风险增加 16%，焦虑风险增加 8%，压力风险增加 26%。在所有模型中，男性和自我报告的身体健康状况与抑郁、焦虑和压力的风险降低相关。
ACE 和成年期的创伤经历与焦虑、抑郁和严重压力的风险显著增加相关。鉴于 ACE 和创伤的高暴露率以及对个人、家庭和社区心理健康的影响，需要加强和扩大创新的综合干预措施，以解决影响资源匮乏环境下人群的多种压力源。
