Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK.
Children and Young People's Mental Health Research Collaboration, University of Exeter Medical School, Exeter, UK.
J Child Psychol Psychiatry. 2024 Oct;65(10):1369-1387. doi: 10.1111/jcpp.13986. Epub 2024 Apr 13.
Adverse childhood experiences (ACEs) are well-established risk factors for self-harm and depression. However, despite their high comorbidity, there has been little focus on the impact of developmental timing and the duration of exposure to ACEs on co-occurring self-harm and depression.
Data were utilised from over 22,000 children and adolescents participating in three UK cohorts, followed up longitudinally for 14-18 years: the Avon Longitudinal Study of Parents and Children (ALSPAC), the Millennium Cohort Study (MCS) and the Environmental Risk (E-Risk) Longitudinal Twin Study. Multinomial logistic regression models estimated associations between each ACE type and a four-category outcome: no self-harm or depression, self-harm alone, depression alone and self-harm with co-occurring depression. A structured life course modelling approach was used to examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of ACEs) had the strongest effects on self-harm and depression in adolescence.
The majority of ACEs were associated with co-occurring self-harm and depression, with consistent findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and across cohorts. For parental mental health problems, longer duration of exposure was strongly associated with co-occurring self-harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI: 1.10-1.25) and MCS (1.18, 1.11-1.26) cohorts. For other ACEs in ALSPAC, exposure in middle childhood was most strongly associated with co-occurring self-harm and depression, and ACE occurrence in early childhood and adolescence was more important in the MCS.
Efforts to mitigate the impact of ACEs should start in early life with continued support throughout childhood, to prevent long-term exposure to ACEs contributing to risk of self-harm and depression in adolescence.
不良的童年经历（ACEs）是自我伤害和抑郁的既定风险因素。然而，尽管它们的共病率很高，但对于 ACEs 的发展时间和暴露持续时间对同时发生的自我伤害和抑郁的影响关注甚少。
利用了来自三个英国队列的 22000 多名儿童和青少年的数据，这些队列进行了长达 14-18 年的纵向随访：雅芳纵向父母和儿童研究（ALSPAC）、千禧年队列研究（MCS）和环境风险（E-Risk）纵向双胞胎研究。多项逻辑回归模型估计了每种 ACE 类型与四类结局之间的关联：无自我伤害或抑郁、仅有自我伤害、仅有抑郁和自我伤害伴同时发生的抑郁。采用结构化的生命历程建模方法，研究了暴露于每种 ACE 的累积（持续时间）或关键时期（ACE 时间）对青春期自我伤害和抑郁的影响是否最强。
大多数 ACEs 与同时发生的自我伤害和抑郁有关，在各个队列中都有一致的发现。ACEs 的时间和持续时间的重要性在 ACEs 之间和队列之间有所不同。对于父母的心理健康问题，在 ALSPAC（调整后的 OR：1.18，95%CI：1.10-1.25）和 MCS（1.18，1.11-1.26）队列中，较长的暴露持续时间与同时发生的自我伤害和抑郁强烈相关。在 ALSPAC 中对于其他 ACEs，童年中期的暴露与同时发生的自我伤害和抑郁最相关，而童年早期和青春期的 ACE 发生在 MCS 中更为重要。
减轻 ACE 影响的努力应从生命早期开始，并在整个儿童期持续提供支持，以防止长期暴露于 ACEs 导致青春期自我伤害和抑郁的风险增加。
