University of California, Irvine, Irvine, California.
Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California; Institute for Addiction Science, University of Southern California, Los Angeles, California.
Am J Prev Med. 2024 Sep;67(3):397-406. doi: 10.1016/j.amepre.2024.04.013. Epub 2024 Apr 30.
Racial/ethnic differences exist in the prevalence of adverse childhood experiences (ACEs). However, few studies have examined racial/ethnic differences in the association between ACEs and poor mental health outcomes in young adulthood.
Data on 10 self-reported, recalled ACEs (prior to age 18) and current symptoms of depression, anxiety, post-traumatic stress disorder, and sleep problems in early adulthood were collected from 2,020 young adults (age 20-23 years) between January and June 2021 enrolled in a Southern California prospective community-based cohort. Logistic regression models run in 2022-2023 evaluated the association of cumulative (0, 1, 2, 3, 4+ ACEs), grouped (abuse, neglect, household dysfunction), and individual ACE exposure with mental health outcomes; interaction models tested for differences by race/ethnicity.
All ACE exposures (cumulative, grouped, individual ACEs) were associated with increased odds of most mental health symptoms. Significant differences by race/ethnicity emerged for individual and grouped (but not cumulative) ACEs. For example, associations of any abuse-related ACE and emotional and physical abuse with depressive symptoms were greater for Hispanic participants than for those of another race/ethnicity. Further, associations of emotional abuse with sleep problems were greater for Hispanic participants than for Asian American and Pacific Islander participants (interaction ps<0.05). Though not significant, the association of familial incarceration with depression symptoms was higher for AAPI participants than for other racial/ethnic groups (interaction p-value=0.06).
Evaluation of individual and grouped ACEs reveals important racial/ethnic heterogeneity in associations with mental health outcomes. Findings have implications for targeted prevention efforts for racial/ethnic groups at higher risk for poor mental health.
在不良童年经历（ACEs）的发生率方面存在种族/民族差异。然而，很少有研究探讨 ACEs 与年轻人期不良心理健康结局之间的关联存在种族/民族差异。
2022 年至 2023 年，我们从 2021 年 1 月至 6 月参加南加州前瞻性社区为基础队列的 2020 名年轻人（年龄 20-23 岁）中收集了 10 项自我报告的、回忆性的 ACEs（18 岁之前）和成年早期抑郁、焦虑、创伤后应激障碍和睡眠问题的当前症状数据。逻辑回归模型评估了累积（0、1、2、3、4+ ACEs）、分组（虐待、忽视、家庭功能障碍）和个体 ACE 暴露与心理健康结局的关联；交互模型测试了种族/民族差异。
所有 ACE 暴露（累积、分组、个体 ACEs）与大多数心理健康症状的发生风险增加有关。种族/民族差异显著的是个体和分组（但不是累积）ACEs。例如，任何与虐待有关的 ACE 和情感与身体虐待与抑郁症状的关联在西班牙裔参与者中比在其他种族/民族参与者中更大。此外，情感虐待与睡眠问题的关联在西班牙裔参与者中比在亚裔美国人和太平洋岛民参与者中更大（交互 p 值<0.05）。尽管没有统计学意义，但家族监禁与抑郁症状的关联在亚裔美国人中比在其他种族/民族群体中更高（交互 p 值=0.06）。
评估个体和分组 ACEs 揭示了与心理健康结局相关的重要种族/民族异质性。研究结果对针对心理健康较差风险较高的种族/民族的有针对性预防工作具有重要意义。
