Venkatesan Umesh M, Juengst Shannon B
Jefferson Moss Rehabilitation Research Institute, Elkins Park, PA, USA; Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
TIRR Memorial Hermann, Houston, TX, USA; Department of Physical Medicine and Rehabilitation, UT Health Sciences Center at Houston, Houston, TX, USA.
Disabil Health J. 2025 Jan;18(1):101714. doi: 10.1016/j.dhjo.2024.101714. Epub 2024 Oct 9.
Adverse childhood experiences (ACEs) confer greater risk for adult traumatic brain injury (TBI), but little is known about their effects on post-injury outcomes.
To determine the prevalence and correlates of conventionally defined ACEs (occurring within household/in private; e.g., physical abuse) and community-level ACEs (e.g., bullying) after TBI.
Participants were 85 Philadelphia-area TBI Model System participants with chronic (>1 year post-injury) TBI. We examined cross-sectional associations between total conventional and community ACEs reported (out of 21) before age 18, mental health symptoms, and health-related quality of life (HRQoL), as well as relationships between ACEs and neighborhood deprivation (census-derived neighborhood socioeconomic status).
The median number of total ACEs was 3 (range: 0-17). Emotional abuse, physical abuse, and alcohol abuse in the household were the most common conventional ACEs (each at 36.5 %). Witnessing violence (45 %) was the most common community ACE. Black individuals (n = 32) reported more community ACEs (p < .001) than White individuals (n = 45). Community ACEs were significantly associated with greater neighborhood deprivation, though this relationship was confounded by race. Total ACEs was significantly related to more severe mental health symptoms (p < .001) and poorer HRQoL (p = .005), even after covariate adjustment. A fully-adjusted path model supported mental health as a mediator between total ACEs and HRQoL.
Results of this preliminary study reveal an appreciable prevalence and potential far-reaching consequences of conventional and community ACEs among those with chronic TBI. The results underscore the value of trauma-informed and life course approaches to research and clinical care in TBI.
童年不良经历（ACEs）会增加成人创伤性脑损伤（TBI）的风险，但对其对损伤后结局的影响知之甚少。
确定创伤性脑损伤（TBI）后传统定义的ACEs（发生在家庭/私人环境中；例如，身体虐待）和社区层面的ACEs（例如，欺凌）的患病率及其相关因素。
研究对象为85名费城地区创伤性脑损伤模型系统的慢性创伤性脑损伤（损伤后>1年）参与者。我们研究了18岁之前报告的传统和社区ACEs总数（共21项）、心理健康症状、与健康相关的生活质量（HRQoL）之间的横断面关联，以及ACEs与邻里贫困（根据人口普查得出的邻里社会经济地位）之间的关系。
ACEs总数的中位数为3（范围：0-17）。家庭中的情感虐待、身体虐待和酒精滥用是最常见的传统ACEs（均为36.5%）。目睹暴力（45%）是最常见的社区ACE。黑人个体（n = 32）报告的社区ACEs比白人个体（n = 45）更多（p <.001）。社区ACEs与更高程度的邻里贫困显著相关，尽管这种关系因种族而混淆。即使在进行协变量调整后，ACEs总数仍与更严重的心理健康症状（p <.001）和更差的HRQoL（p =.005）显著相关。一个完全调整的路径模型支持心理健康作为ACEs总数和HRQoL之间的中介。
这项初步研究的结果揭示了慢性创伤性脑损伤患者中传统和社区ACEs的相当高的患病率及其潜在的深远后果。结果强调了创伤知情和生命历程方法在创伤性脑损伤研究和临床护理中的价值。
