检验多层次因素是否能保护多受侵害儿童在成年早期免受精神病理学影响:一项纵向队列研究。

Testing whether multi-level factors protect poly-victimised children against psychopathology in early adulthood: a longitudinal cohort study.

机构信息

Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.

Department of Psychology and Neuroscience, Duke University, Durham, NC, USA.

出版信息

Epidemiol Psychiatr Sci. 2024 Nov 5;33:e58. doi: 10.1017/S2045796024000660.

Abstract

AIMS

Exposure to multiple forms of victimisation in childhood (often referred to as poly-victimisation) has lifelong adverse effects, including an elevated risk of early-adulthood psychopathology. However, not all poly-victimised children develop mental health difficulties and identifying what protects them could inform preventive interventions. The present study investigated whether individual-, family- and/or community-level factors were associated with lower levels of general psychopathology at age 18, among children exposed to poly-victimisation. Additionally, it examined whether these factors were specific to poly-victimised children or also associated with fewer mental health difficulties in young adults regardless of whether they had been poly-victimised.

METHODS

We used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative cohort of 2,232 children born in 1994-1995 across England and Wales and followed to 18 years of age (with 93% retention, n = 2,066). Poly-victimisation (i.e., exposure to two or more of physical abuse, sexual abuse, emotional abuse and neglect, physical neglect, bullying by peers, and domestic violence) and nine putative protective factors (intelligence quotient, executive functioning, temperament, maternal and sibling warmth, atmosphere at home, maternal monitoring, neighbourhood social cohesion, and presence of a supportive adult) were measured prospectively between ages 5 and 12 years from interviews with mothers and children, surveys of neighbours, child-protection referrals, and researchers' observations. Early-adulthood psychopathology was assessed in interviews with each twin at age 18 and used to construct a latent factor of general psychopathology.

RESULTS

Approximately a third (n = 720) of participants were prospectively defined as exposed to poly-victimisation (53% male). Poly-victimised children had greater levels of general psychopathology at age 18 than non-poly-victimised children (adjusted [adj.] β = 4.80; 95% confidence interval [95% CI] 3.13, 6.47). Presence of a supportive adult was the only factor robustly associated with lower levels of general psychopathology among poly-victimised children (adj.β = -0.61; 95% CI -0.99, -0.23). However, this association was also evident in the whole sample regardless of poly-victimisation exposure (adj.β = -0.52; 95% CI -0.81, -0.24) and no significant interaction was observed between the presence of a supportive adult and poly-victimisation in relation to age-18 general psychopathology.

CONCLUSIONS

Having at least one adult to turn to for support was found to be associated with less psychopathology in early adulthood among both poly-victimised and non-poly-victimised children. This suggests that strategies to promote better availability and utilisation of supportive adults should be implemented universally. However, it may be beneficial to target these interventions at poly-victimised children, given their higher burden of psychopathology in early adulthood.

摘要

目的

儿童时期遭受多种形式的伤害(通常称为多受虐)会产生终身的不良影响,包括成年早期精神病理学风险增加。然而,并非所有遭受多受虐的儿童都会出现心理健康问题,确定哪些因素可以保护他们可以为预防干预措施提供信息。本研究调查了在儿童时期遭受多受虐的情况下,个体、家庭和/或社区层面的因素是否与 18 岁时的一般精神病理学水平较低有关。此外,它还研究了这些因素是否仅与多受虐儿童有关,或者是否与无论是否遭受过多受虐的年轻成年人的心理健康问题较少有关。

方法

我们使用了来自环境风险(E-Risk)纵向双胞胎研究的数据,这是一项具有代表性的英格兰和威尔士 1994-1995 年出生的 2232 名儿童的队列研究,并随访至 18 岁(保留率为 93%,n=2066)。多受虐(即遭受身体虐待、性虐待、情感虐待和忽视、身体忽视、同龄人欺凌和家庭暴力)和九个假定的保护因素(智商、执行功能、气质、母亲和兄弟姐妹的温暖、家庭氛围、母亲监测、邻里社会凝聚力和支持性成年人的存在)在 5 至 12 岁之间通过母亲和儿童的访谈、邻居调查、儿童保护转介和研究人员的观察进行前瞻性测量。在每个双胞胎 18 岁时的访谈中评估成年早期的精神病理学,并用于构建一般精神病理学的潜在因素。

结果

大约三分之一(n=720)的参与者被前瞻性定义为遭受多受虐(53%为男性)。与非多受虐儿童相比,多受虐儿童在 18 岁时的一般精神病理学水平更高(调整后[adj.]β=4.80;95%置信区间[95%CI]3.13,6.47)。有一个支持性成年人是多受虐儿童中与较低一般精神病理学水平相关的唯一因素(adj.β=-0.61;95%CI-0.99,-0.23)。然而,这种关联在整个样本中也很明显,无论是否存在多受虐暴露(adj.β=-0.52;95%CI-0.81,-0.24),并且在成年早期一般精神病理学方面没有观察到支持性成年人的存在与多受虐之间的显著相互作用。

结论

研究发现,对于多受虐和非多受虐的儿童来说,至少有一个可以寻求支持的成年人与成年早期较少的精神病理学有关。这表明应该普遍实施促进更好地提供和利用支持性成年人的策略。然而,鉴于多受虐儿童在成年早期的精神病理学负担更高,针对这些干预措施可能是有益的。

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