Abate Biruk Beletew, Sendekie Ashenafi Kibret, Merchaw Abebe, Abebe Gebremeskel Kibret, Azmeraw Molla, Alamaw Addis Wondmagegn, Zemariam Alemu Birara, Kitaw Tegene Atamenta, Kassaw Amare, Wodaynew Tilahun, Kassie Ayelign Mengesha, Yilak Gizachew, Kassa Mulat Awoke
School of Population Health, Curtin University, Bentley, Washington, Australia.
College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.
Neuropsychobiology. 2025;84(1):48-64. doi: 10.1159/000542392. Epub 2024 Nov 18.
Evidence suggested a link between early adversity and mental health problems. However, it is unclear how much adverse childhood experiences (ACEs) contribute to mental health problems because researchers have produced inconsistent findings. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the effect of ACEs on the development of mental health problems later in life in the global context.
PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar which reported the effect of ACEs on the development of mental health problems was searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.
Forty-three SRM with 14,707,614 study participants were included. The pooled effect of ACEs on the development of mental health problems later in life in the global context is found to be (AOR = 1.66 [1.46, 1.87]). Subgroup analysis based on country revealed (AOR = 1.67 [1.23, 2.11]) in UK, (AOR = 0.61 [0.41, 0.81]) in Canada, (AOR = 1.55 [1.40, 1.69]) in Brazil, (AOR = 5.65 [4.12, 7.18]) in Ethiopia, (AOR = 1.92 [1.45, 2.38]) in USA, (AOR = 2.30 [1.89, 2.72]) in Australia, and (AOR = 1.66 [1.46, 1.87]) in Ireland. While subgroup analysis based on types of adverse childhood adverse experience: domestic violence (AOR = 4.13 [1.96, 6.30]), maltreatment (AOR = 1.5 [0.79, 2.21]), physical abuse (AOR = 1.56 [1.43, 1.63]), sexual abuse (AOR = 2.07 [1.63, 2.51]), child abuse (AOR = 5.66 [4.12, 7.18]), parental mental health problem (AOR = 1.73 [1.39, 2.08]), bullying (AOR = 1.99 [1.69, 2.29], neglect (AOR = 2.11 [1.53, 2.69]), and parental divorce (AOR = 1.66 [1.46, 1.87]). Based on the type of mental health problem, the pooled effect size is 1.87 (1.45, 2.30) for depression and 1.67 (1.22, 2.13) for anxiety.
This umbrella review revealed that ACE is significantly associated (with 66% increased risk) with anxiety and depression later in life in a global context. This association is most noticeable when one is subjected to domestic violence, maltreatment, physical abuse, sexual abuse, child abuse, parental mental health problems, bullying, neglect, and parental divorce. Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures. Preventing childhood maltreatment and addressing psychiatric risk factors can prevent psychopathology. Longitudinal studies are needed to optimize healthcare responses to ACEs. Increased awareness and public health interventions are needed to prevent childhood adversity and prevent mental problems among these victims. To optimize healthcare responses to unfavorable outcomes of childhood adversities, longitudinal and intervention research findings, more public health initiatives, and awareness are required.
有证据表明早期逆境与心理健康问题之间存在联系。然而，目前尚不清楚童年不良经历（ACEs）对心理健康问题的影响程度，因为研究人员得出的结果并不一致。因此，本系统综述的目的是在全球范围内整合关于ACEs对晚年心理健康问题发展影响的相互矛盾的数据。
检索了PubMed、Embase、Scopus、Web of Sciences、Cochrane系统评价数据库、Scopus和谷歌学术，这些数据库报告了ACEs对心理健康问题发展的影响。使用多系统评价评估（AMSTAR）对纳入研究的质量进行评估。应用加权逆方差随机效应模型来计算合并估计值。还评估了亚组分析、异质性、发表偏倚和敏感性分析。
纳入了43项系统综述，涉及14,707,614名研究参与者。发现在全球范围内，ACEs对晚年心理健康问题发展的合并效应为（优势比[AOR]=1.66[1.46,1.87]）。基于国家的亚组分析显示，英国为（AOR=1.67[1.23,2.11]），加拿大为（AOR=0.61[0.41,0.81]），巴西为（AOR=1.55[1.40,1.69]），埃塞俄比亚为（AOR=5.65[4.12,7.18]），美国为（AOR=1.92[1.45,2.38]），澳大利亚为（AOR=2.30[1.89,2.72]），爱尔兰为（AOR=1.66[1.46,1.87]）。基于童年不良经历类型的亚组分析：家庭暴力（AOR=4.13[1.96,6.30]）、虐待（AOR=1.5[0.79,2.21]）、身体虐待（AOR=1.56[1.43,1.63]）、性虐待（AOR=2.07[1.63,2.51]）、儿童虐待（AOR=5.66[4.12,7.18]）、父母心理健康问题（AOR=1.73[1.39,2.08]）、欺凌（AOR=1.99[1.69,2.29]）、忽视（AOR=2.11[1.53,2.69]）以及父母离异（AOR=1.66[1.46,1.87]）。基于心理健康问题类型，抑郁症的合并效应量为1.87（1.45,2.30），焦虑症的合并效应量为1.67（1.22,2.13）。
本系统综述表明，在全球范围内，ACEs与晚年的焦虑和抑郁显著相关（风险增加66%）。当一个人遭受家庭暴力、虐待、身体虐待、性虐待、儿童虐待、父母心理健康问题、欺凌、忽视和父母离异时，这种关联最为明显。童年时期是降低未来患精神疾病风险和实施干预措施的关键机会窗口。预防儿童虐待并解决精神疾病风险因素可以预防精神病理学问题。需要进行纵向研究以优化对ACEs的医疗应对措施。需要提高认识并开展公共卫生干预措施，以预防儿童期逆境并预防这些受害者中的精神问题。为了优化对儿童期逆境不利后果的医疗应对措施，需要纵向和干预研究结果、更多的公共卫生举措以及认识。
