Chandrasekar Rahul, Karamanos Alexis, Learoyd Annastazia, Khanolkar Amal R
University College London Medical School, London, United Kingdom.
Department of Population Health Sciences, King's College London, London, United Kingdom.
PLoS One. 2024 Dec 11;19(12):e0312161. doi: 10.1371/journal.pone.0312161. eCollection 2024.
This study examined associations between adverse childhood experiences (ACEs) and mental health and health-risk behaviours, including differences by sexual minority (SM) identity. We included 8,686 adolescents (males = 50.7%, SM = 10.3%) from the UK-wide Millennium Cohort Study with data on eight ACEs (e.g., domestic violence, parental psychological distress, bullying) recorded between ages 3-14 and a wide-range of health indicators and health-risk behaviours at age 17. Associations between 1) Sexual identity and ACEs were analysed using multinomial logistic regression and 2) Cumulative ACE scores and all outcomes were analysed using linear/logistic regression (with appropriate interactions assessing differences in ACE-outcome associations by sexual identity and adjusted for sex, ethnicity, and parental income). Results showed SM individuals had a higher prevalence of bullying (33.9% vs. 20.3%) and experiencing ≥3ACEs [Bisexual: RRR 1.87 (95% CI 1.35, 2.57), Gay/Lesbian RRR 2.08 (1.24, 3.48)]. The number of individuals experiencing adverse mental health outcomes increased in relation to greater ACE exposure with evidence for effect-moderation by sexual identity in certain outcomes. For example, among individuals with 0 ACEs, 8% of heterosexual adolescents reported psychological distress vs. 22% in bisexual and 17% in gay/lesbian peers, increasing to 16% in heterosexual vs. 41% in bisexual and 45% in gay/lesbian adolescents with ≥3 ACEs. Similar patterns were observed for other health indicators (e.g., self-harm, suicidality, sleep quality) and health-risk behaviours (e.g., risky sex). Our findings indicate that ACEs are associated (with a gradient) with worse mental health and well-being, and higher risk of some health-risk behaviours. However, the detrimental effect of ACEs on health is worse in SM adolescents compared to heterosexual peers.
本研究调查了童年不良经历（ACEs）与心理健康及健康风险行为之间的关联，包括按性少数群体（SM）身份划分的差异。我们纳入了来自全英千年队列研究的8686名青少年（男性占50.7%，SM占10.3%），这些青少年在3至14岁之间记录了8种ACEs（如家庭暴力、父母心理困扰、欺凌）的数据，以及17岁时的一系列健康指标和健康风险行为数据。1）使用多项逻辑回归分析性取向与ACEs之间的关联，2）使用线性/逻辑回归分析累积ACE得分与所有结果之间的关联（通过适当的交互作用评估按性取向划分的ACE-结果关联差异，并对性别、种族和父母收入进行调整）。结果显示，SM个体遭受欺凌的患病率更高（33.9%对20.3%），且经历≥3种ACEs的情况更多[双性恋者：相对风险率（RRR）为1.87（95%置信区间为1.35，2.57），男同性恋/女同性恋者RRR为2.08（1.24，3.48）]。随着ACE暴露增加，经历不良心理健康结果的个体数量也增加，在某些结果中存在按性取向划分的效应调节证据。例如，在没有ACEs的个体中，8%的异性恋青少年报告有心理困扰，而双性恋青少年为22%，男同性恋/女同性恋青少年为17%；在有≥3种ACEs的青少年中，异性恋青少年的这一比例增至16%，双性恋青少年为41%，男同性恋/女同性恋青少年为45%。在其他健康指标（如自我伤害、自杀倾向、睡眠质量）和健康风险行为（如危险性行为）方面也观察到类似模式。我们的研究结果表明，ACEs与更差的心理健康和幸福感以及某些健康风险行为的更高风险相关（呈梯度关系）。然而，与异性恋同龄人相比，ACEs对SM青少年健康的有害影响更严重。
