Xu Peilin, Liu Zhaorui, Xu Yifeng, Li Tao, Xu Guangming, Xu Xiangdong, Wang Limin, Yan Yongping, Xiao Shuiyuan, Li Lingjiang, Zhang Tingting, Yan Jie, Yu Yaqin, Xu Xiufeng, Wang Zhizhong, Wang Bo, Guo Wanjun, Huang Yueqin
Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100091, China.
Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China.
Lancet Reg Health West Pac. 2024 Dec 5;53:101253. doi: 10.1016/j.lanwpc.2024.101253. eCollection 2024 Dec.
Adverse childhood experiences (ACEs) are common and associated with mental disorders. However, the prevalence and co-occurrence of ACEs and their association with mental health outcomes among Chinese adults have not been well demonstrated.
China Mental Health Survey, a cross-sectional nationally representative survey consisting of 28,140 adults, was conducted from July 2013 to March 2015. Twelve ACEs and mental health outcomes, including mood disorder, anxiety disorder, substance-use disorder, and suicide were measured using the Composite International Diagnostic Interview (CIDI) 3.0 in a weighted representative subsample of 9378 respondents. Latent class analysis was used to identify the co-occurrence profiles of ACEs, and logistic regression was applied to examine the association between ACEs and mental health outcomes. Population-attributable fractions (PAFs) were calculated to quantify the attribution of ACEs to these outcomes.
Among the 9378 respondents, the weighted count (proportion) of females was 4642 (49.5%), with a weighted mean (SD) age of 43.0 (15.8) years. In this study, 27.1% of respondents showed at least one ACE, with multiple ACEs common (37.6%) among those affected. Neglect was the most prevalent ACE (11.3%), followed by physical abuse (9.1%). Latent class analysis identified four co-occurrence profiles: low risk of ACEs, maltreatment, caregiver's maladjustment and parental loss. The strongest association with mental health outcomes was found in the caregiver's maladjustment group (OR, 4.9; 95% CI, 3.2-7.6). Estimates of PAFs indicated that all ACEs together explained 39.4% (95% CI, 31.3%-47.4%) of observed mental health outcomes. Gender differences were noted in prevalence and associations with outcomes.
ACEs are highly prevalent and interrelated in China, attributing to over one-third of the mental disorder burden. In resource-limited settings, prioritizing the reduction of the most prevalent and impactful ACEs through education and policy can more effectively alleviate the disease burden.
The National Twelfth Five-Year Plan for Science and Technology Support from the Chinese Ministry of Science and Technology (grant numbers 2012BAI01B01 & 2015BAI13B00), and the National Key R&D Program of China (grant numbers 2017YFC0907800 and 2017YFC0907801).
童年不良经历（ACEs）很常见，且与精神障碍有关。然而，中国成年人中ACEs的患病率、共现情况及其与心理健康结局的关联尚未得到充分证实。
中国精神卫生调查是一项具有全国代表性的横断面调查，于2013年7月至2015年3月进行，共纳入28140名成年人。在9378名具有代表性的加权受访者子样本中，使用复合国际诊断访谈（CIDI）3.0对12种ACEs和心理健康结局进行测量，包括情绪障碍、焦虑障碍、物质使用障碍和自杀。采用潜在类别分析确定ACEs的共现模式，并应用逻辑回归分析ACEs与心理健康结局之间的关联。计算人群归因分数（PAFs）以量化ACEs对这些结局的归因。
在9378名受访者中，女性的加权计数（比例）为4642名（49.5%），加权平均（标准差）年龄为43.0（15.8）岁。在本研究中，27.1%的受访者至少经历过一次ACEs，在受影响者中多种ACEs很常见（37.6%）。忽视是最常见的ACEs（11.3%），其次是身体虐待（9.1%）。潜在类别分析确定了四种共现模式：ACEs低风险、虐待、照顾者适应不良和父母丧失。在照顾者适应不良组中发现与心理健康结局的关联最强（比值比，4.9；95%置信区间，3.2 - 7.6）。PAFs估计表明，所有ACEs共同解释了观察到的心理健康结局的39.4%（95%置信区间，31.3% - 47.4%）。在患病率和与结局的关联方面存在性别差异。
ACEs在中国高度流行且相互关联，导致超过三分之一的精神障碍负担。在资源有限的环境中，通过教育和政策优先减少最常见且影响最大的ACEs可以更有效地减轻疾病负担。
中国科学技术部国家十二五科技支撑计划（资助编号2012BAI01B01 & 2015BAI13B00），以及中国国家重点研发计划（资助编号2017YFC0907800和2017YFC0907801）。
