Finlay Sabine, Adegboye Oyelola, McDermott Brett, Rudd Donna, Sarnyai Zoltán
Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; College of Medicine and Dentistry, James Cook University, Queensland, Australia.
Menzies, School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia.
Psychoneuroendocrinology. 2025 Feb;172:107276. doi: 10.1016/j.psyneuen.2024.107276. Epub 2024 Dec 31.
It has been well-established that the allostatic load (AL) index, a cumulative score of multi-system dysregulation in response to chronic stress, is significantly increased at the time of a psychiatric diagnosis. However, no studies have investigated if there is an association between the AL index in childhood and the later development of mental health symptoms in young adults.
Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population cohort from Bristol, United Kingdom, we investigated the AL index at age 9 years and the risks for mental health symptoms at age 24 years. We used multinomial logistic regression analysis to investigate the association between AL threshold (categorised into bottom third: AL index ≤ 7, middle third: AL index = 7.1-9.9, and top third: AL index ≥ 10) and mental health symptoms while adjusting for sex, the age of mother at delivery, and social class. We used a relative risk ratio (RRR) and 95 % confidence interval(CI) for each variable. We further investigated the association between adverse childhood experiences (ACEs) and mental health symptoms.
We identified a significant association between sex and mental health symptoms, with more females (59 % vs 41 %) showing mental health symptoms than males. We found no direct association between the AL index at age 9 and the later development of mental health symptoms. However, an RRR analysis showed that individuals in the middle and the top third of the AL index had an RRR of 1.99 and 2.20, respectively, to develop mental health symptoms if they were females. We found that individuals who experienced ACE had a much higher risk of developing mental health symptoms as young adults, with the adjusted RRR of 5.39 (95 % CI: 3.00;9.67), 6.79 (95 % CI: 2.55; 18.1), and 2.10 (95 % CI: 0.37;11.8) for neglect, physical and sexual abuse, respectively, in individuals with mood disorder symptoms. The adjusted RRR for neglect and physical and sexual abuse in individuals with psychotic symptoms was 0.99 (95 % CI: 0.37; 2.59), 2.92 (95 % CI: 0.35; 24.4), and 10.5 (95 % CI: 0.99; 112), respectively.
Although the AL index in childhood was not directly associated with the later development of psychotic and mood disorder symptoms in this cohort, females in the higher tertiles of the AL index measured at 9 years of age had an elevated risk of mental health symptoms as young adults. In line with previous work, a strong association was identified between childhood adversity and mental health symptoms in young adulthood. These results highlight the importance of considering the impact of early stress on biological embedding and the later emergence of mental health problems, especially in females.
已有充分证据表明，应激负荷（AL）指数作为对慢性应激反应的多系统失调累积评分，在精神疾病诊断时显著升高。然而，尚无研究调查儿童期的AL指数与青年期心理健康症状的后期发展之间是否存在关联。
利用来自英国布里斯托尔的人群队列“埃文亲子纵向研究”（ALSPAC）的数据，我们调查了9岁时的AL指数和24岁时心理健康症状的风险。我们使用多项逻辑回归分析来研究AL阈值（分为底部三分之一：AL指数≤7，中间三分之一：AL指数=7.1 - 9.9，顶部三分之一：AL指数≥10）与心理健康症状之间的关联，同时对性别、母亲分娩时的年龄和社会阶层进行了调整。我们为每个变量使用了相对风险比（RRR）和95%置信区间（CI）。我们进一步研究了童年不良经历（ACEs）与心理健康症状之间的关联。
我们发现性别与心理健康症状之间存在显著关联，出现心理健康症状的女性（59%对41%）比男性更多。我们发现9岁时的AL指数与心理健康症状的后期发展之间没有直接关联。然而，RRR分析表明，AL指数处于中间和顶部三分之一的个体，如果是女性，出现心理健康症状的RRR分别为1.99和2.20。我们发现经历过ACE的个体在青年期出现心理健康症状的风险要高得多，在有情绪障碍症状的个体中，忽视、身体虐待和性虐待的调整后RRR分别为5.39（95%CI：3.00；9.67）、6.79（95%CI：2.55；18.1）和2.10（95%CI：0.37；11.8）。在有精神病症状的个体中，忽视、身体虐待和性虐待的调整后RRR分别为0.99（95%CI：0.37；2.59）、2.92（95%CI：0.35；24.4）和10.5（95%CI：0.99；112）。
尽管在该队列中儿童期的AL指数与精神病和情绪障碍症状的后期发展没有直接关联，但9岁时AL指数处于较高三分位数的女性在青年期出现心理健康症状的风险升高。与之前的研究一致，我们发现童年逆境与青年期心理健康症状之间存在密切关联。这些结果凸显了考虑早期应激对生物嵌入以及后期心理健康问题出现的影响的重要性，尤其是在女性中。
