Bailey Megan, Fairchild Graeme, Hammerton Gemma, Bauer Andreas, Carpena Marina X, Murray Joseph, Santos Ina S, Barros Aluísio J D, Tovo-Rodrigues Luciana, Danese Andrea, Halligan Sarah L, Matijasevich Alicia
Department of Psychology, University of Bath, Bath, UK.
Department of Psychology, University of Bath, Bath, UK.
Lancet Glob Health. 2025 Feb;13(2):e309-e318. doi: 10.1016/S2214-109X(24)00452-2.
The mental health consequences of exposure to childhood trauma have been little studied among adolescents in low-income and-middle-income countries (LMICs), despite a relatively high burden of trauma in LMIC populations. We investigated associations between trauma and adolescent psychiatric disorders in the 2004 Pelotas Birth Cohort, Brazil.
In the 2004 Pelotas Birth Cohort, current psychiatric diagnoses (anxiety, mood, attention-hyperactivity, and conduct-oppositional disorders) were assessed at age 15 years (caregiver-report Development and Well-being Assessment), and age 18 years (self-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver report up to age 11 years and combined self-report and caregiver-report thereafter. Exposure to 12 trauma types were assessed (serious accident, fire, other disaster, attack or threat, physical abuse, sexual abuse, witnessed domestic violence, witnessed attack, witnessed accident, heard about attack, heard about accident, and parental death). Due to the high prevalence of trauma exposure in the sample, the number of different types of trauma exposure reported was extracted as a proxy for cumulative trauma load. We assessed both cross-sectional and longitudinal associations between cumulative trauma load and psychiatric disorders during adolescence using logistic regression, adjusting for confounders and pre-existing child psychopathology at 48 months. We also computed population attributable fractions (PAFs) for trauma-mental health associations at age 18 years.
4229 adolescents (51·9% male, 48·1% female) were included in logistic regression analyses based on imputed data. Trauma exposure affected 81·2% of adolescents by age 18 years. At age 15 years, the odds of any disorder (adjusted odds ratio [aOR] 1·19 [95% CI 1·03-1·38]), anxiety disorders (1·45 [1·21-1·75]), and conduct-oppositional disorders (1·60 [1·13-2·27]) increased for each category increase in cumulative trauma, but mood and attention-hyperactivity disorders were not related to cumulative trauma. At age 18 years, the odds of any disorder (1·34 [1·24-1·44]), anxiety disorders (1·23 [1·13-1·34]), mood disorders (1·33 [1·22-1·46]), attention-hyperactivity disorders (1·24 [1·09-1·41]), and conduct-oppositional disorders (1·59 [1·36-1·86]) all increased for each category increase in cumulative trauma. In longitudinal analyses, each category increase in cumulative trauma by age 11 years was associated with an increased odds of any disorder (aOR 1·26 [95% CI 1·11-1·44]), anxiety disorders (1·27 [1·04-1·56]), and conduct-oppositional disorders (1·43 [1·04-1·97]) at 15 years; and trauma up to age 15 years was associated with increased odds of any disorder (1·32 [1·21-1·45]), anxiety disorders (1·27 [1·14-1·40]), mood disorders (1·26 [1·12-1·41]), and conduct-oppositional disorders (1·52 [1·24-1·87]) at age 18 years. Trauma up to age 11 years was not predictive of disorders at age 18 years, and there were no longitudinal associations between trauma and attention-hyperactivity disorders. PAF estimates indicated that trauma exposure accounted for 30·6% (95% CI 21·2-38·7) of psychiatric disorders at age 18 years.
Increasing exposure to trauma is associated with mental disorders among Brazilian adolescents. Given the high prevalence of trauma in LMIC populations, strategies to reduce exposure, identify those at greatest risk of mental disorders following trauma, and mitigate the consequences are crucial.
Wellcome Trust, WHO, National Support Program for Centers of Excellence, Brazilian National Research Council, Brazilian Ministry of Health, Children's Pastorate, São Paulo Research Foundation, Rio Grande do Sul Research Foundation, L'Oréal-Unesco-ABC Program for Women in Science in Brazil-2020, All for Health Institute, University of Bath, Economic and Social Sciences Research Council.
For the Portuguese translation of the abstract see Supplementary Materials section.
尽管低收入和中等收入国家（LMICs）人群遭受创伤的负担相对较高，但在这些国家的青少年中，童年创伤对心理健康的影响鲜有研究。我们在巴西2004年佩洛塔斯出生队列中调查了创伤与青少年精神障碍之间的关联。
在2004年佩洛塔斯出生队列中，分别在15岁（由照料者报告的发育与幸福评估）和18岁（自我报告的迷你国际神经精神病学访谈）时评估当前的精神疾病诊断（焦虑、情绪、注意力多动和品行对立违抗障碍）。通过照料者报告评估11岁之前的终生累积创伤，之后结合自我报告和照料者报告进行评估。评估了12种创伤类型的暴露情况（严重事故、火灾、其他灾难、攻击或威胁、身体虐待、性虐待、目睹家庭暴力、目睹攻击、目睹事故、听说攻击、听说事故和父母死亡）。由于样本中创伤暴露的患病率较高，将报告的不同类型创伤暴露的数量作为累积创伤负荷的替代指标。我们使用逻辑回归评估了累积创伤负荷与青少年期精神障碍之间的横断面和纵向关联，并对混杂因素和48个月时已存在的儿童精神病理学进行了调整。我们还计算了18岁时创伤与心理健康关联的人群归因分数（PAF）。
基于插补数据，共有4229名青少年（51.9%为男性，48.1%为女性）纳入逻辑回归分析。到18岁时，81.2%的青少年曾遭受创伤暴露。在15岁时，累积创伤每增加一个类别，任何障碍（调整优势比[aOR]为1.19[95%CI 1.03 - 1.38]）、焦虑障碍（1.
