Syed Shabeer, Howe Laura D, Lacey Rebecca E, Deighton Jessica, Qummer Ul Arfeen Muhammad, Feder Gene, Gilbert Ruth
Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.
Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK.
Lancet Public Health. 2025 Feb;10(2):e111-e123. doi: 10.1016/S2468-2667(24)00301-3.
Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. We aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.
We derived a population-based birth cohort in England using linked electronic health records for first-time mothers (aged 14-55 years) with their children (born 2002-18). We followed up the cohort from 1 year before birth up to 18 years after birth across the Clinical Practice Research Datalink GOLD and Aurum databases (primary care), Hospital Episode Statistics (secondary care), and the Office of National Statistics (death registrations) between April 1, 2001, and March 31, 2020. We included six different ACE domains, including child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment, in the records of the mother or the firstborn in the first 1000 days. The primary outcome was the number of children (aged 5-18 years) with recorded mental health problems per mother. We used adjusted and weighted negative binomial regression models to estimate incidence rate ratios.
Of 333 048 firstborns and their mothers, 123 573 (37·1%) had any ACEs between 1 year before and 2 years after birth, and 65 941 (19·8%) of all mothers had at least one child with a mental health problem between ages 5 years and 18 years (median follow-up 11·4 years [IQR 9·2-14·1]). Mothers with firstborns with ACEs had 1·71 (95% CI 1·68-1·73) times as many children in total with mental health problems (mean 29·8 children per 100 mothers, 29·4-30·1) compared with mothers without firstborns with ACEs (mean 17·4 children per 100 mothers, 17·3-17·6), translating into a mean difference of 12·3 (95% CI 11·9-12·7) additional children with mental health problems per 100 mothers. These mothers also had increased incidence rates of children with all-cause emergency admissions and mental health-related contacts. There was no significant difference in the risk of mental health problems between firstborn and later-born children.
ACEs in firstborns during the first 1000 days were associated with increased mental health problems and health-care needs in multiple children in the same family. The findings highlight the importance of early identification of vulnerable first-time parents and firstborns and increased policy focus on sustained support beyond the first 1000 days to promote healthier long-term family outcomes. Future evaluations of interventions should include the health outcomes of multiple children within families.
NIHR Policy Research Programme.
童年不良经历（ACEs）往往会影响家庭中的多个孩子，但研究往往侧重于单个孩子的健康结果，低估了受影响家庭的需求。我们旨在研究出生前1年至出生后2年（最初1000天）暴露于ACEs的头胎子女与同一母亲的多个孩子出现心理健康问题、与心理健康相关的医疗接触以及全因住院风险之间的关联，并与未暴露于ACEs的头胎子女进行比较。
我们利用首次生育母亲（年龄在14 - 55岁之间）及其子女（2002 - 2018年出生）的关联电子健康记录，在英格兰建立了一个基于人群的出生队列。我们在2001年4月1日至2020年3月31日期间，通过临床实践研究数据链黄金数据库和奥鲁姆数据库（初级保健）、医院事件统计（二级保健）以及国家统计局（死亡登记），对该队列从出生前1年至出生后18年进行随访。我们在母亲或头胎子女最初1000天的记录中纳入了六个不同的ACE领域，包括儿童虐待、亲密伴侣暴力、母亲药物滥用、母亲心理健康问题、不良家庭环境以及儿童虐待的高风险表现。主要结局是每位母亲记录有心理健康问题的5至18岁儿童的数量。我们使用调整后的加权负二项回归模型来估计发病率比。
在333048名头胎子女及其母亲中，123573名（37.1%）在出生前1年至出生后2年有任何ACEs，在所有母亲中，65941名（19.8%）在其孩子5岁至18岁之间至少有一个孩子出现心理健康问题（中位随访时间11.4年[四分位间距9.2 - 14.1]）。头胎子女暴露于ACEs的母亲，其出现心理健康问题的孩子总数是未暴露于ACEs的头胎子女母亲的1.71倍（95%置信区间1.68 - 1.73）（平均每100名母亲有29.8个孩子，29.4 - 30.1），而未暴露于ACEs的头胎子女母亲平均每100名母亲有17.4个孩子（17.3 - 17.6），这意味着每100名母亲中出现心理健康问题的孩子平均多12.3个（95%置信区间11.9 - 12.7）。这些母亲的孩子全因急诊入院和与心理健康相关接触的发病率也有所增加。头胎子女和后出生子女出现心理健康问题的风险没有显著差异。
头胎子女在最初1000天内暴露于ACEs与同一家庭中多个孩子心理健康问题增加和医疗需求增加有关。研究结果凸显了早期识别脆弱的初为人父母者和头胎子女的重要性，以及政策应更多关注在最初1000天之后提供持续支持，以促进更健康的长期家庭结局。未来对干预措施的评估应包括家庭中多个孩子的健康结果。
英国国家卫生研究院政策研究项目。
