Farooq Bushra, Russell Abigail E, Allen Kate, Howe Laura D, Mars Becky
Centre for Academic Mental Health, Population Health Sciences, University of Bristol Medical School, Bristol, UK.
Children and Young People's Mental Health Research Collaboration, University of Exeter Medical School, Exeter, UK.
Eur Child Adolesc Psychiatry. 2025 Jun 6. doi: 10.1007/s00787-025-02781-y.
Adverse childhood experiences (ACEs) elevate the risk of self-harm and depression, which are significant public health concerns. This study examined the association between the longitudinal co-occurrence patterns of ACEs across childhood and adolescence, and self-harm and depression in adolescence and early adulthood. We included 8,859 young people from the Avon Longitudinal Study of Parents and Children (ALSPAC). We examined ten ACEs reported prospectively and retrospectively by parents and children throughout childhood and adolescence, and retrospectively by cohort members in adulthood. Self-harm and depression were self-reported in adolescence (age 16 years) and early adulthood (ages 23 and 24 years). Logistic regression models examined associations between previously derived latent classes of co-occurring ACEs over time, and self-harm and depression. A higher risk of adolescent self-harm was found for each of the latent classes when compared to the Low ACEs reference class (n = 6,380) (Mid-childhood and adolescence ACEsn = 230; adjusted odds ratio (aOR) 1.76, 95% CI 1.11-2.80; Early childhood abuse and parental mental health problemsn = 445; aOR 1.85, 95% CI 1.34-2.56; Persistent parental mental health problemsn = 861; aOR 1.44, 95% CI 1.07-1.94; Early and mid-childhood household disharmonyn = 943; aOR 1.47, 95% CI 1.10-1.97). The association between Persistent parental mental health problems and self-harm persisted in early adulthood (aOR 1.57, 95% CI 1.16-2.12). For adolescent depression, associations were found with the Early childhood abuse and parental mental health problems (aOR 2.89, 95% CI 2.20-3.79), Persistent parental mental health problems (aOR 1.54, 95% CI 1.18-2.01), and Early and mid-childhood household disharmony (aOR 1.36, 95% CI 1.03-1.81) classes when compared to the Low ACEs class. These associations persisted in early adulthood. Early childhood abuse and parental mental health problems (aOR 2.50, 95% CI 1.68-3.73) and Early and mid-childhood household disharmony (aOR 1.58, 95% CI 1.05-2.37) were associated with a higher likelihood of co-occurring self-harm and depression in adolescence. However by early adulthood, only Persistent parental mental health problems were associated with a higher likelihood of co-occurring self-harm and depression (aOR 2.13, 95% CI 1.47-3.10). ACEs occurring throughout childhood and adolescence are associated with a higher risk of adolescent self-harm and both adolescent and early adulthood depression. In contrast, the class most strongly associated with early adult self-harm was Persistent parental mental health problems. Multicomponent interventions and multi-sectoral preventative efforts are needed to address distinct patterns of co-occurring ACEs during childhood and adolescence, to mitigate their short- and long-term impacts on self-harm and depression.
童年不良经历（ACEs）会增加自我伤害和抑郁的风险，这些都是重大的公共卫生问题。本研究调查了童年和青少年时期ACEs的纵向共现模式与青少年期及成年早期的自我伤害和抑郁之间的关联。我们纳入了来自阿冯父母与儿童纵向研究（ALSPAC）的8859名年轻人。我们考察了父母和孩子在整个童年和青少年时期前瞻性和回顾性报告的10种ACEs，以及成年期队列成员的回顾性报告。自我伤害和抑郁情况由青少年（16岁）及成年早期（23岁和24岁）自我报告。逻辑回归模型检验了随时间推移先前得出的ACEs共现潜在类别与自我伤害和抑郁之间的关联。与低ACEs参考类别（n = 6380）相比，每个潜在类别中的青少年自我伤害风险都更高（童年中期和青少年期ACEs，n = 230；调整优势比（aOR）1.76，95%置信区间1.11 - 2.80；幼儿期虐待和父母心理健康问题，n = 445；aOR 1.85，95%置信区间1.34 - 2.56；持续性父母心理健康问题，n = 861；aOR 1.44，95%置信区间1.07 - 1.94；幼儿期和童年中期家庭不和谐，n = 943；aOR 1.47，95%置信区间1.10 - 1.97）。持续性父母心理健康问题与自我伤害之间的关联在成年早期仍然存在（aOR 1.57，95%置信区间1.16 - 2.12）。对于青少年抑郁，与幼儿期虐待和父母心理健康问题（aOR 2.89，95%置信区间2.20 - 3.79）、持续性父母心理健康问题（aOR 1.54，95%置信区间1.18 - 2.01）以及幼儿期和童年中期家庭不和谐（aOR 1.36，95%置信区间1.03 - 1.81）类别相关，与低ACEs类别相比。这些关联在成年早期仍然存在。幼儿期虐待和父母心理健康问题（aOR 2.50，95%置信区间1.68 - 3.73）以及幼儿期和童年中期家庭不和谐（aOR 1.58，95%置信区间1.05 - 2.37）与青少年期自我伤害和抑郁共现的可能性更高相关。然而到成年早期，只有持续性父母心理健康问题与自我伤害和抑郁共现的可能性更高相关（aOR 2.13，95%置信区间1.47 - 3.10）。贯穿童年和青少年时期出现的ACEs与青少年自我伤害以及青少年期和成年早期抑郁的更高风险相关。相比之下，与成年早期自我伤害关联最强烈的类别是持续性父母心理健康问题。需要采取多成分干预和多部门预防措施来应对童年和青少年时期ACEs共现的不同模式，以减轻它们对自我伤害和抑郁的短期和长期影响。
