What is it about ACE's? Understanding the relationship between adversity and mental health

ACE 到底是什么？

• 批准号: 2625989
• 金额: --
• 依托单位: University of Bristol
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2021
• 资助国家: 英国
• 起止时间: 2021 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2625989
• 关键词: What; about; ACE; Understanding; relationship

Adverse childhood experiences (ACEs) such as abuse, bullying or family disruption are increasingly recognised as one of the most potent determinants of later mental health problems. Estimates suggest that mental health problems, including depression and self-harm are at least double among those who have been exposed to ACEs. Despite the recognised importance of ACEs to later mental health outcomes, relatively little is known about the characteristics of ACEs that have the greatest impact. Firstly, many studies have relied on cumulative scores, whereby ACEs are simply dichotomised and summed. This approach assumes that each ACE contributes equitably to the outcome of interest and that they operate via the same mechanisms. Other research has focused on the relationship between individual ACEs and mental health. Although such studies have provided useful insights, it is known that ACEs often co-occur and most have failed to take account of this clustering. Secondly, little attention has been paid to the role of timing, chronicity, or recency of exposure in relation to mental health, and findings from existing studies have been inconclusive. Disentangling these effects is challenging as it may be that those who have been exposed earlier in childhood have also been exposed for longer. Person centred approaches such as Latent Class Analysis (LCA) have been used to identify variability in ACE profiles between individuals, however it is not currently known whether ACE profiles differ during different stages of the life-course. This PhD will address these limitations and generate valuable new insights into the relationship between ACEs and two mental health outcomes - depression and self-harm. Both depression and self-harm are major public health concerns which have been rising over recent years. The proposed study will use data from the Avon Longitudinal Study of Parents and Children (ALSPAC); a UK birth cohort study of over 14,000 participants born in 1991-1992. ALSPAC has unrivalled data on ACEs, with over 500 questions asked prospectively across childhood and adolescence, as well as repeated measures data on depression and self-harm into adulthood. The study also includes rich information on biological (e.g. inflammation), social (e.g. educational outcomes), and cognitive (e.g. emotion recognition) factors that could be explored as potential mechanisms linking ACEs with later mental health outcomes.Research questions What is the relationship between specific ACEs and mental health outcomes (depression and self-harm) in adolescence and adulthood? How do ACEs cluster together during different stages of the life course, and how do different ACE profiles relate to mental health? How do timing, chronicity, and recency of exposure to ACEs impact on risk for mental health problems? What are the mechanisms through which ACEs have an impact on mental health? Key Methods: structural equation modelling, mediation analysis, strategies for dealing with missing data (such as multiple imputation) and causal analysis methods.

不利的童年经历（ACE），例如虐待，欺凌或家庭中断，被越来越多地被认为是后来心理健康问题的最有效的决定因素之一。估计表明，在暴露于ACE的人群中，包括抑郁症和自我伤害在内的心理健康问题至少是两倍。尽管ACE在后来的心理健康状况上具有公认的重要性，但对影响最大的ACE的特征知之甚少。首先，许多研究依赖于累积分数，从而简单地将Aces进行了二分和总结。这种方法假设每个王牌都对感兴趣的结果公平地贡献，并且它们通过相同的机制运行。其他研究的重点是单个ACE与心理健康之间的关系。尽管此类研究提供了有用的见解，但众所周知，ACE经常同时发生，并且大多数人未能考虑到这种聚类。其次，很少关注与心理健康有关的时机，慢性或接触的重新态度的作用，现有研究的发现尚无定论。解开这些效果是具有挑战性的，因为那些在童年早期暴露的人也已经暴露了更长的时间。以人为中心的方法（例如潜在类别分析（LCA））已被用来识别个人之间ACE概况的可变性，但是目前尚不知道ACE概况在生命过程的不同阶段是否有所不同。该博士将解决这些局限性，并对ACE与两个心理健康成果之间的关系（抑郁症和自我伤害）产生宝贵的新见解。抑郁症和自我伤害都是近年来一直在增加的主要公共卫生问题。拟议的研究将使用来自父母和孩子的雅芳纵向研究（ALSPAC）的数据；英国出生队列研究1991 - 1992年出生的14,000多名参与者。 ALSPAC拥有有关ACE的数据无与伦比的数据，在整个儿童和青春期中，有500多个问题，以及重复的衡量抑郁和自我伤害到成年的数据。该研究还包括有关生物学（例如炎症），社交（例如教育成果）和认知（例如情感识别）因素的丰富信息，这些因素可以作为将ACE与后来的心理健康结果联系起来的潜在机制。研究问题是什么是在适应性和精神健康兴趣和自动障碍（抑郁症和自我伤害）之间的关系是什么？在生活课程的不同阶段，ACES如何聚集在一起，不同的ACE概况与心理健康有何关系？时间，慢性和暴露于ACE的重新度如何影响心理健康问题的风险？ ACE对心理健康产生影响的机制是什么？关键方法：结构方程建模，中介分析，处理缺失数据（例如多个插补）和因果分析方法的策略。