三城市中学生童年期不良经历暴露模式与心理亚健康的关联及性别差异

目的 结合童年期不良经历（adverse childhood experiences, ACEs）暴露类型和时相探索ACEs暴露模式，探索ACEs暴露模式与中学生心理亚健康的关联及关联的性别差异。方法 于2020年10月至2021年6月，采用多阶段整群抽样方法随机抽取北京市、广东省阳江市和河南省郑州市部分中学生进行问卷调查，回收有效问卷16 853份。采用世界卫生组织编制的童年期不良经历问卷（adverse childhood experiences international questionnaire, ACE-IQ）调查ACEs暴露情况，通过潜类别分析（latent class analysis, LCA）探索ACEs暴露模式，建立多因素logistic回归分析暴露模式与中学生心理亚健康的关联及性别差异。结果 根据LCA可将ACEs暴露模式分为高ACEs（10.0%）、高虐待忽视（20.3%）、中等ACEs（26.7%）和低ACEs（43.0%）4组。与低ACEs暴露相比，其余ACEs暴露模式均能增加中学生心理亚健康的发生风险，差异有统计学意义（高ACEs组:OR=5.37，95%CI:4.74~6.08；高忽视虐待组:OR=2.30，95%CI:2.06~2.60；中等ACEs组:OR=1.53，95%CI:1.37~1.70）；暴露于同等水平ACEs时，女生发生心理亚健康的风险均高于男生（高ACEs组:ROR=1.96，95%CI:1.52~2.52，P<0.001；高忽视虐待组:ROR=1.60，95%CI:1.27~2.00；中等ACEs组:ROR=1.31，95%CI:1.06~1.63）。结论 ACEs暴露与中学生心理亚健康有关，女生是需要重点关注的对象，减少ACEs暴露有利于中学生心理健康促进。

Relationship between adverse childhood experiences patterns andpsychological sub-health and gender difference among middleschool students:a three-city study in China

Objective To explore adverse childhood experiences (ACEs) patterns combined by ACEs types and timing, to analyse association between patterns of ACEs and psychological sub-health among middle school students and gender difference. Methods : The survey was conducted in part of middle school students in Beijing, Yangjiang (in Guangdong province), Zhenzhou (in Henan province) during October 2020 to June 2021, multi-stage cluster sampling method was adopted to randomly select participants. A total of 16 853 questionnaires were valid. ACE-IQ was adopted to evaluated ACEs, while latent class analysis (LCA) was used to explore patterns of ACEs. Logistic regression was used to verify the relationship between ACEs patterns and psychological sub-health and gender difference. Results Four patterns were identified as follows: high ACEs (10.0%), high abuse/neglect (20.3%), moderate ACEs (26.7%), low ACEs (43.0%). Compared with low ACEs, high ACEs, high abuse/neglect and moderate ACEs all could increase the risk of psychological sub-health (high ACEs: OR=5.37, 95%CI: 4.74-6.08; high neglect/abuse: OR=2.3, 95%CI: 2.06-2.60; moderate ACEs: OR=1.53, 95%CI: 1.37-1.70), exposed to the same level of ACEs, girls are more likely to experience psychological sub-health than boys (high ACEs: ROR=1.96, 95%CI: 1.52-2.52; high neglect/abuse: ROR=1.60, 95%CI: 1.27-2.00; moderate ACEs: ROR=1.31, 95%CI: 1.06-1.63). Conclusion ACEs exposure is associated with psychological sub-health, more attention should be paid on girls, reducing ACEs exposure is beneficial to improve mental health of middle school students.