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  • Title: [Study of association between adverse experiences in childhood, social support, and physical and psychological sub-health status among middle school students in 3 cities in China].
    Author: Wan YH, Ma SS, Xu SJ, Zhang SC, Hao JH, Tao FB.
    Journal: Zhonghua Yu Fang Yi Xue Za Zhi; 2017 Sep 06; 51(9):786-791. PubMed ID: 28881542.
    Abstract:
    Objective: To explore the relationship between adverse experience in childhood, social support, and physical and psychological sub-health status among middle school students in 3 cities in China. Methods: 15 278 adolescents were selected as subjects from 20 junior and senior middle schools located in 3 cities of China by stratified cluster sampling method. The survey collected the demographic information, ACEs, social support and physical-psychological status. A total of 14 820 valid questionnaires were retained for analysis. We assessed ACE score (count of six categories of childhood adversity), social support (adolescent social support questionnaire), and the prevalence of two outcomes: physiological and psychological sub-health status. Logistic regression was used to analyze the relationship between adverse childhood experiences, social support, and physiological and psychological sub-health status. Results: The prevalence of physiological and psychological sub-health status were 26.4% (3 917/14 820) and 24.1%(3 572/14 820), respectively. A total of 89.4% (13 247/14 820) reported at least 1 adverse childhood experiences. The rates of physiological and psychological sub-health status were higher among girls (28.1%(2 092/7 443), 26.0%(1 932/7 443)) than boys (24.7%(1 825/7 377), 22.2%(1 640/7 377)). Among adolescents without ACEs, the rate of physiological and psychological sub-health status were 15.4%(243/1 573) and 10.4%(163/1 573), for those with 5-6 ACEs, the rate were 40.9%(636/1 556) and 43.6%(678/1 556). Among adolescents with higher social support, the rate of physiological and psychological sub-health status were 19.9%(724/3 635) and 13.0%(474/3 635) for those with lower social support, the rate of physiological and psychological sub-health status were 35.9%(1 403/3 913) and 39.0%(1 528/3 913). The rates of physiological and psychological sub-health status were higher with more ACE exposure or less social support. At each level of ACE exposure, physiological and psychological sub-health status were less in those with greater social support. For example, among adolescents reporting 5-6 ACEs, those in the lowest tertile of social support increased the risk of physiological sub-health status than those in the highest tertile (adjusted prevalence ratio (95%CI)=1.79 (1.23-2.56)); for those reporting no ACEs, the ratio was 3.04 (1.91-4.83). Among adolescents reporting 5-6 ACEs, those in the lowest tertile of social support increased the risk of psychological sub-health status than those in the highest tertile (adjusted prevalence ratio (95%CI)=3.77 (2.57-5.52)); for those reporting no ACEs, the ratio was 3.97(2.33-6.76). Conclusion: The findings suggest that ACEs should be considered as risk factors for physiological and psychological sub-health status among middle school students. Across a range of exposures to ACEs, less social support was associated with more physiological and psychological sub-health status. Identifying those with ACE exposure who also have lower social support could be used to improve the health of adolescents. 目的： 探讨中国郑州、贵阳和蚌埠3个城市中学生童年期不良经历（ACEs）和社会支持与身心亚健康状态的关系。 方法： 采用分层整群抽样的方法，以郑州、贵阳和蚌埠3个城市20所学校的中学生作为调查对象，调查内容包括人口学特征、ACEs、社会支持和身心亚健康状态情况。共调查了15 278名中学生，收回有效问卷14 820份。比较不同特征调查对象ACEs、社会支持水平和身心亚健康检出率的差异；采用多因素logistic回归模型，分析ACEs和社会支持水平与身心亚健康状态发生的关联。 结果： 14 820名中学生生理和心理亚健康状态的检出率分别为26.4%（3 917例）和24.1%（3 572例），女生生理和心理亚健康检出率分别为28.1%(2 092/7 443)、26.0%(1 932/7 443)，均高于男生[24.7%(1 825/7 377)、22.2%(1 640/7 377)]（P值均<0.001）。共有89.4% (13 247例)的中学生有ACEs。无ACEs中学生生理和心理亚健康的检出率分别为15.4%(243/1 573)和10.4%(163/1 573)，ACEs为5~6分中学生生理和心理亚健康的检出率分别为40.9%(636/1 556)和43.6%(678/1 556)。高社会支持水平中学生生理和心理亚健康的检出率分别为19.9%（724/3 635）和13.0%（474/3 635），低社会支持水平中学生生理和心理亚健康的检出率分别为35.9%（1 403/3 913）和39.0%（1 528/3 913）。随ACEs得分增加及社会支持水平降低，中学生身心亚健康状态的检出率呈增高趋势（P<0.001）。在无ACEs中学生中，低社会支持水平的调查对象发生生理和心理亚健康的风险增加，OR（95%CI）值分别为3.04（1.91~4.83）和3.97（2.33~6.76）。在ACEs 5~6分的中学生中，低社会支持水平组发生生理和心理亚健康的风险高于高社会支持水平组，OR（95%CI）值分别为1.79（1.23~2.56）和3.77（2.57~5.52）。 结论： ACEs是中学生身心亚健康状态发生的重要影响因素。低社会支持会增加中学生身心亚健康状态的发生风险，提升有ACEs中学生的社会支持水平，有助于促进身心健康。.
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