Meta-analysis of the relationship between maternal adverse childhood experiences and offspring maladaptive social behaviors
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摘要:
目的 分析母亲不良童年经历与儿童社会行为的相关性，为进一步开展母亲及儿童社会行为相关研究提供理论依据。 方法 检索建库至2025年5月中国知网(CNKI)、维普、万方、SinoMed、PubMed、Web of Science、Cochrane Library、Embase、SpringLink数据库中与母亲不良童年经历和儿童不良社会行为发展相关的研究。中文数据库通过3组关键词进行匹配检索：“孕产妇”“母亲”“女性”; “童年不良经历”“早年不良经历”“青少年不良经历”; “儿童”“青少年”“儿童行为”“儿童发展”“青少年行为”“内化行为”“外化行为”。英文数据库通过3组关键词进行检索：“Female”“Pregnant women”“Mothers”; “Adverse childhood experiences”“Adverse early childhood experiences”“Adverse experiences of adolescent”; “Child behavior”“Child development” “Adolescent behavior”“Internalized behaviors”“Externalized behaviors”。对筛选出的文献进行质量评价、资料提取，以比值比(OR)和置信区间(95%CI)为效应指标。采用State 16.0软件进行异质性检验、亚组分析、发表偏倚分析等。 结果 最终纳入14篇文献，共64 302对母子。Meta分析结果显示，母亲不良童年经历与儿童不良的内化行为(OR=1.75，95%CI=1.42~2.15)和外化行为(OR=1.82，95%CI=1.51~2.20)均呈正相关(P值均 < 0.01)。亚组分析结果显示，母亲不良童年经历与儿童不良的内化行为、外化行为在不同研究地区[内化行为：国内、国外OR值(95%CI)分别为2.03(1.49~2.76)，1.55(1.19~2.03)；外化行为：国内、国外OR值(95%CI)分别为2.41(1.52~3.82)，1.65(1.36~2.01)]、研究方法[内化行为：队列研究、横断面研究OR值(95%CI)分别为1.64(1.34~2.00)，1.85(1.30~2.65)；外化行为：队列研究、横断面研究OR值(95%CI)分别为1.76(1.46~2.12)，2.12(1.40~3.20)]、样本量[内化行为：≥4 000， < 4 000对OR值(95%CI)分别为1.69(1.13~2.55)，1.77(1.41~2.24)；外化行为：≥3 000， < 3 000对OR值(95%CI)分别为1.72(1.37~2.17)，2.13(1.44~3.15)]等均呈正相关(P值均 < 0.05)。 结论 母亲不良童年经历与儿童不良内化行为、外化行为的发展均呈正相关，但该结果仍需要更多的研究继续验证。 Abstract:Objective To systematically evaluate the association between maternal adverse childhood experiences (ACEs) and offspring social behavior, so as to provide a theoretical basis for further research on intergenerational social behavioral development. Methods Relevant research literature about maternal ACEs and the development of children's maladaptive social behaviors were collected, from China National Knowledge Infrastructure (CNKI), VIP, Wanfang, SinoMed, PubMed, Web of Science, Cochrane Library, Embase and SpringLink databases, covering the period from the inception of each database to May 2025. The Chinese database matched and searched through three groups of keywords: "Pregnant women" "Mothers" and "Women"; "Bad childhood experience" "Bad early experience" and "Bad adolescent experience"; "Children" "Teenagers" "Children's behavior" "Children's development" "Teenagers' behavior" "Internalized behavior" and "Externalized behavior". The English database was searched by three groups of keywords: "Female" "Pregnant women" "Mothers"; "Adverse childhood experiences" "Adverse early childhood experiences" "Adverse experiences of adolescent"; "Child behavior" "Child development" "Adolescent behavior" "Internalized behaviors" "Externalized behaviors". The selected literature was evaluated for quality and data extraction, with OR and 95%CI as effect indicators. Stata 16.0 software was used for heterogeneity testing, subgroup analysis, and publication bias analysis. Results A total of 14 studies involving 64 302 mother-child pairs were included. The Meta-analysis results showed a significant correlation between maternal ACEs and both offspring maladaptive internalized behaviors (OR=1.75, 95%CI=1.42-2.15, P < 0.01) and externalized behaviors (OR=1.82, 95%CI=1.51-2.20, P < 0.01). The results of subgroup analyses showed that in different regions[internalized behaviors: domestic, foreign OR(95%CI)=2.03(1.49-2.76), 1.55(1.19-2.03); externalized behaviors: domestic, foreign OR(95%CI)=2.41(1.52-3.82), 1.65(1.36-2.01)], study type[internalized behaviors: cohort study, cross-sectional study OR(95%CI)=1.64(1.34-2.00), 1.85(1.30-2.65); externalized behaviors: cohort study, cross-sectional study OR(95%CI)=1.76(1.46-2.12), 2.12(1.40-3.20)], sample size [internalized behaviors: ≥4 000, < 4 000 pairs OR(95%CI)=1.69(1.13-2.55), 1.77(1.41-2.24); externalized behaviors: ≥3 000, < 3 000 pairs OR(95%CI)=1.72(1.37-2.17), 2.13(1.44-3.15)], there were significant and positive association between mothers' ACEs and children's internalizing and externalizing behaviors (all P < 0.05). Conclusion A substantial positive association exists between maternal ACEs and the development of offspring maladaptive internalized and externalized behaviors, but the result needs to be continued to be validated by more research. -
Key words:
- Mothers /
- Life change events /
- Social behavior /
- Meta-analysis /
- Mental health /
- Child
1) 利益冲突声明 所有作者声明无利益冲突。 -
图 1 母亲不良童年经历与儿童不良社会行为关系文献检索流程
Figure 1. Literature retrieval process for the relationship between maternal adverse childhood experiences and children's maladaptive social behaviors
图 2 母亲不良童年经历与儿童内化行为、外化行为关系的异质性检验
Figure 2. Heterogeneity test of the relationship between maternal adverse childhood experiences and children's internalizing and externalizing behavior
图 3 母亲不良童年经历与儿童不良社会行为关系纳入文献的敏感性分析
注：图中圆圈代表单个数据点，表示剔除一篇文献后重新计算剩下文献数据的OR值；短竖线表示该数据点OR值相应的95%CI。
Figure 3. Sensitivity analysis of the relationship between maternal adverse childhood experiences and children's adverse social behaviors
图 4 母亲不良童年经历与儿童不良社会行为关系纳入文献的发表偏倚
Figure 4. Publication bias in literature on the relationship between maternal adverse childhood experiences and children's adverse social behaviors
表 1 母亲不良童年经历与儿童不良社会行为关系纳入文献的基本信息
Table 1. Basic information of included literature on the relationship between maternal adverse childhood experiences and children's maladaptive social behavior
第一作者与年份 国家 研究方法 样本量/对 儿童社会心理类别 测量工具 儿童年龄/岁 OR值(95%CI) 文献质量评价 Moog(2023)[14] 美国 队列研究 3 954 内化问题 工具4 < 18 2.70(1.95~3.72) 高 自闭症 < 18 1.70(1.13~2.55) 多动症 < 18 2.09(1.63~2.67) McDonald(2019)[15] 加拿大 队列研究 3 000 多动/注意力不集中 工具4 3 1.50(1.16~1.94) 高 高程度身体攻击性 3 1.61(1.21~2.13) 焦虑/情绪障碍 3 1.46(1.06~2.02) 高水平分离焦虑 3 1.32(1.03~1.70) Wang(2022)[16] 中国 横断面研究 7 318 行为问题 工具3 4.43±0.98 2.91(2.45~3.45) 中 Zhang(2025)[17] 中国 横断面研究 3 672 抑郁 工具2 13.98±1.62 1.31(1.07~1.61) 高 Doi(2021)[18] 日本 横断面研究 9 390 儿童行为问题 工具7 < 18 2.04(1.64~2.44) 中 儿童抑郁症状 工具10 < 18 0.69(0.39~0.99) Moon(2021)[19] 韩国 横断面研究 461 注意力缺陷多动障碍 工具1 13.26±3.91 1.24(1.04~1.48) 中 Na(2021)[20] 韩国 横断面研究 156 创伤后应激障碍 工具1 16.58±1.47 3.01(1.24~7.31) 中 Luo(2023)[21] 中国 横断面研究 4 243 冲动-多动 工具3 4.60±1.00 2.24(1.29~3.88) 高 焦虑 4.60±1.00 2.46(1.30~4.46) Li(2024)[22] 中国 横断面研究 9 647 行为问题 工具7 5.1±0.9 2.39(1.95~2.94) 中 Hetherington(2020)[23] 加拿大 队列研究 2 909 内化行为 工具9 < 18 1.58(1.12~2.23) 中 外化行为 < 18 2.59(1.75~3.80) McConnell(2025)[24] 美国 队列研究 5 445 外化行为 工具5 4~14 1.50(1.25~1.80) 高 内化行为 4~14 1.50(1.23~1.81) 郭锋(2022)[25] 中国 横断面研究 3 655 自闭症 工具6 3~6 2.77(1.92~3.99) 中 李秋容(2024)[26] 中国 横断面研究 805 解决问题能力 工具8 3~5.6 3.80(1.20~12.00) 中 沟通能力 3~5.6 6.90(2.30~20.30) 粗大动作 3~5.6 3.80(1.50~9.70) 余伟强(2022)[27] 中国 横断面研究 9 647 情绪症状 工具7 5.1±0.9 3.09(2.28~4.18) 中 品行问题 5.1±0.9 2.18(1.70~2.80) 多动障碍 5.1±0.9 2.07(1.67~2.57) 同伴交往 5.1±0.9 1.26(1.08~1.47) 亲社会行为 5.1±0.9 1.37(1.12~1.67) 注：工具1~10分别为诊断预测量表(Predictive Scales, DPS)，流行病学研究中心抑郁量表(Center for Epidemiological Studies Depression Scale, CES-D)，康纳斯父母评分量表(48-Item Conners' Parent Rating Scale, CPRS-48)，儿童行为量表(Child Behaviour Check List, CBCL)，28项行为问题指数(28-Item Behavior Problem Index)，克氏自闭症行为量表(Clancy Autism Behavior Scale, CABS)，长处和困难问卷(Strength and Difficulties Questionnaire, SDQ)，年龄与发育进程问卷-3(Ages and Stages Questionnaines-3, ASQ-3)，儿童行为评估系统第二版(Behavior Assessment System for Children-Second Edition, BASC-2)，抑郁障碍自评量表(Depression Self-rating Scale, DSRS)。 
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表 2 母亲不良童年经历与儿童内化行为、外化行为关系的亚组分析
Table 2. Subgroup analysis of the relationship between maternal adverse childhood experiences and children's internalizing and externalizing behaviors
亚组 选项 内化行为 外化行为 研究数量 OR值(95%CI) I2值/% P值 研究数量 OR值(95%CI) I2值/% P值 地区 国内 4 2.03(1.49~2.76) 86.15 < 0.01 3 2.41(1.52~3.82) 86.12 < 0.01 国外 6 1.55(1.19~2.03) 80.51 < 0.01 5 1.65(1.36~2.01) 74.46 < 0.01 研究方法 队列研究 4 1.64(1.34~2.00) 64.76 0.02 4 1.76(1.46~2.12) 60.04 0.04 横断面研究 6 1.85(1.30~2.65) 89.93 < 0.01 4 2.12(1.40~3.20) 90.62 < 0.01 样本量/对 ≥4 000/3 000 4 1.69(1.13~2.55) 88.18 < 0.01 4 1.72(1.37~2.17) 79.47 < 0.01 < 4 000/3 000 6 1.77(1.41~2.24) 74.38 < 0.01 4 2.13(1.44~3.15) 85.63 < 0.01 注： *P < 0.05，**P < 0.01；内化行为样本量以4 000对为分界点，外化行为以3 000对为分界点。
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