Persistent effects of adverse childhood experiences on the course of pubertal development
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摘要:
目的 探讨童年不良经历对男女童青春发育过程的持续影响，为青春发育规律研究提供基础资料。 方法 采用分层整群抽样方法，于2018年9月抽取黄山市城区和乡镇寄宿制和公立小学各1所的三、四年级共1 156名学生，采用儿童期虐待问卷(CTQ)和青春发育问卷(PDS)进行自我评定的基线调查，根据儿童期虐待问卷不同维度得分将童年不良经历分为无暴露组、轻度暴露组和重度暴露组，2年后再次进行PDS问卷的自我评定，分析童年不良经历类型及严重程度对男女童青春发育的持续影响。 结果 基线调查中，女童发育提前53名(11.32%)，男童发育提前51名(7.41%)，差异有统计学意义(χ2=5.21，P < 0.05)。单因素分析显示，童年不良经历虐待类型及严重程度对青春发育的影响在基线和随访中都具有性别差异，童年不良经历不同暴露组基线和随访时发育提前检出率存在性别差异。多元线性回归分析显示，女童情感虐待、情感忽视和性虐待程度越重，PDS得分越高(B值分别为0.22，0.15，0.08)；男童情感虐待越重PDS得分越高，躯体虐待越重PDS得分越低(B值分别为0.20，0.04)(P值均 < 0.05)。 结论 在男女童青春发育过程中要重视童年不良经历的影响及性别差异。应进行更为长期的时间效应观测。 Abstract:Objective To explore the influence of adverse childhood experiences (ACEs) on pubertal development of boys and girls and to provide a reference for the development of intervention measures. Methods A stratified cluster sampling method was used to select a total of 1 156 students in grades three and four in the boarding school system and public primary schools in Huangshan City and surrounding towns in September 2018, using the Childhood Trauma Questionnaire (CTQ) and the Pubertal Development Scale (PDS). For the baseline self-assessment survey, according to different dimensions, abuse children score no exposure groups. Children were divided into an exposure group and a high exposure level group, according to their childhood experiences. PDS self-report questionnaire was administered two years later, and an analysis of ACE type and severity of the continuous impact of youth development was conducted. Results In the baseline survey, there were 53 girls (11.32%) and 51 boys (7.41%) who developed earlier. The rate of early development in girls was higher than that of boys, and the difference was statistically significant(χ2=5.21, P < 0.05). Univariate analysis showed gender differences in the effects of type and severity of ACEs and abuse on adolescent development at both baseline and follow-up. There were gender differences in the rate of early development between boys and girls at baseline and at follow-up between the exposure groups. Regression analysis showed that the higher the degree of emotional abuse, emotional neglect, and sexual abuse in girls, the higher the PDS score(B=0.22, 0.15, 0.08, P < 0.05). In boys, the more severe the emotional abuse experienced, the higher the PDS score, and the more severe the physical abuse experienced, the lower the PDS score(B=0.20, 0.04, P < 0.05). Conclusion Attention should be paid to the influence of ACEs and gender differences during youth development among male and female students, and more long-term studies should also be carried out. -
Key words:
- Child /
- Life change events /
- Mental health /
- Adolescent development /
- Regression analysis /
- Students
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表 1 基线时男女童各年龄组乳房、睾丸Tanner分期分布
Table 1. Baseline distribution of Tanner stages in all age groups (breast and testicular)for boys and girls
性别 年龄/岁 人数 Ⅰ期 Ⅱ期 Ⅲ期 Ⅳ期 Ⅴ期 女 8 22 21(95.45) 1(4.54) 0 0 0 9 200 105(52.29) 80(40.37) 15(7.34) 0 0 10 218 65(29.82) 104(47.71) 24(11.00) 25(11.47) 0 11 28 1(3.57) 2(7.14) 13(46.43) 10(35.71) 2(7.14) 小计 468 192(41.03) 187(39.96) 52(11.11) 35(7.47) 2(0.43) 男 8 32 31(96.88) 1(3.12) 0 0 0 9 278 252(90.65) 22(7.91) 4(1.44) 0 0 10 309 170(55.02) 121(39.16) 18(5.83) 0 0 11 69 16(23.19) 47(68.12) 6(8.70) 0 0 小计 688 469(68.17) 191(27.77) 28(4.06) 0 0 注： ()内数字为构成比/%。 
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表 2 男童基线和随访时ACEs不同暴露组点PDS得分比较
Table 2. Comparison of PDS scores between ACEs exposure groups at baseline and follow-up in boys
调查时间 组别 统计值 情感虐待 躯体虐待 情感忽视 躯体忽视 人数 x±s 人数 x±s 人数 x±s 人数 x±s 基线 无暴露组 299 1.31±0.67 458 1.36±0.65 387 1.29±0.62 513 1.35±0.66 轻度暴露组 277 1.30±0.75 116 1.32±0.66 135 1.32±0.65 88 1.31±0.67 重度暴露组 112 1.40±0.72 114 1.30±0.61 166 1.35±0.71 87 1.33±0.66 F值 0.97 0.23 0.52 0.15 P值 0.38 0.79 0.60 0.86 随访 无暴露组 299 1.41±0.66 458 1.74±0.68 387 1.51±0.71 513 1.66±0.67 轻度暴露组 277 1.40±0.67 116 1.70±0.71 135 1.58±0.73 88 1.53±0.71 重度暴露组 112 1.87±0.71 114 1.33±0.65 166 1.35±0.71 87 1.33±0.66 F值 18.39 17.27 2.52 1.92 P值 0.00 0.00 0.08 0.15
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表 3 女童基线和随访时ACEs不同暴露组点PDS得分比较
Table 3. Comparison of PDS scores between ACEs exposure groups at baseline and follow-up in girls
调查时间 组别 统计值 情感虐待 躯体虐待 情感忽视 躯体忽视 人数 x±s 人数 x±s 人数 x±s 人数 x±s 基线 无暴露组 122 1.11±0.65 322 1.39±0.62 299 1.21±0.66 325 1.38±0.61 轻度暴露组 270 1.39±0.63 60 1.33±0.61 68 1.48±0.61 88 1.33±0.65 重度暴露组 76 1.56±0.71 86 1.52±0.68 101 1.50±0.70 55 1.28±0.66 F值 12.83 1.95 9.81 0.72 P值 0.00 0.14 0.00 0.49 随访 无暴露组 122 1.69±0.72 322 1.89±0.70 299 1.68±0.71 325 1.89±0.71 轻度暴露组 270 1.95±0.74 60 1.87±0.68 68 1.81±0.71 88 1.82±0.69 重度暴露组 76 2.28±0.74 86 2.01±0.66 101 2.19±0.77 55 1.74±0.70 F值 15.21 1.14 18.77 1.23 P值 0.00 0.32 0.00 0.50
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表 4 ACEs不同暴露组男童发育提前检出率比较
Table 4. Comparison of the early developmental rates of ACEs in boys
童年不良经历 组别 统计值 基线 随访 人数 检出人数 人数 检出人数 情感虐待 无暴露组 421 17(4.04) 421 36(8.56) 轻度暴露组 547 20(3.66) 547 47(8.59) 重度暴露组 188 14(7.45) 188 28(14.89) χ2值 4.99 7.24 P值 0.08 0.03 躯体虐待 无暴露组 780 34(4.36) 780 76(9.74) 轻度暴露组 176 10(5.68) 176 25(14.20) 重度暴露组 200 7(3.50) 200 10(5.00) χ2值 1.07 9.19 P值 0.59 0.01 性虐待 无暴露组 1 043 44(4.22) 1 043 96(9.20) 暴露组 113 7(6.19) 113 15(13.27) χ2值 0.53 1.95 P值 0.47 0.16 情感忽视 无暴露组 686 28(4.08) 686 58(8.45) 轻度暴露组 203 9(4.43) 203 22(10.84) 重度暴露组 267 14(5.24) 267 31(11.61) χ2值 0.62 2.64 P值 0.74 0.27 躯体忽视 无暴露组 838 36(4.30) 838 76(9.07) 轻度暴露组 176 7(3.98) 176 20(11.36) 重度暴露组 142 8(5.63) 142 15(10.56) χ2值 0.61 1.05 P值 0.74 0.59 注： ()内数字为检出率/%。
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表 5 ACEs不同暴露组女童发育提前检出率比较
Table 5. Comparison of the early developmental rates of ACEs in girls
童年不良经历 组别 统计值 基线 随访 人数 检出人数 人数 检出人数 情感虐待 无暴露组 421 6(1.43) 421 34(8.08) 轻度暴露组 547 25(4.57) 547 50(9.14) 重度暴露组 188 22(11.70) 188 30(15.96) χ2值 31.38 8.12 P值 0.00 0.02 躯体虐待 无暴露组 780 35(4.49) 780 70(8.97) 轻度暴露组 176 11(6.25) 176 20(11.36) 重度暴露组 200 7(3.50) 200 24(12.00) χ2值 1.67 2.17 P值 0.43 0.34 性虐待 无暴露组 1 043 43(4.12) 1 043 86(8.25) 暴露组 113 10(8.85) 113 28(24.78) χ2值 5.21 31.35 P值 0.02 0.00 情感忽视 无暴露组 686 25(3.64) 686 49(7.14) 轻度暴露组 203 6(2.96) 203 25(12.32) 重度暴露组 267 22(8.24) 267 40(14.98) χ2值 10.77 14.95 P值 0.01 0.00 躯体忽视 无暴露组 838 32(3.82) 838 72(8.59) 轻度暴露组 176 11(6.25) 176 25(14.20) 重度暴露组 142 10(7.04) 142 17(11.97) χ2值 4.20 5.85 P值 0.12 0.05 注： ()内数字为检出率/%。
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表 6 不同性别儿童ACEs与青春发育的多重线性回归分析
Table 6. Multiple linear regression analysis of ACEs and adolescent development in children of different sexes
性别 常数与自变量 B值 标准误 β值 t值 P值 女 常数 3.10 0.19 - 18.84 0.00 (n=468) 情感虐待 0.22 0.08 0.20 9.35 0.00 躯体虐待 0.02 0.02 0.05 1.58 0.21 性虐待 0.08 0.08 0.07 5.60 0.00 情感忽视 0.15 0.12 0.08 7.23 0.00 躯体忽视 -0.02 0.01 0.05 1.21 0.31 男 常数 3.01 0.17 - 16.12 0.00 (n=688) 情感虐待 0.20 0.08 0.11 6.38 0.00 躯体虐待 -0.04 0.02 -0.08 -2.32 0.02 性虐待 -0.02 0.02 0.03 1.13 0.36 情感忽视 0.02 0.02 0.04 1.21 0.21 躯体忽视 -0.01 0.01 0.05 1.56 0.23
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