BackgroundAdverse childhood experiences (ACEs) are well‐established risk factors for self‐harm and depression. However, despite their high comorbidity, there has been little focus on the impact of developmental timing and the duration of exposure to ACEs on co‐occurring self‐harm and depression.MethodsData were utilised from over 22,000 children and adolescents participating in three UK cohorts, followed up longitudinally for 14–18 years: the Avon Longitudinal Study of Parents and Children (ALSPAC), the Millennium Cohort Study (MCS) and the Environmental Risk (E‐Risk) Longitudinal Twin Study. Multinomial logistic regression models estimated associations between each ACE type and a four‐category outcome: no self‐harm or depression, self‐harm alone, depression alone and self‐harm with co‐occurring depression. A structured life course modelling approach was used to examine whether the accumulation (duration) of exposure to each ACE, or a critical period (timing of ACEs) had the strongest effects on self‐harm and depression in adolescence.ResultsThe majority of ACEs were associated with co‐occurring self‐harm and depression, with consistent findings across cohorts. The importance of timing and duration of ACEs differed across ACEs and across cohorts. For parental mental health problems, longer duration of exposure was strongly associated with co‐occurring self‐harm and depression in both ALSPAC (adjusted OR: 1.18, 95% CI: 1.10–1.25) and MCS (1.18, 1.11–1.26) cohorts. For other ACEs in ALSPAC, exposure in middle childhood was most strongly associated with co‐occurring self‐harm and depression, and ACE occurrence in early childhood and adolescence was more important in the MCS.ConclusionsEfforts to mitigate the impact of ACEs should start in early life with continued support throughout childhood, to prevent long‐term exposure to ACEs contributing to risk of self‐harm and depression in adolescence.

中文翻译：

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暴露于不良童年经历的类型、时间和持续时间与青少年自残和抑郁之间的关系：来自三个英国前瞻性人群队列的结果


背景不良童年经历 （ACE） 是公认的自残和抑郁风险因素。然而，尽管它们的合并症很高，但很少有人关注发育时间和暴露于 ACE 的持续时间对同时发生的自残和抑郁的影响。方法利用了来自三个英国队列的 22,000 多名儿童和青少年的数据，纵向随访了 14-18 年：雅芳父母和儿童纵向研究 （ALSPAC）、千年队列研究 （MCS） 和环境风险 （E-Risk） 纵向双胞胎研究。多项式 logistic 回归模型估计了每种 ACE 类型与四类结局之间的关联： 无自残或抑郁、仅自残、仅抑郁和自残伴有抑郁。使用结构化生命历程建模方法来检查暴露于每种 ACE 的积累（持续时间）或关键时期（ACE 的时间）是否对青春期的自残和抑郁影响最强。结果大多数 ACE 与同时发生的自残和抑郁有关，各队列的发现一致。ACE 的时间和持续时间的重要性因 ACE 和队列而异。对于父母的心理健康问题，在 ALSAC（调整后的 OR：1.18,95% CI：1.10-1.25）和 MCS （1.18,1.11-1.26） 队列中，较长时间的暴露与同时发生的自残和抑郁密切相关。对于 ALSPAC 中的其他 ACEs，童年中期的暴露与同时发生的自残和抑郁最密切相关，而儿童早期和青少年时期的 ACE 发生在 MCS 中更为重要。结论减轻 ACE 影响的努力应从早期开始，并在整个童年时期持续支持，以防止长期接触 ACE 导致青春期自残和抑郁的风险。