Importance Adverse childhood experiences (ACEs) have been associated with poor mental and physical health outcomes. However, the mechanism of this effect, critical to enhancing public health, remains poorly understood. Objective To investigate the neurodevelopmental trajectory of the association between early ACEs and adolescent general and emotional health outcomes. Design, Setting, and Participants A prospective longitudinal study that began when patients were aged 3 to 6 years who underwent neuroimaging later at ages 7 to 12 years and whose mental and physical health outcomes were observed at ages 9 to 15 years. Sequential mediation models were used to investigate associations between early ACEs and brain structure, emotion development, and health outcomes longitudinally. Children were recruited from an academic medical center research unit. Exposure Early life adversity. Main Outcomes and Measures Early ACEs in children aged 3 to 7 years; volume of a subregion of the prefrontal cortex, the inferior frontal gyrus, in children aged 6 to 12 years; and emotional awareness, depression severity, and general health outcomes in children and adolescents aged 9 to 15 years. Results The mean (SD) age of 119 patients was 9.65 (1.31) years at the time of scan. The mean (SD) ACE score was 5.44 (3.46). The mean (SD) depression severity scores were 2.61 (1.78) at preschool, 1.77 (1.58) at time 2, and 2.16 (1.64) at time 3. The mean (SD) global physical health scores at time 2 and time 3 were 0.30 (0.38) and 0.33 (0.42), respectively. Sequential mediation in the association between high early ACEs and emotional and physical health outcomes were found. Smaller inferior frontal gyrus volumes and poor emotional awareness sequentially mediated the association between early ACEs and poor general health (model parameter estimate = 0.002; 95% CI, 0.0002-0.056) and higher depression severity (model parameter estimate = 0.007; 95% CI, 0.001-0.021) in adolescence. An increase from 0 to 3 early ACEs was associated with 15% and 25% increases in depression severity and physical health problems, respectively. Conclusions and Relevance Study findings highlight 1 putative neurodevelopmental mechanism by which the association between early ACEs and later poor mental and physical health outcomes may operate. This identified risk trajectory may be useful to target preventive interventions.

中文翻译：

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早期生活逆境与青春期情绪和身体健康状况不佳风险之间的关联

重要性 童年不良经历 (ACE) 与心理和身体健康状况不佳有关。然而，对增强公共卫生至关重要的这种效应的机制仍然知之甚少。目的 研究早期 ACE 与青少年一般和情绪健康结果之间关联的神经发育轨迹。设计、设置和参与者 一项前瞻性纵向研究开始于 3 至 6 岁的患者，随后在 7 至 12 岁接受神经影像学检查，并在 9 至 15 岁观察其心理和身体健康结果。序贯中介模型用于纵向研究早期 ACE 与大脑结构、情绪发展和健康结果之间的关联。儿童是从学术医学中心研究单位招募的。暴露早年生活中的逆境。主要结果和措施 3 至 7 岁儿童的早期 ACE；6 至 12 岁儿童的前额叶皮层亚区，即额下回的体积；9 至 15 岁儿童和青少年的情绪意识、抑郁严重程度和一般健康结果。结果 扫描时 119 名患者的平均 (SD) 年龄为 9.65 (1.31) 岁。平均 (SD) ACE 得分为 5.44 (3.46)。学龄前儿童的平均 (SD) 抑郁严重程度评分为 2.61 (1.78)，时间 2 为 1.77 (1.58)，时间 3 为 2.16 (1.64)。时间 2 和时间 3 的平均 (SD) 全球身体健康评分为 0.30 (0.38) 和 0.33 (0.42)，分别。发现了高早期 ACE 与情绪和身体健康结果之间关联的顺序中介。较小的额下回体积和较差的情绪意识依次介导了早期 ACE 与一般健康状况不佳（模型参数估计值 = 0.002；95% CI，0.0002-0.056）和较高的抑郁症严重程度（模型参数估计值 = 0.007；95% CI， 0.001-0.021) 在青春期。早期 ACE 从 0 增加到 3 次与抑郁严重程度和身体健康问题分别增加 15% 和 25% 相关。结论和相关性研究结果强调了 1 种假定的神经发育机制，早期 ACE 与后来的身心健康状况不佳之间的关联可能通过该机制起作用。这种确定的风险轨迹可能有助于针对预防性干预措施。