Objective:

Some children are unaffected by mental illness despite exposure to childhood adversity. These children are typically considered resilient. The objective of this study was to follow up such resilient children in adulthood to characterize mental health status, substance use, and functional outcomes.

Methods:

The analysis was based on the prospective, representative Great Smoky Mountains Study (N=1,420). Participants were assessed for psychiatric disorders and exposure to adversity with the structured Child and Adolescent Psychiatric Assessment interview up to eight times in childhood (ages 9–16; 6,674 observations). In total, 1,266 participants (86.3%) were followed up in adulthood at ages 25 and 30 to assess psychiatric disorders, substance use disorders, and functional outcomes.

Results:

Seventy-five percent of the sample had met criteria for a psychiatric disorder or displayed subthreshold psychiatric problems by age 16. The number of adverse childhood experiences was strongly associated with childhood psychiatric status. Of children exposed to multiple adversities (N=650), 12.2% (N=63) did not display psychiatric problems. This group meets common definitions of childhood resilience. In adulthood, these individuals showing childhood resilience had greater risk of anxiety (risk ratio=2.9, 95% CI=1.0–9.1) and depressive (risk ratio=4.5, 95% CI=1.1–16.7) disorders, as well as worse physical health (means ratio=0.7, 95% CI=0.5–0.9) and financial or educational functioning (means ratio=0.6, 95% CI=0.5–0.7), compared with individuals exposed to fewer childhood adversities. These individuals showing childhood resilience did not have elevated risk for substance use disorders.

Conclusions:

Resilience to childhood adversity was uncommon. Individuals who appeared resilient in childhood were at risk for delayed poorer outcomes in adulthood. Public health efforts should prioritize minimizing early adversity exposure over promoting resilience.

中文翻译：

---

成人心理健康、药物滥用障碍以及儿童对早期逆境的恢复能力的功能结果

客观的：

尽管童年时期经历过逆境，但有些儿童并未受到精神疾病的影响。这些孩子通常被认为是有弹性的。这项研究的目的是跟踪这些有弹性的儿童成年后的情况，以了解其心理健康状况、物质使用和功能结果。

方法：

该分析基于前瞻性、代表性的大烟山研究 (N=1,420)。通过结构化的儿童和青少年精神病学评估访谈，对参与者的精神疾病和逆境暴露情况进行了评估，访谈次数在儿童时期最多达八次（9-16 岁；6,674 次观察）。总共 1,266 名参与者 (86.3%) 在 25 岁和 30 岁的成年期接受了随访，以评估精神疾病、物质使用障碍和功能结果。

结果：

75% 的样本在 16 岁时符合精神疾病标准或表现出阈下精神问题。不良童年经历的数量与儿童精神状况密切相关。在经历过多种逆境的儿童 (N=650) 中，12.2% (N=63) 没有表现出精神问题。该组符合儿童复原力的常见定义。成年后，这些表现出童年复原力的人患焦虑症（风险比=2.9，95% CI=1.0-9.1）和抑郁症（风险比=4.5，95% CI=1.1-16.7）的风险更大，身体状况也更差。与童年时期经历较少逆境的个体相比，健康状况（平均比率=0.7，95% CI=0.5–0.9）和财务或教育功能（平均比率=0.6，95% CI=0.5–0.7）。这些表现出童年适应力的人患药物滥用的风险并未升高。

结论：

对童年逆境的适应能力并不常见。童年时期表现出韧性的人在成年后面临着延迟出现较差结果的风险。公共卫生工作应优先考虑最大限度地减少早期逆境暴露，而不是提高复原力。