To the Editor Bethell et al¹ find a dose-response association between positive childhood experiences (PCEs) and depression/poor mental health (D/PMH) and adult-reported social/emotional support after accounting for exposure to adverse childhood experiences. In nonrandomized (real-world) data, treatment selection can be biased by unobservable confounders or inadequately measured explanatory variables, including, in this case, drug use additional to alcohol, exercise, income, wealth, education, race/ethnicity, comorbidities, family and friends, community engagement, job stress, sleep, and major life events. In this case, PCEs may serve as a proxy for such unobservable factors, suggesting that the observed adjusted odds ratio of 0.28 (95% CI, 0.21-0.39; P < .001) for D/PMH among those reporting 6 to 7 PCEs indeed implies a moderate degree of causality after adjusting for age, race/ethnicity, and annual income.

致编辑Bethell 等人¹发现积极的童年经历 (PCE) 与抑郁/不良心理健康 (D/PMH) 和成人报告的社会/情感支持之间存在剂量反应关联，并在考虑到不良童年经历后。在非随机（真实世界）数据中，治疗选择可能会因不可观察的混杂因素或测量不充分的解释变量而产生偏差，在这种情况下，包括酒精以外的药物使用、运动、收入、财富、教育、种族/民族、合并症、家庭和朋友、社区参与、工作压力、睡眠和重大生活事件。在这种情况下，PCE 可以作为此类不可观察因素的代表，表明观察到的调整优势比为 0.28（95% CI，0.21-0.39；P < .001) 在那些报告 6 到 7 次 PCE 的人中，D/PMH 确实意味着在调整了年龄、种族/民族和年收入后的中等程度的因果关系。