The Adverse Childhood Experiences (ACEs) studies transformed our understanding of the true burden of trauma. Notable elements of Felitti and colleagues' findings include the influence of adversity on many physical as well as psychological problems and the persistence of impacts decades after the traumas occurred. In this article, we make the case that the most revolutionary finding was the discovery of a strong dose-response effect, with marked increases in risk observed for individuals who reported four or more adversities. Over the past two decades, our understanding of the cumulative burden of trauma has expanded further, with recognition that experiences outside the family, including peer victimization, community violence, and racism, also contribute to trauma dose. Recent research has provided evidence for the pervasiveness of trauma, which we now realize affects most people, even by the end of adolescence. Extensive scientific evidence has documented that more than 40 biopsychosocial outcomes, including leading causes of adult morbidity and mortality, are associated with adverse childhood experiences, measured by dose. We summarize the state of science and explain how ACEs built a movement for uncovering mechanisms responsible for these relationships. Perhaps unexpectedly, the pervasiveness of trauma also expands our understanding of resilience, which is likewise more common than previously recognized. Emerging research on positive childhood experiences and poly-strengths suggests that individual, family, and community strengths may also contribute to outcomes in a dose-response relationship. We close with an agenda for research, intervention, and policy to reduce the societal burden of adversity and promote resilience. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

中文翻译：

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认识到童年逆境的累积负担改变了创伤和复原力的科学和实践。

童年不良经历 (ACE) 研究改变了我们对创伤真正负担的理解。Felitti 及其同事的发现中值得注意的元素包括逆境对许多身体和心理问题的影响，以及在创伤发生几十年后影响的持续性。在本文中，我们论证了最具革命性的发现是发现了强烈的剂量反应效应，对于报告四个或更多逆境的个体，观察到的风险显着增加。在过去的二十年里，我们对创伤累积负担的理解进一步扩大，认识到家庭以外的经历，包括同伴受害、社区暴力和种族主义，也会导致创伤剂量。最近的研究为创伤的普遍性提供了证据，我们现在意识到它会影响大多数人，即使在青春期结束时也是如此。广泛的科学证据表明，超过 40 种生物心理社会结果，包括成人发病率和死亡率的主要原因，与不良的童年经历有关，以剂量衡量。我们总结了科学现状并解释了 ACE 如何发起运动来揭示造成这些关系的机制。也许出乎意料的是，创伤的普遍性也扩展了我们对韧性的理解，这同样比以前认识到的更为普遍。关于积极的童年经历和多方面优势的新兴研究表明，个人、家庭和社区的优势也可能有助于剂量反应关系的结果。我们以研究、干预、减少逆境带来的社会负担和促进复原力的政策。（PsycInfo 数据库记录 (c) 2021 APA，保留所有权利）。