Recent neurodevelopmental and evolutionary theories offer strong theoretical rationales and some empirical evidence to support the importance of specific dimensions of early adversity. However, studies have often been limited by omission of other adversity dimensions, singular outcomes, and short follow up durations. 1,420 participants in the community, Great Smoky Mountains Study, were assessed up to eight times between age 9 and 16 for four dimensions of early adversity: Threat, Material Deprivation, Unpredictability, and Loss (as well as a Cumulative Adversity measure). Participants were followed up to four times in adulthood (ages 19, 21, 25, and 30) to measure psychiatric disorders, substance disorder, and “real-world” functioning. Every childhood adversity dimension was associated with multiple adult psychiatric, substance, or functional outcomes when tested simultaneously in a multivariable analysis that accounted for other childhood adversities. There was evidence of differential impact of dimensions of adversity exposure on proximal outcomes (e.g., material deprivation and IQ) and even on distal outcomes (e.g., threat and emotional functioning). There were similar levels of prediction between the best set of individual adversity scales and a single cumulative adversity measure when considering distal outcomes. All dimensions of childhood adversity have lasting, pleiotropic effects, on adult health and functioning, but these dimensions may act via distinct proximal pathways.

最近的神经发育和进化理论提供了强有力的理论依据和一些经验证据来支持早期逆境特定维度的重要性。然而，研究常常因遗漏其他逆境维度、单一结果和较短的随访时间而受到限制。大烟山研究社区的 1,420 名参与者在 9 至 16 岁之间接受了多达八次评估，评估早期逆境的四个维度：威胁、物质匮乏、不可预测性和损失（以及累积逆境测量）。参与者在成年期（19 岁、21 岁​​、25 岁和 30 岁）被随访四次，以测量精神障碍、物质障碍和“现实世界”功能。每个童年逆境维度都与多种成人精神、物质、或在考虑其他童年逆境的多变量分析中同时测试时的功能结果。有证据表明，逆境暴露的维度对近端结果（例如，物质匮乏和智商）甚至对远端结果（例如，威胁和情绪功能）的影响不同。在考虑远端结果时，最佳的个体逆境量表集与单一累积逆境测量之间的预测水平相似。童年逆境的所有方面对成人健康和功能都有持久的多效性影响，但这些方面可能通过不同的近端途径起作用。有证据表明，逆境暴露的维度对近端结果（例如，物质匮乏和智商）甚至对远端结果（例如，威胁和情绪功能）的影响不同。在考虑远端结果时，最佳的个体逆境量表集与单一累积逆境测量之间的预测水平相似。童年逆境的所有方面对成人健康和功能都有持久的多效性影响，但这些方面可能通过不同的近端途径起作用。有证据表明，逆境暴露的维度对近端结果（例如，物质匮乏和智商）甚至对远端结果（例如，威胁和情绪功能）的影响不同。在考虑远端结果时，最佳的个体逆境量表集与单一累积逆境测量之间的预测水平相似。童年逆境的所有方面对成人健康和功能都有持久的多效性影响，但这些方面可能通过不同的近端途径起作用。