ImportanceExposure to adverse childhood experiences (ACEs) has consistently been associated with multiple negative mental health outcomes extending into adulthood. However, given that ACEs and psychiatric disorders cluster within families, it remains to be comprehensively assessed to what extent familial confounding contributes to associations between ACEs and clinically confirmed adult psychiatric disorders.ObjectiveTo investigate whether associations between ACEs and adult mental health outcomes remain after adjusting for familial (genetic and environmental) confounding.Design, Setting, and ParticipantsThis Swedish twin cohort study used a discordant twin pair design based on monozygotic (MZ) and dizygotic (DZ) twins. A total of 25 252 adult twins (aged 18-47 years) from the Swedish Twin Registry born between 1959 and 1998 were followed up from age 19 years until 2016, with a maximum follow-up time of 39 years. Data were analyzed from April 2022 to November 2023.ExposuresA total of 7 ACEs, including family violence, emotional abuse or neglect, physical neglect, physical abuse, sexual abuse, rape, and hate crime, were assessed with items from the Life Stressor Checklist-Revised in a web-based survey.Main Outcomes and MeasuresAdult (ages >18 years) clinical diagnosis of psychiatric disorders (ie, depressive, anxiety, alcohol or drug misuse, or stress-related disorders) were obtained from the Swedish National Patient Register.ResultsOf 25 252 twins included in the study (15 038 female [59.6%]; mean [SD] age at ACE assessment, 29.9 [8.7] years), 9751 individuals (38.6%) reported exposure to at least 1 ACE. A greater number of ACEs was associated with increased odds of any psychiatric disorder in the full cohort (odds ratio [OR] per additional ACE, 1.52; 95% CI, 1.48-1.57). The association remained but ORs per additional ACE were attenuated in DZ (1.29; 95% CI, 1.14-1.47) and MZ (1.20; 95% CI, 1.02-1.40) twin pairs. Individuals who were exposed to sexual abuse compared with those who were not exposed had increased odds of any clinically confirmed psychiatric disorder in all comparisons: full cohort (OR, 3.09; 95% CI, 2.68-3.56), DZ twin pairs (OR, 2.10; 95% CI, 1.33-3.32), and MZ twin pairs (1.80; 95% CI, 1.04-3.11).Conclusions and relevanceThis study found that associations between ACEs and adult mental health outcomes remained after controlling for shared genetic and environmental factors, which was particularly evident after multiple ACEs or sexual abuse. These findings suggest that targeted interventions may be associated with reduced risks of future psychopathology.

中文翻译：

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不良童年经历和成人心理健康结果

重要性 童年时期的不良经历 (ACE) 一直与延续到成年期的多种负面心理健康结果相关。然而，鉴于 ACE 和精神疾病在家庭内聚集，家庭混杂因素在多大程度上导致 ACE 与临床确诊的成人精神疾病之间的关联仍有待全面评估。 目的 调查 ACE 与成人心理健康结果之间的关联在调整后是否仍然存在家族（遗传和环境）混杂。设计、设置和参与者这项瑞典双胞胎队列研究使用了基于同卵 (MZ) 和异卵 (DZ) 双胞胎的不一致双胞胎设计。瑞典双胞胎登记处对1959年至1998年出生的总共25252对成年双胞胎（年龄18-47岁）进行了从19岁到2016年的随访，最长随访时间为39年。数据分析时间为 2022 年 4 月至 2023 年 11 月。暴露根据生活压力源清单中的项目评估了总共 7 种 ACE，包括家庭暴力、情感虐待或忽视、身体忽视、身体虐待、性虐待、强奸和仇恨犯罪 -在基于网络的调查中进行了修订。主要结果和措施成人（年龄大于 18 岁）精神疾病（即抑郁、焦虑、酒精或药物滥用或压力相关疾病）的临床诊断来自瑞典国家患者登记。结果在研究中纳入的 25 252 名双胞胎中（15 038 名女性 [59.6%]；ACE 评估时的平均 [SD] 年龄为 29.9 [8.7] 岁），9751 人 (38.6%) 报告暴露于至少 1 种 ACE。在整个队列中，更多的 ACE 与任何精神疾病的几率增加相关（每额外 ACE 的比值比 [OR]，1.52；95% CI，1.48-1.57）。这种关联仍然存在，但在同卵双胞胎 (1.29; 95% CI, 1.14-1.47) 和同卵双胞胎 (1.20; 95% CI, 1.02-1.40) 中，每增加 ACE 的 OR 就会减弱。在所有比较中，与未遭受性虐待的个体相比，遭受过性虐待的个体出现任何临床证实的精神疾病的几率更高：完整队列（OR，3.09；95% CI，2.68-3.56）、异卵双胞胎（OR，2.10） ; 95% CI, 1.33-3.32) 和同卵双胞胎 (1.80; 95% CI, 1.04-3.11)。结论和相关性本研究发现，在控制共同的遗传和环境因素后，ACE 与成人心理健康结果之间的关联仍然存在，这在多次 ACE 或性虐待之后尤其明显。这些发现表明，有针对性的干预措施可能与降低未来精神病理学的风险有关。