童年期不良经历暴露模式与医学生焦虑症状轨迹的关联

Association between exposure patterns of adverse childhood experiences and anxiety symptom trajectories in medical college students

目的:分析童年期不良经历(ACEs)暴露模式与医学生焦虑症状轨迹的关联。方法:以安徽医学高等专科学校、安庆医药高等专科学校大一年级在校学生为研究对象,采用儿童期虐待问卷、家庭功能不全问卷、童年期不良社会经历条目以及焦虑自评量表,于2019年11至12月开始调查,之后每半年调查一次,调查至2020年11至12月。采用潜类别模型分析ACEs暴露模式,潜类别增长模型分析焦虑症状发展轨迹,多元logistic回归模型分析ACEs不同暴露模式和焦虑症状轨迹的关联。结果:共调查3662名大学生,年龄(19.2±1.0)岁。潜类别分析显示,ACEs暴露模式可分为高ACEs组(13.4%)、较高忽视/情感虐待组(25.7%)、高家庭功能不全组(6.9%)、高忽视组(27.1%)、低ACEs组(26.3%);潜类别增长模型将焦虑轨迹分为4组:高焦虑降低轨迹(7.1%)、高焦虑升高轨迹(4.1%)、中等焦虑轨迹(52.9%)、低焦虑轨迹(35.9%)。以低ACEs组为参照组,与低焦虑轨迹相比,高ACEs组、高忽视/情感虐待组、高家庭功能不全组、高忽视组与中高等水平焦虑轨迹发生的风险增加均相关(P<0.05)。结论:ACEs暴露模式在医学生人群中存在异质性,且ACEs暴露模式是焦虑症状轨迹的重要影响因素。

Objective To analyze the association between exposure patterns of adverse childhood experiences(ACEs)and anxiety symptom trajectories in medical college students.Methods A survey was conducted on first-year students from Anhui Medical College and Anqing Medical College,using the Childhood Abuse Questionnaire,Family Disability Questionnaire,Childhood Adverse Social Experience Item,and Anxiety Self Rating Scale.The baseline survey was conducted from November to December 2019,and two follow-up visits were conducted once every six months until November to December 2020.The latent class analysis(LCA)was used to analyze the exposure patterns of ACEs.The latent class growth analysis(LCGA)was used to analyze the development trajectory of anxiety symptoms.The multiple logistic regression model was used to analyze the correlation between different exposure patterns of ACEs and the trajectory of anxiety symptom trajectories.Results A total of 3662 college students aged(19.2±1.0)were surveyed.The LCA showed that the exposure patterns of ACEs could be divided into the"high ACEs"group(13.4%),"high neglect/emotional abuse"group(25.7%),"high family dysfunction"group(6.9%),"high neglect"group(27.1%),and"low ACEs"group(26.3%).The LCGA divided anxiety trajectories into four groups:"high anxiety decline"(7.1%),"anxiety increase"(4.1%),"moderate anxiety"(52.9%),and"low anxiety"(35.9%).Using the low ACEs group as a reference group,compared with the low anxiety trajectory,the high ACEs group,high neglect/emotional abuse group,high family dysfunction group,high neglect group,and medium to high-level anxiety trajectory were all associated with an increased risk(P<0.05).Conclusion There is heterogeneity in ACEs exposure patterns among medical college students,and ACEs exposure patterns are important influencing factors for anxiety symptom trajectories.