背景:不良儿童经历(ACE)通常在一般人群中观察到,并且通常具有持久的神经和生理影响。以前的研究已经发现暴露于ACE之间的联系,头痛,和成人的功能困难。然而,关于ACEs暴露与儿童头痛相关的机制知之甚少.
目的:为了研究儿童接触ACEs与头痛之间的关系,以及功能困难是否会调解这种联系。
方法:这项横断面二次分析研究的数据来自2017-2018年全国儿童健康调查。这项研究中分析的样本是40,953名3至17岁的儿童。我们针对采样设计的复杂性进行了调整,并使用结构方程模型来检查功能困难在暴露于ACE和头痛之间的关联中的中介作用。
结果:基于父报告,我们发现4.1%(1697/40,953)的儿童报告频繁或严重的头痛,9.5%(3906/40,953)暴露于三种或更多种ACE。大约四分之一的儿童(23.4%;9601/40,953)至少有一个功能困难。结果表明,ACEs暴露与功能困难直接相关(β=0.16,p<0.001,95%CI=0.15-0.17),功能障碍与头痛呈正相关(β=0.17,p<0.001,95%CI=0.12-0.22)。间接效应的Sobel检验表明,功能困难部分介导了ACEs暴露与头痛之间的关联(β=0.027,p<0.001,95%CI=0.022-0.029)。此外,年龄较大的儿童和脑损伤儿童更有可能报告头痛。
结论:这项研究的结果表明,儿童接触ACE与头痛之间存在关联。和功能困难部分调解了这种联系。
BACKGROUND: Adverse childhood experiences (ACEs) are commonly observed in the general population and often have lasting neurological and physiological effects. Previous studies have found links between exposure to ACEs, headaches, and functional difficulties in adults. However, little is known about the mechanisms through which exposure to ACEs is associated with headaches among children.
OBJECTIVE: To examine the association between exposure to ACEs and headaches in children, and whether functional difficulties mediate this association.
METHODS: Data for this cross-sectional secondary analysis
study came from the 2017-2018 National Survey of Children\'s Health. The sample analyzed in this
study was 40,953 children who were between ages 3 and 17 years. We adjusted for the complexity of the sampling design and used structural equation modeling to examine the mediating effect of functional difficulties in the association between exposure to ACEs and headaches.
RESULTS: Based on parent reports, we found that 4.1% (1697/40,953) of the children reported frequent or severe headaches, and 9.5% (3906/40,953) were exposed to three or more ACEs. About one in four children (23.4%; 9601/40,953) had at least one functional difficulty. The results show that exposure to ACEs was directly positively associated with functional difficulties (β = 0.16, p < 0.001, 95% CI = 0.15-0.17), and functional difficulties were in turn positively associated with headaches (β = 0.17, p < 0.001, 95% CI = 0.12-0.22). The Sobel test of indirect effect showed that functional difficulties partially mediated the association between exposure to ACEs and headaches (β = 0.027, p < 0.001, 95% CI = 0.022-0.029). Also, older children and children with brain injury were more likely to report experiencing headaches.
CONCLUSIONS: The findings from this
study suggest an association between exposure to ACEs and headaches among children, and functional difficulties partially mediate this association.