Validating the Importance of Positive Childhood Experiences on Adult Mental Health

To the Editor Bethell et al find a dose-response association between positive childhood experiences (PCEs) and depression/poor mental health (D/PMH) and adult-reported social/emotional support after accounting for exposure to adverse childhood experiences. In nonrandomized (real-world) data, treatment selection can be biased by unobservable confounders or inadequately measured explanatory variables, including, in this case, drug use additional to alcohol, exercise, income, wealth, education, race/ethnicity, comorbidities, family and friends, community engagement, job stress, sleep, and major life events. In this case, PCEs may serve as a proxy for such unobservable factors, suggesting that the observed adjusted odds ratio of 0.28 (95% CI, 0.21-0.39; P  <  .001) for D/PMH among those reporting 6 to 7 PCEs indeed implies a moderate degree of causality after adjusting for age, race/ethnicity, and annual income.
Source: JAMA Pediatrics - Category: Pediatrics Source Type: research