Adversidades familiares na infância, depressão e tabagismo na vida adulta: resultados do ELSA-Brasil

Abstract

Introduction: Adverse Childhood Experiences (ACEs), including adversities in a dysfunctional family environment, are highly prevalent worldwide and have a profound and lasting impact on health and well-being throughout life. Understanding the relationship between ACEs and deleterious outcomes in adulthood across different populations is crucial, especially considering the potential cumulative effect of these experiences. Objectives: This thesis aimed to investigate the associations between exposure to specific childhood adversities related to dysfunctional family environments and the existence of a dose-response gradient between the number of these exposures and depression in three follow-up visits, as well as tobacco-related behaviors in a cohort of Brazilian adults. Methods: The findings were presented in the form of two scientific articles. Article 1: A total of 12,636 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who attended the third wave of interviews and examinations (2017–2019) were eligible. Five childhood adversities related to dysfunctional family environments, assessed using the Adverse Childhood Experiences International Questionnaire (ACE-IQ), and a family adversity score (0, 1, and 2 or more) were the explanatory variables. The outcome of this study was depression across three visits, assessed using the Clinical Interview Schedule-Revised (CIS-R). Multinomial regression models estimated crude and adjusted Odds Ratios (OR) with 95% confidence intervals (95% CI) for each childhood family adversity and the family adversity score. Article 2: A total of 12,630 participants from ELSA-Brasil who attended the third wave of interviews and examinations (2017–2019) were eligible. Four childhood family adversities assessed using the Adverse Childhood Experiences International Questionnaire (ACE-IQ), and an adversity frequency score (0, 1, 2, 3, or more) were the explanatory variables. Tobacco-related behaviors included smoking status, lifetime smoking, age at smoking initiation, number of cigarettes smoked per day, duration of smoking in years, and smoking pack-years. Multinomial regression models (for smoking status, age at smoking initiation, and number of cigarettes per day) and binary regression models (for lifetime smoking) estimated crude and adjusted ORs with 95% CI for each childhood family adversity and the family adversity score. Generalized linear models with a gamma distribution estimated the magnitude of the associations, expressed as the ratio of arithmetic means (RAM) and 95% CI, for smoking duration and smoking pack-years. Results: Article 1: The mean age was 59.6 years (SD = 8.8); 7.4% had depression in one visit, and 2.2% in two or three visits. After adjustments, compared to the absence of childhood family adversity, the presence of parental mental illness (OR: 3.91; 95% CI: 2.94–5.21), substance abuse (OR: 2.14; 95% CI: 1.65–2.77), and parental separation (OR: 1.55; 95% CI: 1.12–2.15) increased the likelihood of depression in two or three visits. Exposure to two or more family adversities increased the likelihood of depression in one visit and in two or three visits, showing a dose-response gradient. Parental death was not associated with the outcomes. Article 2: A total of 9% were current smokers, 30.3% were former smokers, and 39.3% had smoked at least once in their lifetime. Among participants, 10.9% initiated smoking by age 14, and 14.7% smoked more than 20 cigarettes per day. Substance abuse in the family environment, parental mental illness, incarceration/conviction, and parental separation were associated with higher odds of lifetime smoking, smoking status, early smoking initiation (by age 14), and number of cigarettes per day. A dose-response gradient was identified in the association between the family adversity score and these behaviors. Incarceration/conviction and parental separation were not associated with smoking pack-years or smoking duration. Conclusion: Our findings confirm the association between childhood adversities in the family environment and both the occurrence and recurrence of depression in adulthood, as well as tobacco-related behaviors in adult life. The results support that the accumulation of childhood family adversities exhibits a dose-response association with depression and tobacco-related behaviors.