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Comment & Response
April 6, 2020

Validating the Importance of Positive Childhood Experiences on Adult Mental Health—Reply

Author Affiliations
  • 1Child and Adolescent Health Measurement Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
JAMA Pediatr. 2021;175(2):204-205. doi:10.1001/jamapediatrics.2020.0097

In Reply We are delighted that Gong et al, using methods borrowed from economics, confirmed the validity of the associations reported in our article on the association between positive childhood experiences (PCEs) and adult mental health. Although it was a rigorous population sample and both demographic and childhood adversity exposures were controlled for, the 2015 Wisconsin Behavioral Risk Factor Survey data sample size was insufficient to fully explore many other factors. However, extensive sensitivity analyses were conducted when developing the models for our study that did consider many other variables, such as health behaviors and other health conditions. In cases where samples allowed models to be fit, inclusion of these variables did not meaningfully alter estimated associations for the PCEs variable of interest and in most cases were either not statistically significant or associations were very small. No effect sizes for any additional variables were observed that approached the E-value Gong et al suggest would be required to eliminate the observed effect of PCEs. In most cases, additional variables associated with health behaviors and concurrent health conditions were not included owing to lack of sufficient sample, lack of significance or effect on PCEs associations, as well owing to concerns about multicollinearity or simultaneity. We do note that our explorations were not exhaustive and could not take into account potentially critical unobserved factors, such as noted in the letter. Clearly, although the main results are robust, further research and longitudinal study designs are needed. We hope that Gong et al will continue to bring novel methodologic techniques and approaches to better elucidate the association between a full range of childhood experiences and subsequent adult health. We are enriched by this letter’s contribution to our own work in this area.

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