Adverse childhood experiences and mental health symptoms among aviation shift workers in China: A national cohort study.

BACKGROUND

Adverse childhood experiences (ACEs) are known risk factors for mental health issues in adulthood. Shift workers, especially those in high-stress roles like aviation, are particularly vulnerable to these mental health conditions. However, limited research has explored the relationship between ACE exposure and mental health in this population.

METHODS

This cross-sectional study used data from the Civil Aviation Health Cohort of China (November to December 2023). Aviation personnel (aged 18-60) reported 11 ACE types, categorized by count and latent class analysis. Mental health symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and a single-item screener for depression, anxiety, and suicidal ideation, respectively.

RESULTS

The study analyzed 19,137 aviation personnel (61.7% male, mean age 31.7 years). Latent class analysis identified three ACE patterns: low ACE (96.5%), abuse (2.8%), and family dysfunction (0.7%). Notably, 22.6% reported ≥1 ACE and 1.2% reported ≥4, showing a dose-response association with mental health risks. Family dysfunction showed the strongest associations with depression (AOR 5.22, 95% CI 3.80-7.17), anxiety (AOR 3.94, 95% CI 2.82-5.50), and suicidal ideation (AOR 4.46, 95% CI 2.55-7.82).

LIMITATIONS: The cross-sectional design precludes causal inference. The reliance on retrospective self-report of ACEs may be subject to recall bias. Potential residual confounding and selection bias further limit generalizability.

CONCLUSIONS

These findings highlight the need for workplace mental health strategies to support shift workers, particularly those with a history of ACEs. Further research is needed on mechanisms linking ACEs to aviation shift workers' mental health and potential protective factors.