Brown J, Cohen P, Johnson J G, Smailes E M
College of Physicians and Surgeons, Columbia University, New York, USA.
J Am Acad Child Adolesc Psychiatry. 1999 Dec;38(12):1490-6. doi: 10.1097/00004583-199912000-00009.
To investigate the magnitude and independence of the effects of childhood neglect, physical abuse, and sexual abuse on adolescent and adult depression and suicidal behavior.
A cohort of 776 randomly selected children was studied from a mean age of 5 years to adulthood in 1975, 1983, 1986, and 1992 during a 17-year period. Assessments included a range of child, family, and environmental risks and psychiatric disorders. A history of abuse was determined by official abuse records and by retrospective self-report in early adulthood on 639 youths. Attrition rate since 1983 has been less than 5%.
Adolescents and young adults with a history of childhood maltreatment were 3 times more likely to become depressed or suicidal compared with individuals without such a history (p < .01). Adverse contextual factors, including family environment, parent and child characteristics, accounted for much of the increased risk for depressive disorders and suicide attempts in adolescence but not in adulthood (p < .01). The effects of childhood sexual abuse were largest and most independent of associated factors. Risk of repeated suicide attempts was 8 times greater for youths with a sexual abuse history (odds ratio = 8.40, p < .01).
Individuals with a history of sexual abuse are at greater risk of becoming depressed or suicidal during adolescence and young adulthood. Adolescence is the most vulnerable period for those youths who may attempt suicide repeatedly. Many of the apparent effects of neglect, in contrast, may be attributable to a range of contextual factors, suggesting broader focus for intervention in these cases.
探讨儿童期忽视、身体虐待和性虐待对青少年及成年期抑郁和自杀行为影响的程度及独立性。
1975年、1983年、1986年和1992年期间，对随机选取的776名儿童进行了为期17年的研究，从平均5岁追踪至成年。评估内容包括一系列儿童、家庭和环境风险以及精神疾病。通过官方虐待记录以及成年早期对639名青少年的回顾性自我报告来确定虐待史。自1983年以来的失访率低于5%。
有儿童期虐待史的青少年和青年成人出现抑郁或自杀的可能性是无此类病史者的3倍（p < 0.01）。不良环境因素，包括家庭环境、父母和孩子的特征，在很大程度上解释了青少年期患抑郁症和自杀未遂风险的增加，但在成年期并非如此（p < 0.01）。儿童期性虐待的影响最大，且最独立于相关因素。有性虐待史的青少年反复自杀未遂的风险高8倍（优势比 = 8.40，p < 0.01）。
有性虐待史的个体在青少年期和青年成人期患抑郁症或自杀的风险更高。对于那些可能反复自杀未遂的青少年来说，青春期是最脆弱的时期。相比之下，许多明显的忽视影响可能归因于一系列环境因素，这表明在这些情况下干预应更具广泛性。
