Harkness Kate L, Wildes Jennifer E
Department of Psychology, University of Oregon, USA.
Psychol Med. 2002 Oct;32(7):1239-49. doi: 10.1017/s0033291702006177.
Childhood adversity places individuals with major depression at risk for anxiety and dysthymia co-morbidity. The goal of the present paper is to broaden this area of research by examining specificity between the type of adversity (e.g. abuse versus neglect/indifference) and the resulting co-morbid disorder (e.g. anxiety versus dysthymia co-morbidity).
The volunteer sample consisted of 76 women meeting Diagnostic and Statistical Manual (DSM-IV) criteria for major depression. Of these, 28 were diagnosed with a co-morbid anxiety disorder and 21 were diagnosed with co-morbid dysthymia. Childhood physical abuse, sexual abuse, psychological abuse, antipathy and indifference were assessed using a contextual interview and rating system.
Severe sexual abuse and psychological abuse were significantly and preferentially associated with co-morbid anxiety, while severe physical abuse was significantly and preferentially associated with co-morbid dysthymia. Indifference and antipathy were significantly associated with both co-morbid anxiety and dysthymia. Multivariate analyses revealed that severe sexual abuse was the adverse childhood experience most strongly associated with co-morbid anxiety.
These results suggest that particular adverse experiences in childhood do set up specific vulnerabilities to the expression of anxiety versus dysthymia co-morbidity in adulthood major depression. Cognitive mediators of these associations are discussed as avenues of future research.
童年逆境使重度抑郁症患者面临焦虑和心境恶劣共病的风险。本文的目的是通过研究逆境类型（如虐待与忽视/冷漠）与由此产生的共病障碍（如焦虑与心境恶劣共病）之间的特异性，来拓宽这一研究领域。
志愿者样本包括76名符合《精神疾病诊断与统计手册》（DSM-IV）重度抑郁症标准的女性。其中，28人被诊断为共病焦虑障碍，21人被诊断为共病心境恶劣。使用情境访谈和评分系统评估童年期身体虐待、性虐待、心理虐待、反感和冷漠情况。
严重性虐待和心理虐待与共病焦虑显著且优先相关，而严重身体虐待与共病心境恶劣显著且优先相关。冷漠和反感与共病焦虑和心境恶劣均显著相关。多变量分析显示，严重性虐待是与共病焦虑最密切相关的童年不良经历。
这些结果表明，童年期特定的不良经历确实会使成年期重度抑郁症患者在出现焦虑与心境恶劣共病方面产生特定的易感性。这些关联的认知中介因素作为未来研究的途径进行了讨论。
