Langeland Willie, Draijer Nel, van den Brink Wim
Amsterdam Institute for Addiction Research, Department of Psychiatry, Vrije Universiteit, Amsterdam, The Netherlands.
Alcohol Clin Exp Res. 2004 Mar;28(3):441-7. doi: 10.1097/01.alc.0000117831.17383.72.
This study among treatment-seeking alcoholics examined the relationship between childhood abuse (sexual abuse only [CSA], physical abuse only [CPA], or dual abuse [CDA]) and the presence of comorbid affective disorders, anxiety disorders, and suicide attempts, controlling for the potential confounding effects of other childhood adversities (early parental loss, witnessing domestic violence, parental alcoholism, and/or dysfunction) and adult assault histories.
We assessed 155 (33 females, 122 males) treatment-seeking alcoholics using the European Addiction Severity Index, the Structured Trauma Interview, and the Composite International Diagnostic Interview.
The severity of childhood abuse was associated with posttraumatic stress disorder (PTSD) and suicide attempts in females and with PTSD, social phobia, agoraphobia, and dysthymia in males. Among men, multiple logistic regression models showed that CPA and CDA were not independently associated with any of the examined comorbid disorders or with suicide attempts. However, CSA independently predicted comorbid social phobia, agoraphobia, and PTSD. For the presence of comorbid affective disorders (mainly major depression) and suicide attempts, maternal dysfunctioning was particularly important. CSA also independently contributed to the number of comorbid diagnoses. For females, small sample size precluded the use of multivariate analyses.
Childhood abuse is an important factor in understanding clinical impairment in treated alcoholics, especially regarding comorbid phobic anxiety disorders, PTSD, and suicidality. These findings underline the importance of routine assessment of childhood trauma and possible trauma-related disorders in individuals presenting to alcohol treatment services. More studies with bigger samples sizes of female alcohol-dependent patients are needed.
本研究针对寻求治疗的酗酒者，考察了童年期虐待（仅性虐待[CSA]、仅身体虐待[CPA]或双重虐待[CDA]）与共病情感障碍、焦虑障碍及自杀未遂之间的关系，并控制了其他童年期逆境（早年父母丧亡、目睹家庭暴力、父母酗酒和/或功能失调）及成年期攻击史的潜在混杂效应。
我们使用欧洲成瘾严重程度指数、结构化创伤访谈和综合国际诊断访谈，对155名（33名女性，122名男性）寻求治疗的酗酒者进行了评估。
童年期虐待的严重程度与女性的创伤后应激障碍（PTSD）及自杀未遂相关，与男性的PTSD、社交恐惧症、广场恐惧症和心境恶劣相关。在男性中，多项逻辑回归模型显示，CPA和CDA与任何所考察的共病障碍或自杀未遂均无独立关联。然而，CSA独立预测了共病的社交恐惧症、广场恐惧症和PTSD。对于共病情感障碍（主要是重度抑郁症）和自杀未遂的存在，母亲功能失调尤为重要。CSA也独立导致了共病诊断的数量增加。对于女性，样本量较小妨碍了多变量分析的使用。
童年期虐待是理解接受治疗的酗酒者临床损害的一个重要因素，尤其是在共病恐惧性焦虑障碍、PTSD和自杀倾向方面。这些发现强调了对寻求酒精治疗服务的个体进行童年期创伤及可能的创伤相关障碍常规评估的重要性。需要对更大样本量的女性酒精依赖患者进行更多研究。
