Brown George R, McBride Linda, Bauer Mark S, Williford William O
Mountain Home VAMC and East Tennessee State University, Johnson City, TN, USA.
J Affect Disord. 2005 Dec;89(1-3):57-67. doi: 10.1016/j.jad.2005.06.012. Epub 2005 Oct 4.
The association between early childhood abuse and the course of illness, including psychiatric comorbidities, in adults with bipolar disorder has not been examined in a predominantly male or veteran population.
As part of the VA Cooperative Study 430, "Reducing the Efficacy-Effectiveness Gap in Bipolar Disorder," 330 veterans (91% male) with bipolar I or II disorder who were enrolled in a 3-year prospective study were examined for baseline data obtained at study entry. Diagnoses were determined by the use of the SCID. A semistructured interview designed to elicit data about exposure to childhood physical, sexual, or combined abuse was conducted as part of baseline demographic and clinical information. Other reports from this data set have not addressed the issues of childhood adversity.
Childhood abuse was reported by 48.3% of the subjects (47.3% of men). Any abuse (AA) was reported by 48.3%; sexual abuse without physical abuse (SA) was reported by 8%, physical abuse without sexual abuse (PA) by 20.7%, and both types of abuse (combined abuse, CA) by 18.7% of the male subjects. Female veterans reported more SA (27%) and less PA (6.7%). AA subjects were more likely to have current PTSD and lifetime diagnoses of panic disorder and alcohol use disorders. CA was associated with lower SF-36 Mental scores, higher likelihood of current PTSD and lifetime diagnoses of alcohol use disorders, as well as more lifetime episodes of major depression and higher likelihood of at least one suicide attempt. Younger age at study entry was associated with AA and PA.
Potential limitations include generalizability beyond the male, veteran population of patients with bipolar disorder and the methodology used to elicit abuse histories.
Similar to studies of predominantly female nonveteran samples, this study extends the finding that a history of childhood abuse acts as a disease course modifier in male veterans with bipolar disorder. Clinicians should routinely seek information regarding abuse and be aware that these patients may be more difficult to treat than bipolar patients who have no abuse histories.
在以男性为主的人群或退伍军人中，尚未对童年期受虐与双相情感障碍成年患者的病程（包括精神共病）之间的关联进行研究。
作为退伍军人事务部合作研究430“缩小双相情感障碍疗效与效果差距”的一部分，对330名患有双相I型或II型障碍且参加了一项为期3年的前瞻性研究的退伍军人（91%为男性）进行了研究，以获取研究开始时的基线数据。诊断由SCID确定。作为基线人口统计学和临床信息的一部分，进行了一项半结构化访谈，旨在收集有关童年期身体虐待、性虐待或两者皆有的虐待经历的数据。该数据集的其他报告尚未涉及童年期逆境问题。
48.3%的受试者报告有童年期受虐经历（男性受试者中为47.3%）。48.3%的受试者报告有任何一种虐待（AA）；8%的男性受试者报告有非身体虐待的性虐待（SA），20.7%报告有非性虐待的身体虐待（PA），18.7%报告有两种类型的虐待（混合虐待，CA）。女性退伍军人报告有更多的SA（27%）和更少的PA（6.7%）。AA受试者更有可能目前患有创伤后应激障碍（PTSD），且终生诊断患有惊恐障碍和酒精使用障碍。CA与较低的SF - 36精神评分、目前患有PTSD的更高可能性、终生诊断患有酒精使用障碍、更多的终生重度抑郁发作次数以及至少一次自杀未遂的更高可能性相关。研究开始时年龄较小与AA和PA相关。
潜在的局限性包括该研究结果能否推广到双相情感障碍患者中的男性退伍军人以外的人群，以及用于获取虐待史的方法。
与主要针对非退伍军人女性样本的研究类似，本研究扩展了以下发现：童年期受虐史在患有双相情感障碍的男性退伍军人中是疾病病程的一个调节因素。临床医生应常规询问有关受虐的信息，并意识到这些患者可能比没有受虐史的双相情感障碍患者更难治疗。
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