Anda Robert F, Brown David W, Felitti Vincent J, Bremner J Douglas, Dube Shanta R, Giles Wayne H
ACE Study Group, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3717, USA.
Am J Prev Med. 2007 May;32(5):389-94. doi: 10.1016/j.amepre.2007.01.005.
Prescription drugs are one of the fastest growing healthcare costs in the United States. However, the long-term influence of child abuse and related traumatic stressors on prescriptions for psychotropic medications in adults has not been described. This study assessed the relationship of eight adverse childhood experiences (ACEs) to rates of prescriptions for psychotropic medications throughout adulthood. These ACEs included: abuse (emotional, physical, or sexual), witnessing domestic violence, growing up with substance abusing, mentally ill, or criminal household members, and parental separation/divorce.
Data about ACEs were collected between 1995 and 1997 from adult health maintenance organization patients; prescription data were available from 1997 to 2004. The number of ACEs (ACE Score: maximum 8) was used as a measure of cumulative traumatic stress during childhood. The relationship of the score to rates of prescribed psychotropic drugs was prospectively assessed among 15,033 adult patients eligible for the follow-up phase of the study (mean follow-up: 6.1 years). Data were analyzed in 2006. Multivariate models were adjusted for age, race, gender, and education.
Prescription rates increased yearly during the follow-up and in a graded fashion as the ACE Score increased (p for trend <0.001). After adjusting compared with persons with an ACE Score of 0, persons with a score of equal to or more than 5 had a nearly threefold increase in rates of psychotropic prescriptions. Graded relationships were observed between the score and prescription rates for antidepressant, anxiolytic, antipsychotic, and mood-stabilizing/bipolar medications; rates for persons with a score of equal to or more than 5 for these classes of drugs increased 3-, 2-, 10-, and 17-fold, respectively.
The strong relationship of the ACE Score to increased utilization of psychotropic medications underscores the contribution of childhood experience to the burden of adult mental illness. Moreover, the huge economic costs associated with the use of psychotropic medications provide additional incentive to address the high prevalence and consequences of childhood traumatic stressors.
处方药是美国医疗保健费用中增长最快的项目之一。然而，儿童期虐待及相关创伤应激源对成人精神类药物处方的长期影响尚未得到描述。本研究评估了八种童年不良经历（ACEs）与成年期精神类药物处方率之间的关系。这些ACEs包括：虐待（情感、身体或性虐待）、目睹家庭暴力、与有药物滥用、精神疾病或犯罪记录的家庭成员一起长大，以及父母分居/离婚。
1995年至1997年期间收集了成人健康维护组织患者的ACEs数据；1997年至2004年的处方数据可用。ACEs的数量（ACE评分：最高8分）被用作童年期累积创伤应激的衡量指标。在15033名符合研究随访阶段条件的成年患者中（平均随访时间：6.1年），前瞻性评估了该评分与精神类药物处方率之间的关系。2006年对数据进行了分析。多变量模型对年龄、种族、性别和教育程度进行了调整。
随访期间处方率逐年上升，且随着ACE评分的增加呈分级上升趋势（趋势p<0.001）。与ACE评分为0的人相比，经调整后，评分等于或大于5的人精神类药物处方率增加了近三倍。在抗抑郁药、抗焦虑药、抗精神病药和心境稳定剂/双相情感障碍药物的评分与处方率之间观察到分级关系；这些药物类别中评分等于或大于5的人的处方率分别增加了3倍、2倍、10倍和17倍。
ACE评分与精神类药物使用增加之间的密切关系强调了童年经历对成人精神疾病负担的影响。此外，与使用精神类药物相关的巨大经济成本为解决童年创伤应激源的高患病率及其后果提供了额外的动力。
