Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Psychol Med. 2010 May;40(5):847-59. doi: 10.1017/S0033291709991115. Epub 2009 Sep 7.
Despite evidence that childhood adversities (CAs) are associated with increased risk of mental disorders, little is known about their associations with disorder-related impairment. We report the associations between CAs and functional impairment associated with 12-month DSM-IV disorders in a national sample.
We used data from the US National Comorbidity Survey Replication (NCS-R). Respondents completed diagnostic interviews that assessed 12-month DSM-IV disorder prevalence and impairment. Associations of 12 retrospectively reported CAs with impairment among cases (n=2242) were assessed using multiple regression analysis. Impairment measures included a dichotomous measure of classification in the severe range of impairment on the Sheehan Disability Scale (SDS) and a measure of self-reported number of days out of role due to emotional problems in the past 12 months.
CAs were positively and significantly associated with impairment. Predictive effects of CAs on the SDS were particularly pronounced for anxiety disorders and were significant in predicting increased days out of role associated with mood, anxiety and disruptive behavior disorders. Predictive effects persisted throughout the life course and were not accounted for by disorder co-morbidity. CAs associated with maladaptive family functioning (MFF; parental mental illness, substance disorder, criminality, family violence, abuse, neglect) were more consistently associated with impairment than other CAs. The joint effects of co-morbid MFF CAs were significantly subadditive. Simulations suggest that CAs account for 19.6% of severely impairing disorders and 17.4% of days out of role.
CAs predict greater disorder-related impairment, highlighting the ongoing clinical significance of CAs at every stage of the life course.
尽管有证据表明儿童逆境（CA）与精神障碍的风险增加有关，但对于它们与障碍相关的损害之间的关系知之甚少。我们报告了在全国样本中，CA 与 12 个月 DSM-IV 障碍相关的功能损害之间的关系。
我们使用了来自美国国家共病调查再调查（NCS-R）的数据。受访者完成了诊断访谈，评估了 12 个月 DSM-IV 障碍的患病率和损害。使用多元回归分析评估了 12 项回顾性报告的 CA 与病例（n=2242）中损害之间的关系。损害测量包括在 Sheehan 残疾量表（SDS）严重损害范围内的分类的二分测量，以及过去 12 个月中由于情绪问题而失去角色的天数的自我报告测量。
CA 与损害呈正相关且具有统计学意义。CA 对 SDS 的预测作用在焦虑障碍中尤为明显，并且在预测与情绪、焦虑和破坏性行为障碍相关的增加的角色丧失天数方面具有统计学意义。预测效果贯穿整个生命过程，并且不受疾病共病的影响。与适应不良的家庭功能（MFF；父母的精神疾病、物质障碍、犯罪、家庭暴力、虐待、忽视）相关的 CA 与损害的相关性更为一致。共患 MFF CA 的联合效应明显具有亚加性。模拟表明，CA 占严重致残障碍的 19.6%，占角色丧失天数的 17.4%。
CA 预测了更大的与障碍相关的损害，突显了 CA 在生命过程的每个阶段的持续临床意义。
