慢性儿童期逆境与三个生命阶段(儿童期、青春期和成年期)精神病理学发病。

Chronic childhood adversity and onset of psychopathology during three life stages: childhood, adolescence and adulthood.

机构信息

Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.

出版信息

J Psychiatr Res. 2010 Aug;44(11):732-40. doi: 10.1016/j.jpsychires.2010.01.004. Epub 2010 Feb 9.

Abstract

BACKGROUND

The aim is to report the individual and joint effects of a range of chronic childhood adversities on the first onset of a broad range of psychiatric disorders, and to evaluate their impact at different stages of the life course in a representative sample of the Mexican population.

METHOD

The data is from the Mexican National Comorbidity Survey (M-NCS), a stratified, multistage area probability sample of persons aged 18-65. The WHO World Mental Health Composite International Diagnostic Interview (WMH-CIDI) measured 12 childhood adversities, 20 psychiatric disorders and ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset.

RESULTS

In bivariate models, all adversities (except economic adversity and parental death) were significant predictors of psychopathology; however in multivariate models which correct for the clustering of adversities, family dysfunction and abuse adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined (mood, anxiety, substance use and externalizing), and for the most part, over all three life course stages (childhood, adolescence and adulthood). The effect of the number of adversities was nonlinear such that although the odds of disorder onset increased with increasing numbers of adversities, the odds increased at a decreasing rate.

CONCLUSIONS

Childhood family dysfunction and abuse is a strong predictor of the onset of psychopathology throughout the life course, consistent with evidence for the enduring effects of chronic stress on brain structures involved in many psychiatric disorders and with stress-sensitization models of psychopathology.

摘要

背景

本研究旨在报告一系列慢性儿童逆境对广泛精神障碍首次发作的个体和联合影响,并在墨西哥代表性人群样本中评估其在生命历程不同阶段的影响。

方法

数据来自墨西哥国家共病调查(M-NCS),这是一项分层、多阶段的区域概率抽样,对象为 18-65 岁的人群。世界卫生组织(WHO)世界精神卫生复合国际诊断访谈(WMH-CIDI)测量了 12 种儿童逆境、20 种精神障碍和发病年龄。采用离散时间生存模型来估计发病的几率。

结果

在双变量模型中,所有逆境(经济逆境和父母死亡除外)都是精神病理学的显著预测因素;然而,在多元模型中,纠正了逆境的聚类,家庭功能障碍和虐待逆境是所有四类精神病理学(情绪、焦虑、物质使用和外化)最强烈和最一致的预测因素,并且在所有三个生命阶段(儿童期、青春期和成年期)都如此。逆境数量的影响是非线性的,尽管发病几率随着逆境数量的增加而增加,但增加的速度在下降。

结论

儿童期家庭功能障碍和虐待是精神病理学发病的一个强有力的预测因素,这与慢性应激对许多精神障碍相关脑结构的持久影响以及精神病理学的应激敏感化模型的证据一致。

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