Department of Mental Health Sciences, University College London, UK.
Psychol Med. 2011 Apr;41(4):709-19. doi: 10.1017/S003329171000111X. Epub 2010 Jun 10.
Evidence is accumulating that child sexual abuse (CSA) is associated with many psychiatric disorders in adulthood. This paper uses the detailed information available from the 2007 Adult Psychiatric Morbidity Survey of England (APMS 2007) to quantify links between CSA and a range of psychiatric conditions.
The prevalence of psychiatric disorder was established in a random sample of the English household population (n=7403), which also provided sociodemographic and experiential information.
We analyzed six types of common mental disorder, alcohol abuse and drug abuse, and people who screened positively for post-traumatic stress disorder (PTSD) and eating disorders. All were strongly and highly significantly associated with CSA, particularly if non-consensual sexual intercourse was involved, for which odds ratios (ORs) ranged from 3.7 to 12.1. These disorders were also related to adult sexual abuse (ASA), although the likelihood of reverse causality is then increased. Revictimization in adulthood was common, and increased the association of CSA with disorder. For several disorders, the relative odds were higher in females but formal tests for moderation by gender were significant only for common mental disorders and only in relation to non-consensual sexual intercourse. The population attributable fraction (PAF) was higher in females in all cases.
The detailed and high-quality data in APMS 2007 provided important confirmation both of the strength of association of CSA with psychiatric disorder and of its relative non-specificity. Our results have major implications at the public health level and the individual level, in particular the need for better recognition and treatment of the sequelae of CSA.
越来越多的证据表明，儿童性虐待（CSA）与成年后患多种精神障碍有关。本文利用 2007 年英格兰成人精神疾病发病率调查（APMS 2007）中提供的详细信息，定量分析 CSA 与一系列精神疾病之间的关系。
在英格兰的家庭人群（n=7403）随机样本中确定精神疾病的患病率，该样本还提供了社会人口统计学和经验信息。
我们分析了六种常见的精神障碍、酒精滥用和药物滥用，以及对创伤后应激障碍（PTSD）和饮食失调症筛查呈阳性的人群。所有这些都与 CSA 强烈且高度显著相关，特别是如果涉及非自愿的性行为，其比值比（OR）范围从 3.7 到 12.1。这些疾病也与成人性虐待（ASA）有关，尽管随后增加了反向因果关系的可能性。成年后的再次受害很常见，并增加了 CSA 与疾病之间的关联。对于几种疾病，女性的相对优势更高，但性别调节的正式检验仅在常见精神障碍方面且仅与非自愿性行为有关时才具有统计学意义。在所有情况下，女性的人群归因分数（PAF）都更高。
APMS 2007 中的详细和高质量数据重要地证实了 CSA 与精神障碍之间的关联强度及其相对非特异性。我们的研究结果在公共卫生和个人层面都具有重大意义，特别是需要更好地认识和治疗 CSA 的后果。
