Scott Kate M, Smith Don R, Ellis Pete M
Department of Psychological Medicine, University of Otago-Wellington, Wellington, New Zealand.
Arch Gen Psychiatry. 2010 Jul;67(7):712-9. doi: 10.1001/archgenpsychiatry.2010.71.
Evidence for an association between child maltreatment and later psychopathology heavily relies on retrospective reports of maltreatment. The few studies using prospective ascertainment of child maltreatment show weaker associations, raising the possibility that it is not maltreatment, but rather the memory of maltreatment, that raises the risk of later mental disorders.
To estimate associations between prospectively ascertained child maltreatment and a wide range of subsequently measured DSM-IV mental disorders and to show the influence of retrospectively reported maltreatment in the comparison group on these associations.
Retrospective cohort study.
Nationally representative New Zealand community.
Respondents aged 16 to 27 years (n = 2144) from a mental health survey, 221 of whom were identified as having records on a national child protection agency database.
Twelve-month and lifetime prevalence of individual DSM-IV mood, anxiety, and substance use disorders, and disorder groups assessed with the World Health Organization Composite International Diagnostic Interview.
After adjusting for demographic and socioeconomic correlates, child protection agency history was associated with several individual mental disorders, mental disorder comorbidity, and all mental disorder groups, both 12-month and lifetime. Odds of 12-month posttraumatic stress disorder were 5.12 (95% confidence interval [CI], 2.42-10.83); of any 12-month mood disorder, 1.86 (95% CI, 1.12-3.08); of any anxiety disorder, 2.41 (95% CI, 1.47-3.97); and of any substance use disorder, 1.71 (95% CI, 1.01-2.88). These associations increased in magnitude when those who retrospectively reported child maltreatment were removed from the comparison group.
Prospectively ascertained child maltreatment is significantly associated with a range of subsequent mood, anxiety, and substance use disorders, indicating that maltreatment, not just the memory of maltreatment, is associated with subsequent psychopathology. There is a need for both targeted mental health interventions with the present and past clients of child welfare agencies and for concerted population-level strategies to meet the needs of the many other children who experience maltreatment.
儿童虐待与后期精神病理学之间存在关联的证据严重依赖于对虐待行为的回顾性报告。少数使用前瞻性确定儿童虐待情况的研究显示出较弱的关联，这增加了一种可能性，即增加后期精神障碍风险的不是虐待行为本身，而是对虐待行为的记忆。
评估前瞻性确定的儿童虐待与随后测量的一系列《精神疾病诊断与统计手册》第四版（DSM-IV）精神障碍之间的关联，并展示比较组中回顾性报告的虐待行为对这些关联的影响。
回顾性队列研究。
具有全国代表性的新西兰社区。
来自一项心理健康调查的16至27岁受访者（n = 2144），其中221人被确定在国家儿童保护机构数据库中有记录。
通过世界卫生组织综合国际诊断访谈评估的个体DSM-IV情绪、焦虑和物质使用障碍以及障碍组的12个月患病率和终生患病率。
在对人口统计学和社会经济相关因素进行调整后，儿童保护机构记录与多种个体精神障碍、精神障碍共病以及所有精神障碍组在12个月和终生患病率方面均有关联。12个月创伤后应激障碍的比值比为5.12（95%置信区间[CI]，2.42 - 10.83）；任何12个月情绪障碍的比值比为1.86（95%CI，1.12 - 3.08）；任何焦虑障碍的比值比为2.41（95%CI，1.47 - 3.97）；任何物质使用障碍的比值比为1.71（95%CI，1.01 - 2.88）。当将回顾性报告有儿童虐待行为的人从比较组中排除后，这些关联的强度增加。
前瞻性确定的儿童虐待与一系列随后的情绪、焦虑和物质使用障碍显著相关，表明虐待行为本身，而不仅仅是对虐待行为的记忆，与随后的精神病理学有关。需要针对儿童福利机构的当前和过去客户进行有针对性的心理健康干预，并制定协调一致的人群层面策略，以满足许多其他遭受虐待儿童的需求。
