Department of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Calzada México Xochimilco 101, Colonia San Lorenzo Huipulco, Mexico City 14370, Mexico.
Eur Child Adolesc Psychiatry. 2011 Sep;20(9):459-68. doi: 10.1007/s00787-011-0199-8. Epub 2011 Jul 17.
The purpose of this paper is to estimate the impact of chronic adversity on psychopathology in adolescents, taking into account the type of adversity, number of adversities experienced and type of psychiatric disorder, as well as to estimate the impact on severity of the disorder. A total of 3,005 male and female adolescents from the Mexican Adolescent Mental Health Survey aged 12-17 years were interviewed in a stratified multistage general population probability survey. Assessment of 20 DSM-IV disorders, disorder severity and 12 chronic childhood adversities were assessed with the adolescent version of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI-A). Family dysfunction adversities including abuse presented the most consistent associations between chronic adversity and psychopathology and their impact was generally non-specific with regard to the type of disorder. Parental divorce, parental death and economic adversity were not individually associated with psychopathology. Among those with a psychiatric disorder, sexual abuse and family violence were associated with having a seriously impairing disorder. The odds of having a psychiatric disorder and a serious disorder increased with increasing numbers of adversities; however, each additional adversity increased the odds at a decreasing rate. While the study design does not allow for conclusions regarding causality, these findings suggest general pathways from family dysfunction to psychopathology rather than specific associations between particular adversities and particular disorders, and provide further evidence for the importance of family-focused intervention and prevention efforts.
本文旨在探讨慢性逆境对青少年精神病理学的影响，同时考虑逆境的类型、经历的逆境数量和精神障碍的类型，以及对疾病严重程度的影响。研究采用分层多阶段概率抽样方法，对 3005 名年龄在 12-17 岁的墨西哥青少年进行了访谈。采用青少年版世界心理健康复合国际诊断访谈 (WMH-CIDI-A) 评估了 20 种 DSM-IV 障碍、疾病严重程度和 12 种慢性儿童逆境。家庭功能障碍包括虐待等逆境与精神病理学之间存在最一致的关联，其影响通常与障碍类型无关。父母离婚、父母去世和经济逆境与精神病理学没有单独的关联。在患有精神障碍的人群中，性虐待和家庭暴力与严重致残障碍相关。患有精神障碍和严重障碍的几率随着逆境数量的增加而增加；然而，每个额外的逆境增加的几率呈递减趋势。虽然研究设计不允许得出关于因果关系的结论，但这些发现表明，从家庭功能障碍到精神病理学存在一般途径，而不是特定逆境与特定障碍之间的特定关联，并进一步证明了以家庭为中心的干预和预防措施的重要性。
