Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, USA.
Soc Psychiatry Psychiatr Epidemiol. 2012 Oct;47(10):1591-605. doi: 10.1007/s00127-011-0466-5. Epub 2012 Jan 13.
A considerable amount of research has examined violence experiences and psychopathology; however, few studies have examined how multiple settings and experiences of violence are associated with major depressive disorder (MDD) and generalized anxiety disorder (GAD).
The sample included 2,345 adolescents from a community-based sample in the US. The mean age was 14 years at the time that violence experiences in the home, school, and neighborhood were reported; psychiatric outcomes were assessed 2 years later using the Diagnostic Interview Schedule for Children. We applied latent class analysis to identify adolescents with common patterns of violence exposure and obtained adjusted prevalence ratios for the associations between violence classes and psychopathology.
A four-class model was selected based on fit statistics and meaningfulness, and adolescents were categorized into four classes: low violence, home violence, neighborhood violence/traumatic news, and multiple settings of violence. Relative to adolescents in the low violence class, risk of MDD for adolescents in the home violence, neighborhood violence/traumatic news, and multiple settings classes was 1.62, 1.47, and 2.44 times higher, respectively (p values <0.05); risk for GAD was 1.61 and 2.87 times higher for adolescents in the neighborhood violence/traumatic news and multiple settings classes, respectively (p values <0.05).
Exposure to a high level of violence-within a single domain or multiple domains-poses significant risk for MDD and GAD, and risk increases with high exposure in multiple domains. Thus, pervasive exposure to violence is associated with the highest risk for the development of psychopathology. Based on these results, prevention and treatment efforts should target adolescents exposed to violence in multiple settings.
大量研究已经考察了暴力经历和精神病理学；然而，很少有研究考察了多种环境和暴力经历与重度抑郁症（MDD）和广泛性焦虑症（GAD）的关系。
该样本包括来自美国基于社区的样本中的 2345 名青少年。在报告家庭、学校和社区中的暴力经历时，平均年龄为 14 岁；2 年后使用儿童诊断访谈表评估精神病理学结果。我们应用潜在类别分析来识别具有常见暴力暴露模式的青少年，并获得暴力类别与精神病理学之间关联的调整后患病率比。
基于拟合统计和意义，选择了一个四类别模型，将青少年分为四类：低暴力、家庭暴力、邻里暴力/创伤性新闻和多种暴力环境。与低暴力类别中的青少年相比，家庭暴力、邻里暴力/创伤性新闻和多种暴力环境类别的青少年患 MDD 的风险分别高出 1.62、1.47 和 2.44 倍（p 值均<0.05）；邻里暴力/创伤性新闻和多种暴力环境类别的青少年患 GAD 的风险分别高出 1.61 和 2.87 倍（p 值均<0.05）。
在单一领域或多个领域内暴露于高水平的暴力会对 MDD 和 GAD 构成重大风险，并且随着多个领域的高暴露，风险会增加。因此，普遍暴露于暴力与发展为精神病理学的风险最高。基于这些结果，预防和治疗工作应针对暴露于多种环境中的青少年。
