McMaster University, Department of Psychiatry and Behavioural Neuroscience, Offord Centre for Child Studies, 1280 Main Street West, Chedoke Site, Patterson Building, Hamilton, ON L8S 3K1, Canada.
J Psychiatr Res. 2012 Nov;46(11):1475-82. doi: 10.1016/j.jpsychires.2012.08.004. Epub 2012 Sep 6.
Previous research has shown that various childhood risk factors are related to depression and chronic physical conditions (CPCs) later in life. However, little is known about risk factors associated with comorbidity for these conditions. The purpose of this study was to examine the association between individual (school performance, childhood physical and sexual abuse) and family risk variables (socioeconomic status, parental mental health, medical condition, and functional limitation) with depression only, chronic pain conditions (back pain and headaches) or other CPCs (respiratory, cardiovascular and digestive disorders, and diabetes) and the comorbidity of either CPC category with depression assessed in early adulthood.
We used data from the Ontario Child Health Study, a prospective, population-based study of 3294 children (ages 4-16) enrolled in 1983 and meeting inclusion criteria at follow-up in 2001 (N = 1475; ages 21-35 years).
Using multinomial logistic regression models, controlling for sex and age, childhood history of physical abuse was associated with most outcomes (OR = 1.86, 95% confidence interval [CI] 1.16-2.97 to 4.36, 95% CI, 1.74-10.97). Parental mental health, childhood functional limitation, childhood history of sexual abuse and family functioning were all related to comorbid depression and chronic pain conditions. Parental mental health was also related to increased risk of other CPCs (ORs = 1.66; 95% CI, 1.08-2.55).
We found that the greatest disease risk (comorbid depression and chronic pain conditions) was related to the greatest number of childhood risk factors. Although there was some evidence of specificity, there was overlap in childhood physical abuse predicting almost all outcomes. Efforts targeting the prevention and treatment of childhood maltreatment are critical in order to prevent the long lasting impact of childhood adversity on mental and physical outcomes in early adulthood.
先前的研究表明，各种儿童时期的风险因素与成年后抑郁和慢性躯体疾病（CPCs）有关。然而，对于与这些疾病共病相关的风险因素知之甚少。本研究旨在探讨个体（学业成绩、儿童期身体和性虐待）和家庭风险变量（社会经济地位、父母心理健康、医疗状况和功能限制）与仅抑郁、慢性疼痛疾病（背痛和头痛）或其他 CPC（呼吸、心血管和消化系统疾病以及糖尿病）之间的关联，以及在成年早期评估的任何 CPC 类别与抑郁的共病情况。
我们使用了安大略省儿童健康研究的数据，这是一项针对 3294 名儿童（4-16 岁）的前瞻性、基于人群的研究，这些儿童在 1983 年入组并在 2001 年随访时符合纳入标准（N=1475；年龄 21-35 岁）。
使用多项逻辑回归模型，控制性别和年龄因素，儿童期身体虐待史与大多数结果相关（OR=1.86，95%置信区间[CI]1.16-2.97 至 4.36，95%CI，1.74-10.97）。父母心理健康、儿童期功能限制、儿童期性虐待史和家庭功能均与抑郁和慢性疼痛共病有关。父母心理健康也与其他 CPC 风险增加有关（ORs=1.66；95%CI，1.08-2.55）。
我们发现，最大的疾病风险（抑郁和慢性疼痛共病）与最多的儿童时期风险因素有关。尽管存在一些特异性证据，但儿童期身体虐待几乎可以预测所有结果。针对儿童期虐待的预防和治疗的努力至关重要，以防止儿童逆境对成年早期心理和身体结果产生持久影响。
