儿童期创伤暴露与成年期酒精依赖严重程度：情绪虐待严重程度和神经质的中介作用。
Childhood trauma exposure and alcohol dependence severity in adulthood: mediation by emotional abuse severity and neuroticism.
机构信息
Laboratory of Clinical and Translational Studies, National Institute on Alcohol Abuse and Alcoholism/NIH, Bethesda, MD 20892, USA.
出版信息
Alcohol Clin Exp Res. 2013 Jun;37(6):984-92. doi: 10.1111/acer.12053. Epub 2012 Dec 27.
BACKGROUND
Childhood trauma has been linked with a number of negative outcomes later in life, including alcohol dependence (AD). Previous studies have suggested a mediating role for neuroticism in the relationship between childhood trauma and psychopathology. In this study, we investigate the prevalence of multiple types of childhood trauma in treatment-seeking alcohol-dependent patients, and the associations between childhood trauma and AD severity using multiple mediation analysis.
METHODS
The prevalence of 5 types of childhood trauma-emotional abuse, sexual abuse, physical abuse, emotional neglect, and physical neglect-was assessed in treatment-seeking alcohol-dependent patients (n = 280) and healthy controls (n = 137) using the Childhood Trauma Questionnaire. Multiple mediation analyses were used to model associations between childhood trauma measures and alcohol-related outcomes, primarily the severity of AD in the alcohol-dependent sample.
RESULTS
Childhood trauma was significantly more prevalent and more severe in the alcohol-dependent subjects. In addition, childhood trauma was found to influence AD severity, an effect that was mediated by neuroticism. When individual trauma types were examined, emotional abuse was found to be the primary predictor of AD severity, both directly and through the mediating effects of the impulsivity subfacet of neuroticism. Physical abuse also had a moderate direct effect on AD severity. Mediation analysis did not reveal any association between childhood trauma and Alcohol Use Disorders Identification Test score in the nondependent control sample.
CONCLUSIONS
Childhood trauma is highly prevalent in treatment-seeking alcoholics and may play a significant role in the development and severity of AD through an internalizing pathway involving negative affect. Our findings suggest that alcoholics with a history of childhood emotional abuse may be particularly vulnerable to severe dependence.
背景
童年创伤与许多负面后果有关，包括酒精依赖症（AD）。先前的研究表明，神经质在童年创伤与精神病理学之间的关系中起中介作用。在这项研究中，我们调查了在寻求治疗的酒精依赖患者中多种类型的童年创伤的发生率，并使用多重中介分析研究了童年创伤与 AD 严重程度之间的关系。
方法
使用儿童期创伤问卷（Childhood Trauma Questionnaire）评估了 280 名寻求治疗的酒精依赖患者和 137 名健康对照者中 5 种类型的童年创伤的发生率，包括情绪虐待、性虐待、身体虐待、情感忽视和身体忽视。采用多重中介分析来建立儿童期创伤措施与酒精相关结果之间的关联模型，主要是酒精依赖组中 AD 的严重程度。
结果
童年创伤在酒精依赖患者中更为普遍和严重。此外，发现童年创伤会影响 AD 的严重程度，这种影响是通过神经质的中介作用产生的。当检查个别创伤类型时，发现情绪虐待是 AD 严重程度的主要预测因素，既直接影响，也通过神经质的冲动子维度的中介作用产生影响。身体虐待对 AD 严重程度也有中等直接影响。中介分析并未发现童年创伤与非依赖对照组中酒精使用障碍识别测试评分之间存在任何关联。
结论
童年创伤在寻求治疗的酗酒者中非常普遍，可能通过涉及负性情绪的内化途径，在 AD 的发展和严重程度中起重要作用。我们的研究结果表明，有童年情绪虐待史的酗酒者可能特别容易产生严重的依赖。
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