Aas M, Etain B, Bellivier F, Henry C, Lagerberg T, Ringen A, Agartz I, Gard S, Kahn J-P, Leboyer M, Andreassen O A, Melle I
KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Norway.
AP-HP, Hôpital H. Mondor - A. Chenevier, Pôle de Psychiatry, Créteil, France.
Psychol Med. 2014 Jun;44(8):1653-62. doi: 10.1017/S0033291713002316. Epub 2013 Sep 13.
Previous studies of bipolar disorders indicate that childhood abuse and substance abuse are associated with the disorder. Whether both influence the clinical picture, or if one is mediating the association of the other, has not previously been investigated.
A total of 587 patients with bipolar disorders were recruited from Norway and France. A history of childhood abuse was obtained using the Childhood Trauma Questionnaire. Diagnosis and clinical variables, including substance abuse, were based on structured clinical interviews (Structured Clinical Interview for DSM-IV Axis I disorders or French version of the Diagnostic Interview for Genetic Studies).
Cannabis abuse was significantly associated with childhood abuse, specifically emotional and sexual abuse (χ 2 = 8.63, p = 0.003 and χ 2 = 7.55, p = 0.006, respectively). Cannabis abuse was significantly associated with earlier onset of the illness (z = -4.17, p < 0.001), lifetime history of at least one suicide attempt (χ 2 = 11.16, p = 0.001) and a trend for rapid cycling (χ 2 = 3.45, p = 0.06). Alcohol dependence was associated with suicide attempt (χ 2 = 10.28, p = 0.001), but not with age at onset or rapid cycling. After correcting for possible confounders and multiple testing, a trend was observed for an interaction between cannabis abuse and childhood abuse and suicide attempt (logistic regression: r 2 = 0.06, p = 0.039). Significant additive effects were also observed between cannabis abuse and childhood abuse on earlier age at onset (p < 0.001), increased rapid cycling and suicide attempt (logistic regression: r 2 = 0.03-0.04, p < 0.001). No mediation effects were observed; childhood abuse and cannabis abuse were independently associated with the disorder.
Our study is the first to demonstrate significant additive effects, but no mediation effects, between childhood abuse and cannabis abuse on increased clinical expressions of bipolar disorders.
先前关于双相情感障碍的研究表明，童年期受虐和物质滥用与该疾病有关。两者是否都影响临床表现，或者其中一个是否介导了另一个的关联，此前尚未进行研究。
从挪威和法国招募了总共587名双相情感障碍患者。使用儿童创伤问卷获取童年期受虐史。诊断和临床变量，包括物质滥用，基于结构化临床访谈（《精神疾病诊断与统计手册》第四版轴I障碍结构化临床访谈或遗传研究诊断访谈的法语版本）。
大麻滥用与童年期受虐显著相关，特别是情感虐待和性虐待（χ2 = 8.63，p = 0.003和χ2 = 7.55，p = 0.006）。大麻滥用与疾病更早发作显著相关（z = -4.17，p < 0.001），有至少一次自杀未遂的终生史（χ2 = 11.16，p = 0.001）以及快速循环的趋势（χ2 = 3.45，p = 0.06）。酒精依赖与自杀未遂相关（χ2 = 10.28，p = 0.001），但与发病年龄或快速循环无关。在校正可能的混杂因素和多重检验后，观察到大麻滥用与童年期受虐和自杀未遂之间存在交互作用的趋势（逻辑回归：r2 = 0.06，p = 0.039）。在发病年龄更早、快速循环增加和自杀未遂方面，大麻滥用与童年期受虐之间也观察到显著的相加效应（逻辑回归：r2 = 0.03 - 0.04，p < 0.001）。未观察到中介效应；童年期受虐和大麻滥用与该疾病独立相关。
我们的研究首次证明童年期受虐和大麻滥用之间对双相情感障碍临床症状增加有显著的相加效应，但无中介效应。
