Department of Psychiatry, 9500 Gilman Dr, La Jolla, CA 92093-0737.
Psychosom Med. 2014 Jan;76(1):2-11. doi: 10.1097/PSY.0000000000000010. Epub 2013 Dec 12.
This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship.
Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random-effects model was used to estimate the pooled odds ratio and 95% confidence interval. Planned subgroup analyses and meta-regression examined potential moderators.
Individuals who reported exposure to trauma were 2.7 (95% confidence interval = 2.27-3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than that with sexual or physical abuse. The association of reported trauma with chronic fatigue syndrome was larger than the association with either irritable bowel syndrome or fibromyalgia. Studies using nonvalidated questionnaires or self-report of trauma reported larger associations than did those using validated questionnaires.
Findings are consistent with the hypothesis that traumatic events are associated with an increased prevalence of functional somatic syndromes. The analyses also highlight limitations of the existing literature and emphasize the importance of prospective studies, examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.
本荟萃分析系统地考察了报告的心理创伤和创伤后应激障碍（PTSD）与包括纤维肌痛、慢性广泛性疼痛、慢性疲劳综合征、颞下颌关节紊乱和肠易激综合征在内的功能性躯体综合征之间的关联。我们的目标是确定该关联的总体效应大小，并检查该关系的调节因素。
文献检索确定了 71 项具有对照组或比较组的研究，并考察了综合征与创伤性事件之间的关联，这些事件包括儿童期或成年期持续发生的心理、情感、性或身体虐待、战斗暴露或 PTSD。使用随机效应模型估计合并的优势比和 95%置信区间。计划的亚组分析和荟萃回归检验了潜在的调节因素。
报告暴露于创伤的个体发生功能性躯体综合征的可能性是未暴露于创伤个体的 2.7 倍（95%置信区间=2.27-3.10）。这种关联在存在出版偏倚和文献总体质量较低的情况下仍然稳健。与性或身体虐待相比，与 PTSD 的关联幅度更大。报告的创伤与慢性疲劳综合征的关联大于与肠易激综合征或纤维肌痛的关联。使用非验证性问卷或创伤的自我报告进行的研究报告的关联大于使用验证性问卷进行的研究。
研究结果与创伤事件与功能性躯体综合征患病率增加的假设一致。分析还突出了现有文献的局限性，并强调了前瞻性研究的重要性，这些研究应考察这些疾病的潜在相似性和差异，并对创伤、PTSD 和功能性躯体综合征之间联系的机制进行假设驱动研究。
