Sansone Randy A, Jordan Bohinc R, Wiederman Michael W
Departments of Psychiatry (Dr Sansone) and Internal Medicine (Drs Sansone and Bohinc), Wright State University School of Medicine, Dayton, Ohio; Department of Psychiatry Education, Kettering Medical Center, Kettering, Ohio (Dr Sansone); and Department of Psychology, Columbia College, Columbia, South Carolina (Dr Wiederman).
Prim Care Companion CNS Disord. 2014 Nov 13;16(6). doi: 10.4088/PCC.14m01692. eCollection 2014.
Beyond the examination of medication compliance among individuals with substance abuse or human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), few studies have examined relationships between childhood trauma and health care compliance in adulthood-the focus of the present study.
Using a cross-sectional approach and a self-report survey methodology, we examined 5 types of childhood trauma (ie, witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) in relationship to 4 measures of general health care compliance (ie, self-rated general conscientiousness with medical treatment; 5 items pertaining to general health care compliance such as scheduling regular dental checkups, timely arrival for doctor's appointments, and timely completion of laboratory work; 2 medication compliance items; and the Medical Outcomes Study general adherence score) among a sample of adult primary care outpatients (N = 272). Data were collected in March 2014.
According to findings, some health care adherence variables demonstrated relationships with the summed childhood trauma score, whereas others did not. It could be interpreted that the more subjective health care compliance variables (eg, self-rated conscientiousness with regard to medical treatment) demonstrated no relationship with a summed childhood trauma score, whereas the more objective health care compliance variables (eg, frequency of regular dental checkups, ability to remember to take all medications, Medical Outcomes Study general adherence score) did demonstrate statistically significant relationships with a summed childhood trauma score (most at P < .01).
Patients with histories of childhood trauma demonstrate some deficits with health care compliance in comparison to those without childhood trauma. One interpretation is that the mistreated appear to believe that they are fairly compliant with health care treatment, but objective variables appear to suggest otherwise.
除了对药物滥用或感染人类免疫缺陷病毒（HIV）/获得性免疫缺陷综合征（AIDS）的个体的用药依从性进行研究外，很少有研究探讨童年创伤与成年期医疗保健依从性之间的关系，而这正是本研究的重点。
我们采用横断面研究方法和自我报告调查方法，在272名成年初级保健门诊患者样本中，研究了5种童年创伤（即目睹暴力、身体忽视、情感虐待、身体虐待、性虐待）与4种一般医疗保健依从性指标（即自我评定的总体医疗治疗自觉性；与一般医疗保健依从性相关的5个项目，如安排定期牙科检查、按时赴约看医生以及及时完成实验室检查；2个用药依从性项目；以及医疗结果研究总体依从性评分）之间的关系。数据于2014年3月收集。
根据研究结果，一些医疗保健依从性变量与童年创伤总分存在关联，而其他变量则没有。可以这样解释，更主观的医疗保健依从性变量（例如自我评定的医疗治疗自觉性）与童年创伤总分没有关联，而更客观的医疗保健依从性变量（例如定期牙科检查的频率、记得服用所有药物的能力、医疗结果研究总体依从性评分）与童年创伤总分确实存在统计学上的显著关联（大多数P <.01）。
与没有童年创伤的患者相比，有童年创伤史的患者在医疗保健依从性方面存在一些不足。一种解释是，受虐待者似乎认为他们相当遵守医疗保健治疗，但客观变量似乎表明并非如此。
