Trauelsen Anne Marie, Bendall Sarah, Jansen Jens Einar, Nielsen Hanne-Grethe Lyse, Pedersen Marlene Buch, Trier Christopher Høier, Haahr Ulrik H, Simonsen Erik
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Psychiatric Research Unit, Region Zealand Psychiatry Roskilde, Roskilde, Denmark; Early Psychosis Intervention Center, Region Zealand Psychiatry Roskilde, Roskilde, Denmark.
Centre for Youth Mental Health,The University of Melbourne, Australia; Orygen: The National Centre of Excellence in Youth Mental Health, Australia.
Schizophr Res. 2015 Jun;165(1):52-9. doi: 10.1016/j.schres.2015.03.014. Epub 2015 Apr 11.
Reviews conclude that childhood and adolescence sexual, physical, emotional abuse and emotional and physical neglect are all risk factors for psychosis. However, studies suggest only some adversities are associated with psychosis. Dose-response effects of several adversities on risk of psychosis have not been consistently found. The current study aimed to explore adversity specificity and dose-response effects of adversities on risk of psychosis.
Participants were 101 persons with first-episode psychosis (FEP) diagnosed with ICD-10 F20 - F29 (except F21) and 101 non-clinical control persons matched by gender, age and parents' socio-economic status. Assessment included the Childhood Trauma Questionnaire and parts of the Childhood Experience of Care and Abuse Questionnaire.
Eighty-nine percent of the FEP group reported one or more adversities compared to 37% of the control group. Childhood and adolescent sexual, physical, emotional abuse, and physical and emotional neglect, separation and institutionalization were about four to 17 times higher for the FEP group (all p<0.01). The risk of psychosis increased two and a half times for each additional adversity. All associations between specific adversities and psychosis decreased when they were adjusted for other adversities.
Our findings suggest that there is a large shared effect of adversities on the risk of psychosis. Contrary to the call for further research into specific adversities, we suggest a search for mechanisms in the shared effects of traumatization. Clinical implications are thorough assessment of adversities and their possible effects.
综述得出结论，童年期和青春期的性虐待、身体虐待、情感虐待以及情感忽视和身体忽视均为精神病的风险因素。然而，研究表明只有部分不良经历与精神病有关。尚未一致发现多种不良经历对精神病风险的剂量反应效应。本研究旨在探讨不良经历的特异性以及不良经历对精神病风险的剂量反应效应。
参与者为101例首次发作精神病（FEP）患者，根据国际疾病分类第十版（ICD - 10）诊断为F20 - F29（F21除外），以及101名非临床对照者，后者在性别、年龄和父母社会经济地位方面与之匹配。评估包括儿童创伤问卷以及儿童关爱与虐待经历问卷的部分内容。
89%的FEP组报告有一项或多项不良经历，而对照组这一比例为37%。FEP组童年期和青春期的性虐待、身体虐待、情感虐待、身体和情感忽视、分离及机构养育经历的发生率比对照组高约4至17倍（均p<0.01）。每增加一项不良经历，患精神病的风险增加2.5倍。当对特定不良经历与精神病之间的关联进行其他不良经历调整后，所有关联均减弱。
我们的研究结果表明，不良经历对精神病风险有很大的共同影响。与呼吁进一步研究特定不良经历相反，我们建议探寻创伤共同影响中的机制。临床意义在于全面评估不良经历及其可能产生的影响。
