Muenzenmaier Kristina H, Seixas Azizi A, Schneeberger Andres R, Castille Dorothy M, Battaglia Joseph, Link Bruce G
a Bronx Psychiatric Center, Albert Einstein College of Medicine , Bronx , New York , USA.
J Trauma Dissociation. 2015;16(4):442-62. doi: 10.1080/15299732.2015.1018475.
The association between stressful childhood experiences (SCE) and psychotic symptoms is still not clearly understood, and different causal pathways have been proposed. Generalized estimating equation modeling was used to test the dose-response relationship between SCE and delusions and hallucinations at baseline and follow-up periods and the possible confounding effects of dissociation on this relationship. The prevalence of SCE in individuals with psychotic disorders was high, with more co-occurring SCE categories being positively associated with more types of delusions and hallucinations. Each additional SCE was associated with a 1.20 increase in the incidence rate ratio (95% confidence interval [CI; 1.09, 1.32]) for hallucinations and a 1.19 increase (CI [1.09, 1.29]) for delusions, supporting a dose-response association. After we controlled for the mediating effects of dissociative symptoms at follow-up, SCE remained independently associated with delusions. We propose that cumulative SCE can result in complex trauma reactions that present with a broad range of symptomatology, including dissociative, posttraumatic stress disorder, and psychotic symptoms.
童年应激经历（SCE）与精神病性症状之间的关联仍未完全明确，且已提出了不同的因果途径。采用广义估计方程模型来检验基线期和随访期SCE与妄想及幻觉之间的剂量反应关系，以及解离对这种关系可能产生的混杂效应。精神病性障碍患者中SCE的患病率较高，同时出现的SCE类别越多，与更多类型的妄想和幻觉呈正相关。每增加一次SCE，幻觉的发病率比增加1.20（95%置信区间[CI；1.09，1.32]），妄想的发病率比增加1.19（CI[1.09，1.29]），支持剂量反应关联。在我们控制了随访期间解离症状的中介效应后，SCE仍与妄想独立相关。我们认为，累积的SCE可导致复杂的创伤反应，表现为广泛的症状，包括解离症状、创伤后应激障碍和精神病性症状。
