Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK.
MRC Social, Genetic and Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK.
Psychol Med. 2015;45(12):2481-98. doi: 10.1017/S0033291715000574. Epub 2015 Apr 23.
Evidence suggests that childhood adversity is associated with the development of psychotic experiences (PE), psychotic symptoms and disorders. However, less is known regarding the impact of early adversity on the persistence of PE and clinically relevant psychosis. Thus we conducted a systematic review of the association between childhood adversity and the course of PE and symptoms over time.
A systematic search of Medline, EMBASE and PsychINFO databases was undertaken to identify articles published between January 1956 and November 2014. We included studies conducted on general population samples, individuals at ultra-high risk (UHR) of psychosis, and patients with full-blown psychotic disorders. A meta-analysis was performed on a subgroup.
A total of 20 studies were included. Of these, 17 reported positive associations between exposure to overall or specific subtypes of childhood adversity and persistence of PE or clinically relevant psychotic symptoms. A meta-analysis of nine studies yielded a weighted odds ratio of 1.76 [95% confidence interval (CI) 1.19-2.32, p < 0.001] for general population studies and 1.55 (95% CI 0.32-2.77, p = 0.007) for studies conducted using clinical populations.
The available evidence is limited but tentatively suggests that reported exposure to adverse events in childhood is associated with persistence of PE and clinically relevant psychotic symptoms. This partially strengthens the case for addressing the consequences of early adversity in individuals presenting with psychotic phenomena to improve long-term outcomes. However, the heterogeneity of studies was high which urges caution in interpreting the results and highlights the need for more methodologically robust studies.
有证据表明，童年逆境与精神病性体验（PE）、精神病症状和障碍的发展有关。然而，对于早期逆境对 PE 和临床相关精神病的持续性的影响知之甚少。因此，我们对童年逆境与 PE 和症状随时间推移的相关性进行了系统综述。
系统检索了 Medline、EMBASE 和 PsychINFO 数据库，以确定 1956 年 1 月至 2014 年 11 月期间发表的文章。我们纳入了在一般人群样本、精神病超高风险（UHR）个体以及全面精神病患者中进行的研究。对一个亚组进行了荟萃分析。
共纳入 20 项研究。其中，17 项研究表明，暴露于童年期总体或特定亚型的逆境与 PE 或临床相关精神病症状的持续存在之间存在正相关。对 9 项研究的荟萃分析得出，一般人群研究的加权优势比为 1.76 [95%置信区间（CI）1.19-2.32，p < 0.001]，临床人群研究的加权优势比为 1.55 [95%置信区间（CI）0.32-2.77，p = 0.007]。
现有证据有限，但初步表明报告的童年期不良事件暴露与 PE 和临床相关精神病症状的持续存在有关。这在一定程度上支持了在出现精神病现象的个体中解决早期逆境后果以改善长期结果的观点。然而，研究的异质性很高，在解释结果时需要谨慎，并强调需要进行更具方法学稳健性的研究。
