Elliott Jennifer C, Stohl Malka, Wall Melanie M, Keyes Katherine M, Skodol Andrew E, Eaton Nicholas R, Shmulewitz Dvora, Goodwin Renee D, Grant Bridget F, Hasin Deborah S
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
New York State Psychiatric Institute, New York, NY, USA.
Addiction. 2016 May;111(5):913-23. doi: 10.1111/add.13292. Epub 2016 Feb 18.
Persistent cases of alcohol and nicotine dependence are associated with considerable morbidity and mortality, and are predicted by childhood maltreatment and personality disorders. Our aim was to test whether personality disorders (individually or conjointly) mediate the relationship between childhood maltreatment and the persistence of dependence.
Personality disorders, modeled dimensionally, were tested as mediators of the relationship between childhood maltreatment and the 3-year persistence of alcohol and nicotine dependence in participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had current alcohol and nicotine dependence in their baseline interview. Individual personality disorders were assessed in separate models. Then, those that were significant were examined jointly in multiple mediator models to determine their total and unique effects.
A large, nationally representative US survey.
Participants ≥ 18 years who completed baseline and 3-year follow-up NESARC interviews who had baseline alcohol dependence (n = 1172; 68% male) or nicotine dependence (n = 4017; 52.9% male).
Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-IV) measures of childhood maltreatment, personality disorders and alcohol/nicotine dependence.
Individual models indicated that many personality disorders mediated the relationship between childhood maltreatment and the 3-year persistence of alcohol and nicotine dependence (each explaining 6-46% of the total effect, Ps < 0.05). In multiple mediator models, borderline and antisocial symptoms remained significant mediators, each explaining 20-37% of the total effect (Ps < 0.01).
Personality disorder symptoms (especially borderline and antisocial) help explain the association between childhood maltreatment and persistent alcohol and nicotine dependence.
酒精和尼古丁持续依赖病例与相当高的发病率和死亡率相关，童年期受虐及人格障碍可预测此类情况。我们的目的是检验人格障碍（单独或共同作用）是否介导童年期受虐与持续依赖之间的关系。
以维度建模的人格障碍被作为童年期受虐与酒精和尼古丁持续依赖3年情况之间关系的中介因素进行检验，研究对象为全国酒精及相关状况流行病学调查（NESARC）中在基线访谈时存在当前酒精和尼古丁依赖的参与者。在单独模型中评估个体人格障碍。然后，在多个中介模型中联合检验那些具有显著意义的人格障碍，以确定它们的总体和独特效应。
一项具有全国代表性的大型美国调查。
年龄≥18岁，完成NESARC基线和3年随访访谈，基线时存在酒精依赖（n = 1172；68%为男性）或尼古丁依赖（n = 4017；52.9%为男性）的参与者。
使用酒精使用障碍及相关残疾访谈表（AUDADIS-IV）测量童年期受虐、人格障碍及酒精/尼古丁依赖情况。
个体模型表明，许多人格障碍介导了童年期受虐与酒精和尼古丁3年持续依赖之间的关系（每种人格障碍解释总效应的6 - 46%，P < 0.05）。在多个中介模型中，边缘型和反社会症状仍是显著的中介因素，每种症状解释总效应的20 - 37%（P < 0.01）。
人格障碍症状（尤其是边缘型和反社会型）有助于解释童年期受虐与持续酒精和尼古丁依赖之间的关联。
