Parsaik Ajay K, Abdelgawad Noha, Chotalia Jigar K, Lane Scott D, Pigott Teresa A
PARSAIK, ABDELGAWAD, CHOTALIA, LANE, and PIGOTT: Department of Psychiatry and Behavioral Sciences, The University of Texas Medical School at Houston, Houston, TX.
J Psychiatr Pract. 2017 Jan;23(1):36-43. doi: 10.1097/PRA.0000000000000202.
The prevalence of childhood trauma and its impact on clinical outcomes in hospitalized patients with mood disorders is unknown. We studied the frequency of childhood trauma among inpatient adults with mood disorders and its association with clinical outcomes.
Patients admitted to our hospital with a primary diagnosis of mood disorders completed the short form of the Early Trauma Inventory-Self-Report (ETISR-SF), the Sheehan Disability Scale, and the Clinician-Rated Dimensions of Psychosis Symptom Severity scale. A regression model adjusted for multiple comparisons was used to examine the association between scores on the ETISR-SF and clinical outcomes.
Subjects were 167 patients, all of whom reported ≥1 types of childhood trauma: 90% general trauma, 75% physical abuse, 71% emotional abuse, 50% sexual abuse, and 35% all 4 types of abuse. The subtypes of abuse did not differ by sex or race. Diagnoses in the sample were bipolar disorder 56%, major depressive disorder 24%, schizoaffective disorder 14%, and substance-induced mood disorder 5%. The mean age in the sample was 35±11.5 years, 53% were male, and 64% also had substance abuse disorders. Higher scores on the ETISR-SF were associated with longer hospital stays [odds ratio (OR)=1.13; 95% confidence interval (CI), 1.05-1.22], and greater disruption of work/school life (OR=1.12; 95% CI, 1.04-1.21). There was also a trend for higher ETISR-SF scores to be associated with more severe psychotic symptoms (OR=1.13; 95% CI, 1.01-1.27) and more disruption in social (OR=1.14; 95% CI, 1.06-1.22) and family life (OR=1.09; 95% CI, 1.02-1.17).
Childhood trauma was reported by all of the 167 patients, with general trauma the most common and approximately half reporting sexual abuse. Childhood trauma was associated with poor clinical outcomes. Early recognition of trauma and trauma-related therapeutic interventions may improve outcomes.
儿童期创伤的患病率及其对住院情绪障碍患者临床结局的影响尚不清楚。我们研究了成年住院情绪障碍患者中儿童期创伤的发生频率及其与临床结局的关联。
以情绪障碍为主要诊断入院的患者完成了《早期创伤量表-自我报告简表》（ETISR-SF）、《希恩残疾量表》以及《临床医生评定的精神病症状严重程度维度量表》。采用经多重比较调整的回归模型来检验ETISR-SF得分与临床结局之间的关联。
研究对象为167名患者，他们均报告了≥1种类型的儿童期创伤：90%为一般性创伤，75%为身体虐待，71%为情感虐待，50%为性虐待，35%报告了所有4种虐待类型。虐待亚型在性别或种族方面无差异。样本中的诊断包括双相情感障碍56%、重度抑郁症24%、分裂情感性障碍14%以及物质所致情绪障碍5%。样本的平均年龄为35±11.5岁，53%为男性，64%还患有物质使用障碍。ETISR-SF得分较高与住院时间延长相关[比值比（OR）=1.13；95%置信区间（CI），1.05 - 1.22]，以及工作/学校生活受到更大干扰（OR=1.12；95% CI，1.04 - 1.21）。ETISR-SF得分较高还有与更严重的精神病症状（OR=1.13；95% CI，1.01 - 1.27）以及社交（OR=1.14；95% CI，1.06 - 1.22）和家庭生活受到更大干扰（OR=1.09；95% CI，1.02 - 1.17）相关的趋势。
167名患者均报告有儿童期创伤，一般性创伤最为常见，约半数报告有性虐待。儿童期创伤与不良临床结局相关。早期识别创伤及与创伤相关的治疗干预可能改善结局。
