Sachs-Ericsson Natalie J, Sheffler Julia L, Stanley Ian H, Piazza Jennifer R, Preacher Kristopher J
Florida State University.
California State University, Fullerton.
J Clin Psychol. 2017 Oct;73(10):1403-1428. doi: 10.1002/jclp.22444. Epub 2017 Mar 22.
We examined the association between retrospective reports of adverse childhood experiences (ACEs) and painful medical conditions. We also examined the mediating and moderating roles of mood and anxiety disorders in the ACEs-painful medical conditions relationship.
Ten-year longitudinal data were obtained from the National Comorbidity Surveys (NCS-1, NCS-2; N = 5001). The NCS-1 obtained reports of ACEs, current health conditions, current pain severity, and mood and anxiety disorders. The NCS-2 assessed for painful medical conditions (e.g., arthritis/rheumatism, chronic back/neck problems, severe headaches, other chronic pain).
Specific ACEs (e.g., verbal and sexual abuse, parental psychopathology, and early parental loss) were associated with the painful medical conditions. Baseline measures of depression, bipolar disorder, and posttraumatic stress disorder were also associated with the number of painful medical conditions. Anxiety and mood disorders were found to partially mediate the ACEs-painful medical conditions relationship. We determined through mediation analyses that ACEs were linked to an increase in anxiety and mood disorders, which, in turn, were associated with an increase in the number of painful medical conditions. We determined through moderation analyses that ACEs had an effect on increasing the painful medical conditions at both high and low levels of anxiety and mood disorders; though, surprisingly, the effect was greater among participants at lower levels of mood and anxiety disorders.
There are pernicious effects of ACEs across mental and physical domains. Dysregulation of the hypothalamic-pituitary-adrenal stress response and the theory of reserve capacity are reviewed to integrate our findings of the complex relationships.
我们研究了童年不良经历（ACEs）的回顾性报告与疼痛性医疗状况之间的关联。我们还研究了情绪和焦虑障碍在ACEs与疼痛性医疗状况关系中的中介和调节作用。
从全国共病调查（NCS - 1、NCS - 2；N = 5001）中获取了十年的纵向数据。NCS - 1收集了ACEs、当前健康状况、当前疼痛严重程度以及情绪和焦虑障碍的报告。NCS - 2评估了疼痛性医疗状况（如关节炎/风湿病、慢性背部/颈部问题、严重头痛、其他慢性疼痛）。
特定的ACEs（如言语和性虐待、父母精神病理学问题以及早年父母离世）与疼痛性医疗状况相关。抑郁症、双相情感障碍和创伤后应激障碍的基线测量也与疼痛性医疗状况的数量相关。焦虑和情绪障碍被发现部分介导了ACEs与疼痛性医疗状况之间的关系。我们通过中介分析确定，ACEs与焦虑和情绪障碍的增加有关，而这又与疼痛性医疗状况数量的增加相关。我们通过调节分析确定，ACEs在高焦虑和低焦虑及情绪障碍水平时均对增加疼痛性医疗状况有影响；然而，令人惊讶的是，在情绪和焦虑障碍水平较低的参与者中这种影响更大。
ACEs在心理和身体领域均有有害影响。对下丘脑 - 垂体 - 肾上腺应激反应失调和储备能力理论进行了综述，以整合我们关于复杂关系的研究结果。
