Erin C. Dunn, ScD, MPH, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Department of Psychiatry, Harvard Medical School, Boston and Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Yan Wang, PhD, MPH, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts; Jenny Tse, BA, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Katie A. McLaughlin, PhD, Department of Psychology, University of Washington, Seattle, Washington; Garrett Fitzmaurice, PhD, Department of Psychiatry, Harvard Medical School, McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Stephen E. Gilman, ScD, Department of Epidemiology and Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health and Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Ezra S. Susser, MD, DrPH, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York and New York State Psychiatric Institute, New York, USA
Erin C. Dunn, ScD, MPH, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Department of Psychiatry, Harvard Medical School, Boston and Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, Massachusetts; Yan Wang, PhD, MPH, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts; Jenny Tse, BA, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Katie A. McLaughlin, PhD, Department of Psychology, University of Washington, Seattle, Washington; Garrett Fitzmaurice, PhD, Department of Psychiatry, Harvard Medical School, McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Stephen E. Gilman, ScD, Department of Epidemiology and Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health and Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland; Ezra S. Susser, MD, DrPH, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York and New York State Psychiatric Institute, New York, USA.
Br J Psychiatry. 2017 Dec;211(6):365-372. doi: 10.1192/bjp.bp.117.208397. Epub 2017 Nov 2.
Although childhood adversity is a strong determinant of psychopathology, it remains unclear whether there are 'sensitive periods' when a first episode of adversity is most harmful.To examine whether variation in the developmental timing of a first episode of interpersonal violence (up to age 18) associates with risk for psychopathology.Using cross-sectional data, we examined the association between age at first exposure to four types of interpersonal violence (physical abuse by parents, physical abuse by others, rape, and sexual assault/molestation) and onset of four classes of DSM-IV disorders (distress, fear, behaviour, substance use) ( = 9984). Age at exposure was defined as: early childhood (ages 0-5), middle childhood (ages 6-10) and adolescence (ages 11-18).Exposure to interpersonal violence at any age period about doubled the risk of a psychiatric disorder (odds ratios (ORs) = 1.51-2.52). However, few differences in risk were observed based on the timing of first exposure. After conducting 20 tests of association, only three significant differences in risk were observed based on the timing of exposure; these results suggested an elevated risk of behaviour disorder among youth first exposed to any type of interpersonal violence during adolescence (OR = 2.37, 95% CI 1.69-3.34), especially being beaten by another person (OR = 2.44; 95% CI 1.57-3.79), and an elevated risk of substance use disorder among youth beaten by someone during adolescence (OR = 2.77, 95% CI 1.94-3.96).Children exposed to interpersonal violence had an elevated risk of psychiatric disorder. However, age at first episode of exposure was largely unassociated with psychopathology risk.
尽管童年逆境是精神病理学的一个重要决定因素，但目前尚不清楚是否存在“敏感期”，即在这个时期首次遭遇逆境对健康的危害最大。本研究旨在探讨首次遭遇人际暴力（直至 18 岁）的时间变化是否与精神病理学风险相关。本研究使用横断面数据，研究了 4 种人际暴力（父母的身体虐待、他人的身体虐待、强奸和性侵犯/性骚扰）首次暴露年龄与 4 种 DSM-IV 障碍（痛苦、恐惧、行为、物质使用）发病之间的关系（n = 9984）。暴露年龄定义为：幼儿期（0-5 岁）、儿童中期（6-10 岁）和青少年期（11-18 岁）。任何年龄段的人际暴力暴露都使精神障碍的风险增加一倍（比值比（ORs）= 1.51-2.52）。然而，首次暴露时间的差异对风险的影响很小。进行了 20 次关联检验后，仅根据暴露时间观察到 3 个显著的风险差异；这些结果表明，在青少年期首次遭受任何类型人际暴力的青少年中，行为障碍的风险升高（OR = 2.37，95%CI 1.69-3.34），尤其是被他人殴打（OR = 2.44；95%CI 1.57-3.79），以及在青少年期被他人殴打者患物质使用障碍的风险升高（OR = 2.77，95%CI 1.94-3.96）。遭受人际暴力的儿童患精神障碍的风险增加。然而，首次暴露年龄与精神病理学风险相关性不大。
