Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China; Center for ADR monitoring of Guangdong, Guangzhou 510080, People's Republic of China.
J Affect Disord. 2018 Mar 15;229:14-21. doi: 10.1016/j.jad.2017.12.029. Epub 2017 Dec 26.
Childhood maltreatment might increase the risk of subsequent drug use behavior, and depressive symptoms have been reported to be associated both childhood maltreatment and non-medical use of prescription drugs (NMUPD). This large-scale study aimed to test the mediating effects of depressive symptoms on the association of childhood maltreatment with NMUPD among Chinese adolescents.
A secondary analysis of the cross-sectional data collected from 7th to 12th graders who were sampled using a multistage, stratified cluster, random sampling method in the 2015 School-based Chinese Adolescents Health Survey. There were 24,457 students who were invited to participate and 23,039 students' questionnaires were completed and qualified for our survey (response rate: 94.2%).
In the adjusted models without mediation, the results showed that students who reported that they had experienced emotional abuse were at a higher risk of past year use and past month use of opioids (past year: Adjusted OR [AOR] = 1.07, 95% CI = 1.05-1.10; past month: AOR = 1.08, 95% CI = 1.06-1.10) and sedatives (past year: AOR = 1.06, 95% CI = 1.03-1.08; past month: AOR = 1.15, 95% CI = 1.13-1.16). The results of mediation analyses demonstrated that there were significant standardized indirect effects of emotional abuse on opioids use and sedatives use through depressive symptoms, respectively (P < 0.001).
Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design.
Depressive symptoms play a significant mediator role on the association of childhood maltreatment with NMUPD. Interventions targeted at adolescents who are involved in NMUPD should pay attention to their histories of childhood maltreatment.
儿童期虐待可能会增加随后使用药物的风险，而抑郁症状既与儿童期虐待有关，也与非医疗使用处方药物（NMUPD）有关。本大规模研究旨在检验抑郁症状在儿童期虐待与中国青少年 NMUPD 之间的关联中的中介作用。
使用多阶段、分层聚类、随机抽样方法，对 2015 年全国青少年健康状况调查中从 7 年级到 12 年级的学生进行横断面数据的二次分析。邀请了 24457 名学生参加，有 23039 名学生完成了问卷，符合我们的调查要求（应答率：94.2%）。
在无中介的调整模型中，结果表明，报告曾遭受情感虐待的学生过去一年和过去一个月使用阿片类药物（过去一年：调整后的比值比[OR] = 1.07，95%置信区间[CI] = 1.05-1.10；过去一个月：OR = 1.08，95%CI = 1.06-1.10）和镇静剂（过去一年：OR = 1.06，95%CI = 1.03-1.08；过去一个月：OR = 1.15，95%CI = 1.13-1.16）的风险更高。中介分析的结果表明，情感虐待对阿片类药物和镇静剂使用的抑郁症状存在显著的标准化间接效应（P<0.001）。
我们的研究样本仅包括在校学生，由于横断面设计，无法进行因果推断。
抑郁症状在儿童期虐待与 NMUPD 之间的关联中起着显著的中介作用。针对涉及 NMUPD 的青少年的干预措施应注意他们的儿童期虐待史。
