六大欧洲国家一大群性发育障碍成年患者的心理健康。
Mental Health of a Large Group of Adults With Disorders of Sex Development in Six European Countries.
机构信息
From the Department of Child and Adolescent Psychiatry (de Vries), Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, the Netherlands; Charité - Universitätsmedizin Berlin (Roehle), Coordinating Center for Clinical Studies, Institute of Biometry and Clinical Epidemiology, Berlin Institute of Health; Klinik fur Kinder- und Jugendmedizin (Marshall, Thyen, Rapp), Universitat zu Lubeck, Germany; Department of Clinical Neuroscience (Frisén), Karolinska Institutet; Child and Adolescent Psychiatry Research Center (Frisén), Stockholm, Sweden; Department of Medical Psychology (van de Grift, Kreukels, Cohen-Kettenis), Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers; Department of Plastic (van de Grift), Reconstructive and Hand Surgery, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands; Endocrinologie pediatrique (Bouvattier), Centre de reference des maladies rares du developpement sexuel, Hopital Bicetre, Universite Paris-Sud, Le Kremlin Bicetre, France; Charité - Universitätsmedizin Berlin (Köhler), Klinik fur Padiatrie mit Schwerpunkt Endokrinologie und Diabetologie, Berlin, Germany; and Department of Women's and Children's Health (Nordenström), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
出版信息
Psychosom Med. 2019 Sep;81(7):629-640. doi: 10.1097/PSY.0000000000000718.
OBJECTIVE
The aim of the study was to evaluate psychiatric symptoms among 1022 persons with various disorders of sex development (DSDs).
METHODS
The study was a European multicenter cross-sectional clinical evaluation in six countries. The mean (SD) age of participants was 32.1 (13.4) years. The cohort consisted of 325 individuals with Turner syndrome, 219 individuals with Klinefelter syndrome (KS), female individuals with various XY-DSD conditions (107 with and 67 without androgenization), 87 male individuals with XY-DSD conditions, and 221 female individuals with congenital adrenal hyperplasia. The Hospital Anxiety and Depression Scale, the Short Autism Spectrum Quotient, the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale, and self-reported mental health history were used to assess psychiatric symptoms.
RESULTS
Across the six DSD diagnostic groups, clinical cutoff symptom scores were reached in 19.5% of participants for anxiety, in 7.1% for depression, in 4.1% for attention-deficit/hyperactivity disorder, and in 9.1% for autism. The mean depression and anxiety scores were higher compared with population norms in men with KS and men with XY-DSD. Compared with participants with other DSD conditions, men with KS reported significantly more mental health symptoms. Self-esteem, satisfaction with care, body dissatisfaction, and experiences of shame were associated with psychiatric symptoms in many DSD conditions.
CONCLUSIONS
A substantial minority of adults with DSD, with KS in particular, experience psychiatric morbidity. Across DSD conditions, adults may share feelings of shame. Developing a positive self-esteem and body image may be challenging. Multidisciplinary DSD care that involves specialized mental health support can be of important value.
TRIAL REGISTRATION
German Clinical Trials Register DRKS00006072.
目的
本研究旨在评估 1022 名各种性别发育障碍（DSD）患者的精神症状。
方法
这是一项在六个国家进行的欧洲多中心横断面临床评估研究。参与者的平均（SD）年龄为 32.1（13.4）岁。该队列包括 325 名特纳综合征患者、219 名克氏综合征（KS）患者、107 名有雄激素化的各种 XY-DSD 女性患者和 67 名无雄激素化的 XY-DSD 女性患者、87 名 XY-DSD 男性患者和 221 名先天性肾上腺增生女性患者。采用医院焦虑抑郁量表、短自闭症谱系商数、成人注意缺陷/多动障碍自评量表和自我报告的心理健康史评估精神症状。
结果
在六个 DSD 诊断组中，19.5%的参与者出现焦虑症状、7.1%出现抑郁症状、4.1%出现注意力缺陷/多动障碍症状、9.1%出现自闭症症状。与KS 男性和 XY-DSD 男性的人口统计学正常值相比，这些男性的抑郁和焦虑评分均较高。与其他 DSD 条件的参与者相比，KS 男性报告的心理健康症状明显更多。在许多 DSD 条件中，自尊心、对护理的满意度、身体不满和羞耻感与精神症状相关。
结论
相当一部分 DSD 成人，特别是 KS 患者，存在精神疾病。在 DSD 各种条件下，成年人可能都有羞耻感。培养积极的自尊心和身体形象可能具有挑战性。涉及专门心理健康支持的多学科 DSD 护理可能具有重要价值。
试验注册
德国临床试验注册处 DRKS00006072。
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