University of Toronto, Ontario, Canada.
Sinai Health System, Toronto, Ontario, Canada.
J Interpers Violence. 2021 Oct;36(19-20):9060-9076. doi: 10.1177/0886260519865968. Epub 2019 Jul 24.
Childhood abuse, neglect, and loss are common in psychiatric patients, and the relationship between childhood adversity and adult mental illness is well known. However, beyond diagnoses that are specifically trauma-related, such as posttraumatic stress disorder, there has been little research on how childhood adversity contributes to complex presentations that require more intensive treatment. We examined the relationship between childhood adversity and other contributors to clinical complexity in adult outpatients seeking mental health assessment. In a cross-sectional study, patients completed standard measures of psychological distress and functional impairment. Psychiatrists completed an inventory of clinical complexity, which included childhood abuse, neglect, and loss. Of 4,903 patients seen over 15 months, 1,315 (27%) both consented to research and had the measure of complexity completed. Childhood abuse or neglect was identified in 474 (36.0%) and significant childhood loss in 236 (17.9%). Correcting for multiple comparisons and controlling for psychiatric diagnosis, age, and sex, patients with childhood abuse or neglect were significantly more likely to also have 11 of 31 other indices of clinical complexity, with odds ratios ranging from 1.7 to 5.0. Both childhood abuse or neglect and childhood loss were associated with greater overall complexity (i.e., more indices of complexity, χ = 136 and 38 respectively, each < .001). Childhood abuse and neglect (but not childhood loss) were significantly associated with psychological distress (Kessler Psychological Distress Scale [K10] score, = 6.2, = .01) and disability (World Health Organization Disability Assessment Scale 2.0 [WHODAS 2.0] score, = 5.0, = .03). Childhood abuse and neglect were associated with many characteristics that contribute to clinical complexity, and thus to suboptimal outcomes to standard, guideline-based care. Screening may alert psychiatrists to the need for intensive, patient-centered, and trauma-informed treatments. Identifying childhood adversity as a common antecedent of complexity may facilitate developing transdiagnostic programs that specifically target sources of complexity.
儿童期虐待、忽视和丧失在精神科患者中很常见，童年逆境与成年精神疾病之间的关系是众所周知的。然而，除了特定于创伤的诊断，如创伤后应激障碍之外，对于童年逆境如何导致需要更强化治疗的复杂表现形式，研究甚少。我们研究了童年逆境与寻求心理健康评估的成年门诊患者的其他临床复杂性因素之间的关系。在一项横断面研究中，患者完成了心理困扰和功能障碍的标准测量。精神科医生完成了临床复杂性清单，其中包括儿童期虐待、忽视和丧失。在 15 个月期间，共观察了 4903 名患者，其中 1315 名（27%）既同意参与研究又完成了复杂性测量。在 474 名患者（36.0%）中发现了儿童期虐待或忽视，在 236 名患者（17.9%）中发现了重大儿童期丧失。在纠正了多次比较并控制了精神科诊断、年龄和性别后，有儿童期虐待或忽视的患者更有可能还有 31 个其他临床复杂性指标中的 11 个，比值比范围为 1.7 至 5.0。儿童期虐待或忽视和儿童期丧失均与更大的整体复杂性相关（即，复杂性指标更多， = 136 和 38，均 <.001）。儿童期虐待和忽视（但不是儿童期丧失）与心理困扰（Kessler 心理困扰量表[K10]评分， = 6.2， =.01）和残疾（世界卫生组织残疾评估量表 2.0[WHODAS 2.0]评分， = 5.0， =.03）显著相关。儿童期虐待和忽视与许多导致临床复杂性的特征相关，因此导致标准、基于指南的护理效果不佳。筛查可能会提醒精神科医生需要进行强化、以患者为中心和以创伤为导向的治疗。将童年逆境识别为复杂性的常见前因可能有助于制定专门针对复杂性来源的跨诊断计划。
