Kafali Helin Yilmaz, Biler Elif Demirkilinc, Palamar Melis, Ozbaran Burcu
Department of Child and Adolescent Psychiatry, Ankara City Hospital, Ministry of Health, Ankara, Turkey.
Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey.
Chin J Traumatol. 2020 Apr;23(2):71-77. doi: 10.1016/j.cjtee.2019.11.008. Epub 2020 Mar 4.
Given the increased risk of accidents in patients with attention deficit and hyperactivity disorder (ADHD) or maternal anxiety/depression, we aimed to investigate the frequency of the two diseases in children with penetrating eye injury (PEI).
Altogether 79 children, 39 with PEIs and 40 healthy individuals (control group), aged 5-15 years, underwent a complete ophthalmologic examination. Afterwards, schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children. Turgay diagnostic and statistical manual of mental disorders (DSM-IV)-based child and adolescent behavior disorders screening and rating scale (T-DSM-IV-S) was filled by parents to evaluate the severity of ADHD symptoms. The depression and anxiety levels of mothers of each group were evaluated by two self-report measures: the Beck depression scale and the state-trait anxiety inventory (STAI), respectively. Data were analyzed by IBM SPSS version 22.0. The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables.
The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs (48.7% in PEI vs. 17.5% in control group, χ = 7.359, p = 0.007). The total scores of the T-DSM-IV-S (attention subscale U = 418.000, p = 0.006; hyperactivity subscale U = 472.000, p = 0.022) and maternal state-trait anxiety inventory (maternal STAI-state U = 243.000, p = 0.003; maternal STAI-trait U = 298.000, p = 0.021) were significantly higher in the PEI group than in control group. In logistic regression, children with PEI had a tendency to have a 3.5-fold increased risk for ADHD (OR = 3.538, CI = 0.960-13.039, p = 0.058).
ADHD was detected almost 1 in 2 children with PEIs. Besides, the maternal anxiety level was significantly higher in the PEI group than in the control group. This association should be further explored via a future prospective longitudinal study. Since a proper treatment of ADHD in children and anxiety treatment in mothers may prevent vision loss following PEIs in children.
鉴于注意力缺陷多动障碍（ADHD）患者或母亲焦虑/抑郁患者发生事故的风险增加，我们旨在调查穿透性眼外伤（PEI）患儿中这两种疾病的发生率。
共79名年龄在5至15岁的儿童，其中39名患有PEI，40名健康个体（对照组），接受了全面的眼科检查。之后，使用学龄儿童情感障碍和精神分裂症量表对所有儿童进行精神疾病诊断评估。父母填写基于图尔盖精神障碍诊断与统计手册（DSM-IV）的儿童和青少年行为障碍筛查与评定量表（T-DSM-IV-S），以评估ADHD症状的严重程度。分别通过两种自我报告量表：贝克抑郁量表和状态-特质焦虑量表（STAI），评估每组母亲的抑郁和焦虑水平。数据采用IBM SPSS 22.0版进行分析。卡方检验和费舍尔精确检验用于确定定性变量之间是否存在显著差异，独立样本t检验和曼-惠特尼U检验用于比较定量变量。
唯一的诊断差异是PEI患者中ADHD的发生率显著更高（PEI组为48.7%，对照组为17.5%，χ² = 7.359，p = 0.007）。PEI组的T-DSM-IV-S总分（注意力子量表U = 418.000，p = 0.006；多动子量表U = 472.000，p = 0.022）以及母亲状态-特质焦虑量表（母亲STAI-状态U = 243.000，p = 0.003；母亲STAI-特质U = 298.000，p = 0.021）均显著高于对照组。在逻辑回归分析中，PEI患儿患ADHD的风险有增加3.5倍的趋势（OR = 3.538，CI = 0.960 - 13.039，p = 0.058）。
几乎每2名PEI患儿中就有1名被检测出患有ADHD。此外，PEI组母亲的焦虑水平显著高于对照组。这种关联应通过未来的前瞻性纵向研究进一步探讨。因为对儿童ADHD的适当治疗以及对母亲焦虑的治疗可能会预防儿童PEI后视力丧失。
