Park Young-Min, Shekhtman Tatyana, Kelsoe John R
Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Korea.
Deparrtment of Psychiatry, University of California San Diego, San Diego, CA 92093, USA.
Brain Sci. 2020 Apr 27;10(5):254. doi: 10.3390/brainsci10050254.
Studies have reported an association between adverse childhood experiences (ACEs) and the clinical outcomes of bipolar disorder (BD). However, these studies have several limitations; therefore, we aimed to clarify the effect of the type and number of ACEs and the timing of adverse experiences on clinical outcomes in patients with BD. We analyzed the data of patients with BD ( = 2675) obtained from the National Institute of Mental Health: Bipolar Disorder Genetic Association Information Network, Translational Genomic Institute-I, and Translational Genomic Institute-II. All patients had been diagnosed using the Diagnostic Interview for Genetic Studies. ACEs were evaluated using the Childhood Life Events Scale (CLES). We analyzed the relationship between childhood trauma and clinical outcome in patients with and without exposure to ACEs. We found that ACEs had a robust negative effect on clinical outcomes, including earlier age at onset, presence of psychotic episodes, suicide attempts, mixed symptoms or episodes, substance misuse comorbidity, and worse life functioning. Specifically, the number of ACEs had the most significant effect on clinical outcomes; however, specific ACEs, such as physical abuse, had a considerable influence. Moreover, post-childhood adverse experiences had a weaker effect on clinical outcomes than ACEs did. There was an association of ACEs with negative clinical outcomes in patients with BD. This indicates the importance of basic and clinical research on ACEs in patients with BD.
研究报告了童年不良经历（ACEs）与双相情感障碍（BD）临床结局之间的关联。然而，这些研究存在若干局限性；因此，我们旨在阐明ACEs的类型和数量以及不良经历发生的时间对BD患者临床结局的影响。我们分析了从美国国立精神卫生研究所：双相情感障碍遗传关联信息网络、转化基因组学研究所-I和转化基因组学研究所-II获得的BD患者（n = 2675）的数据。所有患者均使用遗传研究诊断访谈进行诊断。使用儿童生活事件量表（CLES）评估ACEs。我们分析了有和没有暴露于ACEs的患者童年创伤与临床结局之间的关系。我们发现ACEs对临床结局有强烈的负面影响，包括发病年龄较早、出现精神病性发作、自杀企图、混合症状或发作、物质滥用合并症以及较差的生活功能。具体而言，ACEs的数量对临床结局影响最为显著；然而，特定的ACEs，如身体虐待，也有相当大的影响。此外，童年期后的不良经历对临床结局的影响比ACEs弱。BD患者中ACEs与负面临床结局存在关联。这表明对BD患者ACEs进行基础和临床研究的重要性。
