Departamento de Saúde Mental, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
Braz J Psychiatry. 2020 Sep-Oct;42(5):558-567. doi: 10.1590/1516-4446-2019-0592.
Patients with bipolar disorders have a high risk of suicidal behavior. Childhood maltreatment is a well-established risk factor for suicidal behavior. The objective of this study was to examine the association between childhood-maltreatment subtypes and vulnerability to suicide attempts in bipolar disorder using the Childhood Trauma Questionnaire (CTQ).
A literature review was performed using the MEDLINE, Embase, and PsycINFO databases. Thirteen studies met the selection criteria. In the meta-analysis, the Childhood Trauma Questionnaire (CTQ) was used to assess a wide range of childhood maltreatment subtypes, which were analyzed by using a random-effects model to account for the likely variations of true effect sizes between the included studies.
In the systematic review, 13 studies met the selection criteria. The CTQ was selected for the meta-analysis to increase the homogeneity of assessment and to encompass a wide range of childhood-maltreatment subtypes. The data were analyzed using a random-effects model. Compared to bipolar non-attempters, bipolar suicide attempters had experienced childhood maltreatment with a significantly higher frequency and had higher total CTQ scores (Hedges' g = -0.38, 95%CI -0.52 to -0.24, z = -5.27, p < 0.001) and CTQ sub-scores (sexual abuse: g = -0.39, 95%CI -0.52 to -0.26, z = -5.97; physical abuse: g = -0.26, 95%CI -0.39 to -0.13, z = -4.00; emotional abuse: g = -0.39, 95%CI -0.65 to -0.13, z = -2.97; physical neglect: g = -0.18, 95%CI -0.31 to -0.05, z = -2.79; emotional neglect: g = -0.27, 95%CI -0.43 to -0.11, z = -3.32).
Childhood maltreatment, as assessed by the CTQ, may contribute to an increased risk of suicidal behavior among people with bipolar disorders. Recognizing maltreatment as an etiological risk factor is a crucial step toward furthering science-based preventive psychiatry.
双相情感障碍患者自杀行为的风险很高。儿童期虐待是自杀行为的一个既定风险因素。本研究的目的是使用儿童期创伤问卷（CTQ）检查儿童期虐待亚型与双相情感障碍患者自杀企图易感性之间的关联。
使用 MEDLINE、Embase 和 PsycINFO 数据库进行文献复习。符合选择标准的有 13 项研究。在荟萃分析中，使用儿童期创伤问卷（CTQ）评估广泛的儿童期虐待亚型，使用随机效应模型分析，以考虑纳入研究中真实效应大小的可能变化。
在系统综述中，符合选择标准的有 13 项研究。选择 CTQ 进行荟萃分析以提高评估的同质性，并涵盖广泛的儿童期虐待亚型。使用随机效应模型分析数据。与双相情感障碍非企图者相比，双相情感障碍自杀企图者经历过儿童期虐待的频率更高，且 CTQ 总分（Hedges' g = -0.38，95%CI -0.52 至 -0.24，z = -5.27，p < 0.001）和 CTQ 子量表得分（性虐待：g = -0.39，95%CI -0.52 至 -0.26，z = -5.97；身体虐待：g = -0.26，95%CI -0.39 至 -0.13，z = -4.00；情感虐待：g = -0.39，95%CI -0.65 至 -0.13，z = -2.97；身体忽视：g = -0.18，95%CI -0.31 至 -0.05，z = -2.79；情感忽视：g = -0.27，95%CI -0.43 至 -0.11，z = -3.32）更高。
CTQ 评估的儿童期虐待可能会增加双相情感障碍患者自杀行为的风险。将虐待视为病因风险因素是推进基于科学的预防精神病学的关键一步。
