Coêlho Bruno Mendonça, Andrade Laura Helena, Santana Geilson Lima, Viana Maria Carmen, Wang Yuan-Pang
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Section of Psychiatric Epidemiology - LIM 23, Department and Institute of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
J Psychiatr Res. 2021 Mar;135:8-14. doi: 10.1016/j.jpsychires.2020.12.046. Epub 2020 Dec 19.
Childhood adversities (ECA) are deleterious experiences that can occur during individuals' development, which has been associated with several negative health outcomes.
Analyze the effect of ECA on the onset of DSM-IV disorders throughout life.
The Composite International Diagnostic Interview (CIDI) was used in a stratified, multistage area probability sample of 5037 individuals aged 18 or more to assess the presence of childhood adversities, 20 psychiatric disorders and their ages of onset. Discrete-time survival models were performed to estimate the odds of disorder onset. Data are from the São Paulo Megacity Mental Health Survey, the Brazilian branch of the World Mental Health Survey Initiative.
53.6% of the sample experienced at least one ECA, and parental death (16.1%) and physical abuse (16%) were the most reported occurrences. Parental mental illness (OR = 1.99 to 2.27) and family violence (OR = 1.55 to 1.99) were the adversities most consistently associated with psychopathology across all age groups, while economic adversities (OR = 2.71 to 3.30) and parent criminality (OR = 1.72 to 1.77) were associated with psychopathology in individuals whose onset of disorder occurred from age 13 years on. Parental mental disorders and economic adversities were the strongest and most consistent predictors of all four classes of psychopathologies examined in multivariate models controlled for the clustering of adversities. Physical abuse was associated with externalizing disorders, while sexual abuse with internalizing disorders.
Childhood adversities were consistently associated with mental disorders. Economic adversities and parent mental disorders were predictive of psychopathology even if controlled for type (additive) and type and number of adversities (interactive models). Parental mental disorder and family violence were the main predictors of psychopathology onset across all age groups. Parental mental disorder was the only adversity that predicted all classes of disorders investigated.
童年逆境（ECA）是个体发育过程中可能发生的有害经历，与多种负面健康结果相关。
分析童年逆境对一生中《精神疾病诊断与统计手册》第四版（DSM-IV）障碍发病的影响。
采用综合国际诊断访谈（CIDI），对5037名18岁及以上个体进行分层多阶段区域概率抽样，以评估童年逆境、20种精神障碍及其发病年龄的存在情况。采用离散时间生存模型来估计障碍发病的几率。数据来自圣保罗大城市心理健康调查，这是世界心理健康调查倡议的巴西分支。
53.6%的样本经历过至少一次童年逆境，最常报告的事件是父母死亡（16.1%）和身体虐待（16%）。父母精神疾病（优势比[OR]=1.99至2.27）和家庭暴力（OR=1.55至1.99）是所有年龄组中与精神病理学最一致相关的逆境，而经济逆境（OR=2.71至3.30）和父母犯罪（OR=1.72至1.77）与13岁及以上发病的个体的精神病理学相关。在控制逆境聚类的多变量模型中，父母精神障碍和经济逆境是所研究的所有四类精神病理学的最强和最一致的预测因素。身体虐待与外化障碍相关，而性虐待与内化障碍相关。
童年逆境与精神障碍始终相关。即使在控制了逆境类型（相加）以及逆境类型和数量（交互模型）的情况下，经济逆境和父母精神障碍仍可预测精神病理学。父母精神障碍和家庭暴力是所有年龄组中精神病理学发病的主要预测因素。父母精神障碍是唯一能预测所有所研究障碍类别的逆境。
