The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.
Division of Psychiatry, University College London, London, UK.
Acta Psychiatr Scand. 2021 Jun;143(6):495-502. doi: 10.1111/acps.13302. Epub 2021 Apr 10.
To use data from electronic health records (EHRs) to describe the demographic, clinical and functional correlates of childhood sexual abuse (CSA) in patients with severe mental illness (SMI), and compare their clinical outcomes (admissions and receipt of antipsychotic medications) to those of patients with no recorded history of CSA.
We applied a string-matching technique to clinical text records of 7000 patients with SMI (non-organic psychotic disorders or bipolar disorder), identifying 619 (8.8%) patients with a recorded history of CSA. Data were extracted from both free-text and structured fields of patients' EHRs.
Comorbid diagnoses of major depressive disorder, post-traumatic stress disorder and personality disorders were more prevalent in patients with CSA. Positive psychotic symptoms, depressed mood, self-harm, substance use and aggression were also more prevalent in this group, as were problems with relationships and living conditions. The odds of inpatient admissions were higher in patients with CSA than in those without (adjusted OR = 1.95, 95% CI: 1.64-2.33), and they were more likely to have spent more than 10 days per year as inpatients (adjusted OR = 1.32, 95% CI: 1.07-1.62). Patients with CSA were more likely to be prescribed antipsychotic medications (adjusted OR = 2.48, 95% CI: 1.69-3.66) and be given over 75% of the maximum recommended daily dose (adjusted OR = 1.72, 95% CI: 1.44-2.04).
Data-driven approaches are a reliable, promising avenue for research on childhood trauma. Clinicians should be trained and skilled at identifying childhood adversity in patients with SMI, and addressing it as part of the care plan.
利用电子健康记录（EHR）中的数据，描述患有严重精神疾病（SMI）的患者中儿童期性虐待（CSA）的人口统计学、临床和功能相关性，并将其临床结局（住院和接受抗精神病药物治疗）与无记录 CSA 病史的患者进行比较。
我们对 7000 名患有 SMI（非器质性精神病障碍或双相情感障碍）的患者的 EHR 中的临床文本记录应用了字符串匹配技术，识别出 619 名（8.8%）有记录 CSA 病史的患者。数据从患者 EHR 的自由文本和结构化字段中提取。
在 CSA 患者中，合并诊断为重度抑郁障碍、创伤后应激障碍和人格障碍的情况更为常见。阳性精神病症状、情绪低落、自残、物质使用和攻击行为也更为常见，同时还存在人际关系和生活条件问题。与无 CSA 病史的患者相比，CSA 患者住院的可能性更高（校正比值比 [OR] = 1.95，95%置信区间：1.64-2.33），且每年住院超过 10 天的可能性更大（校正 OR = 1.32，95%置信区间：1.07-1.62）。CSA 患者更有可能被开处抗精神病药物（校正 OR = 2.48，95%置信区间：1.69-3.66），且更有可能接受建议日剂量的 75%以上（校正 OR = 1.72，95%置信区间：1.44-2.04）。
数据驱动方法是研究儿童创伤的可靠、有前途的途径。临床医生应该接受培训并熟练掌握识别 SMI 患者儿童期逆境的技能，并将其作为护理计划的一部分。
