School of Medicine, Royal College of Surgeons in Ireland, Ireland.
Department of Psychiatry, Royal College of Surgeons in Ireland, Ireland; Department of Psychology, Royal College of Surgeons in Ireland, Ireland.
Addict Behav. 2021 Sep;120:106936. doi: 10.1016/j.addbeh.2021.106936. Epub 2021 Mar 26.
Exposure to childhood adversity has been linked to long-term negative mental health consequences in adulthood.
This review examined the association between exposure to the death of a family member (i.e., parent or sibling) during childhood or adolescence and the subsequent diagnosis of a substance use disorder.
Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for cohort and case-control studies in the English language. Studies were retained if it was demonstrable that exposure to death occurred before age 18, and that disorder was diagnosed subsequently. Sensitivity analyses were performed for the meta-analysis, and study quality assessed using the Newcastle-Ottawa Scale.
Nine studies, seven cohort and two case-control, were retained. Due to differential metrics (hazard ratios [HRs] versus odds/risk ratios [ORs/RRs]), only one meta-analysis was possible. Individuals experiencing familial death had 1.42 (95% CI = 0.96, 2.09) times the odds of developing a substance use disorder compared to those non-exposed. Where there was a statistically significant effect in other studies, these were mostly studies using National Registers (1.4 ≤ HR ≤ 2.51).
Meta-analysis options were limited by the variety of study designs.
Evidence for a significant association between familial death and subsequent disorder appears to be an artefact of the study design. Implications of key findings. Further studies are required to better understand and estimate the association between familial death and substance use disorders. Registration and funding. The review was pre-registered (PROSPERO Reg No: CRD42020192892) and funded by the Irish Research Council (COALESCE/2019/61).
儿童期逆境暴露与成年后患长期负面心理健康后果有关。
本综述研究了儿童期或青少年时期家庭成员（即父母或兄弟姐妹）死亡暴露与随后诊断物质使用障碍之间的关联。
使用电子数据库（Scopus、Medline（Ovid 版）、EMBASE 和 PsychINFO）搜索英语队列和病例对照研究。如果暴露于死亡发生在 18 岁之前，并且随后诊断出障碍，则保留研究。对荟萃分析进行了敏感性分析，并使用纽卡斯尔-渥太华量表评估了研究质量。
保留了九项研究，七项队列研究和两项病例对照研究。由于指标不同（危害比 [HR]与比值比 [OR] /风险比 [RR]），仅进行了一项荟萃分析。与未暴露者相比，经历过家庭死亡的个体发生物质使用障碍的可能性是其 1.42 倍（95%CI=0.96，2.09）。在其他研究中存在统计学意义的效应，这些研究大多使用国家登记处（1.4≤HR≤2.51）。
元分析选项受到各种研究设计的限制。
家族死亡与随后的障碍之间存在显著关联的证据似乎是研究设计的一个假象。主要发现的意义。需要进一步的研究来更好地理解和估计家族死亡与物质使用障碍之间的关联。注册和资金。该综述已预先注册（PROSPERO 注册号：CRD42020192892），并由爱尔兰研究委员会（COALESCE/2019/61）资助。
