Wan Anthony, Bernstein Charles N, Graff Lesley A, Patten Scott B, Sareen Jitender, Fisk John D, Bolton James M, Hitchon Carol, Marriott James J, Marrie Ruth Ann
From the Max Rady College of Medicine (Wan) and Departments of Internal Medicine (Bernstein, Hitchon, Marriott, Marrie) and Clinical Health Psychology (Graff), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Departments of Community Health Sciences and Psychiatry (Patten), Cumming School of Medicine, University of Calgary, Calgary; Department of Psychiatry (Sareen, Bolton), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; Nova Scotia Health Authority (Fisk), Departments of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax; and Department of Community Health Sciences (Bolton), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Psychosom Med. 2022 Jan 1;84(1):10-19. doi: 10.1097/PSY.0000000000001025.
To determine whether childhood maltreatment is associated with immune-mediated inflammatory disorders (IMIDs; multiple sclerosis [MS], inflammatory bowel disease [IBD], and rheumatoid arthritis [RA]). We further aimed to determine the relationship between maltreatment and psychiatric comorbidity in IMIDs and whether these relationships differed across IMID.
Six hundred eighty-one participants (MS, 232; IBD, 216; RA, 130; healthy controls, 103) completed a structured psychiatric interview to identify psychiatric disorders, and the Childhood Trauma Questionnaire to evaluate five types of maltreatment: emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect. We evaluated associations between maltreatment, IMID, and psychiatric comorbidity using multivariable logistic regression models.
The prevalence of having ≥1 maltreatment was similar across IMID but higher than in controls (MS, 63.8%; IBD, 61.6%; RA, 62.3%; healthy controls, 45.6%). Emotional abuse was associated with having an IMID (adjusted odds ratio [aOR] = 2.37; 1.15-4.89). In the sex-specific analysis, this association was only present in women. History of childhood maltreatment was associated with a lifetime diagnosis of a psychiatric disorder in the IMID cohort (OR = 2.24; 1.58-3.16), but this association did not differ across diseases. In those with IMID, total types of maltreatments (aOR = 1.36; 1.17-1.59) and emotional abuse (aOR = 2.64; 1.66-4.21) were associated with psychiatric comorbidity.
Childhood maltreatment is more common in IMID than in a healthy population and is associated with psychiatric comorbidity. Given the high burden of psychiatric disorders in the IMID population, clinicians should be aware of the contribution of maltreatment and the potential need for trauma-informed care strategies.
确定童年期虐待是否与免疫介导的炎症性疾病（IMIDs；多发性硬化症[MS]、炎症性肠病[IBD]和类风湿性关节炎[RA]）相关。我们还旨在确定虐待与IMIDs中精神疾病共病之间的关系，以及这些关系在不同的IMID中是否存在差异。
681名参与者（MS患者232名、IBD患者216名、RA患者130名、健康对照者103名）完成了一项结构化精神科访谈以识别精神疾病，并完成儿童创伤问卷以评估五种类型的虐待：情感虐待、身体虐待、性虐待、情感忽视和身体忽视。我们使用多变量逻辑回归模型评估虐待、IMID和精神疾病共病之间的关联。
≥1种虐待的患病率在各IMID中相似，但高于对照组（MS患者中为63.8%；IBD患者中为61.6%；RA患者中为62.3%；健康对照者中为45.6%）。情感虐待与患有IMID相关（校正比值比[aOR]=2.37；1.15 - 4.89）。在按性别分层的分析中，这种关联仅在女性中存在。童年期虐待史与IMID队列中精神疾病的终生诊断相关（比值比[OR]=2.24；1.58 - 3.16），但这种关联在不同疾病之间没有差异。在患有IMID的人群中，虐待的总类型（aOR = 1.36；1.17 - 1.59）和情感虐待（aOR = 2.64；1.66 - 4.21）与精神疾病共病相关。
童年期虐待在IMID中比在健康人群中更常见，并且与精神疾病共病相关。鉴于IMID人群中精神疾病的高负担，临床医生应意识到虐待的影响以及对创伤知情护理策略的潜在需求。
