Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA; Child and Adolescent Psychiatry and Psychology Department. Hospital Sant Joan de Déu Barcelona, Spain. Passeig Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Spain.
Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
J Affect Disord. 2022 Mar 1;300:296-304. doi: 10.1016/j.jad.2022.01.003. Epub 2022 Jan 3.
Childhood abuse negatively impacts the course of Bipolar Disorder (BD). Yet, no study has examined risk factors associated with prospectively evaluated physical/sexual abuse, specifically, those preceding first abuse among BD youth. We investigate past/intake/follow-up factors preceding first physical/sexual abuse among BD youth.
Childhood-onset BD participants (n = 279 youth, mean age at intake = 12, mean length of follow-up = 12 years) enrolled in the Course and Outcome of Bipolar Youth (COBY) study. Demographic, clinical and family history variables were assessed every 7 months on average using Longitudinal Interval Follow-up Evaluation and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Abuse was evaluated at intake using the K-SADS-PL, over follow-up with a Traumatic Events Screen. Family psychopathology was assessed using Family History Screen/Structured Clinical Interview for Diagnostic Statistical Manual-IV.
Fifteen-percent of youth reported new-onset abuse during follow-up (62% physical, 26% sexual; 12% both). Intake predictors included more severe depressive symptoms (HR = 1.29), low socioeconomic-status (SES) in families with substance abuse (HR = 0.84) (physical abuse), and female sex (HR = 2.41) (sexual abuse). Follow-up predictors preceding physical abuse included: older age (HR = 1.42), disruptive disorders (HR = 1.39), and the interaction between low SES and family substance abuse (HR = 0.86). For sexual abuse, female sex (HR = 4.33) and a non-biologically related father presence in the household (HR = 2.76). Good relationships with friends (prospectively evaluated) protected against physical/sexual abuse (HR = 0.72/0.70, respectively).
Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; perpetrator information and abuse severity were not available.
Identifying factors temporally preceding new onset physical/sexual abuse may hold promise for identifying high-risk youth with BD.
儿童期虐待会对双相情感障碍（BD）的病程产生负面影响。然而，尚无研究探讨与前瞻性评估的身体/性虐待相关的风险因素，特别是在 BD 青少年中，首次虐待之前的风险因素。我们调查了 BD 青少年首次身体/性虐待之前的过去/入组/随访因素。
本研究纳入了参加 Course and Outcome of Bipolar Youth（COBY）研究的儿童起病的 BD 参与者（n=279 名青少年，入组时的平均年龄为 12 岁，平均随访时间为 12 年）。使用 Longitudinal Interval Follow-up Evaluation 和 Kiddie Schedule for Affective Disorders and Schizophrenia（K-SADS-PL），平均每 7 个月评估一次人口统计学、临床和家族史变量。在入组时使用 K-SADS-PL 评估虐待情况，在随访期间使用创伤事件筛查进行评估。使用家族病史筛查/诊断统计手册-IV 结构临床访谈评估家族精神病理学。
15%的青少年在随访期间出现新的虐待（62%为身体虐待，26%为性虐待，12%为两者兼有）。入组时的预测因素包括更严重的抑郁症状（HR=1.29）、家庭中有物质滥用的低社会经济地位（SES）（HR=0.84）（身体虐待）和女性性别（HR=2.41）（性虐待）。身体虐待之前的随访预测因素包括：年龄较大（HR=1.42）、破坏性行为障碍（HR=1.39）以及 SES 低和家庭物质滥用之间的交互作用（HR=0.86）。对于性虐待，女性性别（HR=4.33）和家中非生物学相关父亲的存在（HR=2.76）。与朋友保持良好的关系（前瞻性评估）可以预防身体/性虐待（HR=0.72/0.70）。
虽然前瞻性数据是纵向收集的，但每次随访时都是回顾性评估的；没有获得施害者信息和虐待严重程度。
识别新发生的身体/性虐待之前的时间因素可能有助于识别 BD 青少年的高危人群。
