IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia.
Orygen, Parkville, Victoria, Australia.
Acta Psychiatr Scand. 2022 Jun;145(6):615-627. doi: 10.1111/acps.13420. Epub 2022 Mar 11.
Childhood trauma affects the course of mood disorders. Researchers are now considering childhood trauma as an influential factor in the treatment of mood disorders. However, the role of childhood trauma in the treatment of bipolar disorder remains understudied.
The effect of childhood trauma on treatment outcomes was evaluated among participants randomised to treatment with lithium or quetiapine in the Clinical and Health Outcomes Initiatives in Comparative Effectiveness for Bipolar Disorder (Bipolar CHOICE) study by clinician assessment. Mixed effects linear regression models were used to analyse rates of improvement in symptom severity (assessed with the Bipolar Inventory of Symptoms Scale and the Clinical Global Impression Scale for Bipolar Disorder) and functional impairment (assessed with the Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool).
A history of any childhood trauma was reported by 52.7% of the sample (N = 476). Although participants with a history of any childhood trauma presented with greater symptom severity and functional impairment at most study visits, participants with and without a history of any childhood trauma showed similar rates of improvement in symptom severity and functional impairment over the 24 weeks of treatment.
This is the first study to explore the association between childhood trauma and treatment outcomes during treatment with lithium or quetiapine in the context of a randomised trial. In Bipolar CHOICE, a history of childhood trauma did not inhibit improvement in symptom severity or functional impairment. Nevertheless, these findings need replication across different settings.
儿童期创伤会影响情绪障碍的病程。研究人员现在将儿童期创伤视为情绪障碍治疗的一个影响因素。然而，儿童期创伤在双相情感障碍治疗中的作用仍研究不足。
通过临床医生评估，在临床和健康成果倡议比较有效性双相情感障碍研究（Bipolar CHOICE）中，对随机分配至锂或喹硫平治疗的参与者，评估儿童期创伤对治疗结果的影响。使用混合效应线性回归模型分析症状严重程度（用双相情感障碍症状量表和双相情感障碍临床总体印象量表评估）和功能障碍（用纵向间隔随访评估-功能障碍范围工具评估）改善的速度。
在该样本（N=476）中，有 52.7%的人报告有任何儿童期创伤史。尽管有儿童期创伤史的参与者在大多数研究访视时表现出更严重的症状严重程度和功能障碍，但有和没有儿童期创伤史的参与者在 24 周的治疗中，症状严重程度和功能障碍的改善速度相似。
这是第一项在随机试验背景下探索锂或喹硫平治疗期间儿童期创伤与治疗结果之间关联的研究。在 Bipolar CHOICE 中，儿童期创伤史并没有抑制症状严重程度或功能障碍的改善。然而，这些发现需要在不同环境中复制。
