Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia.
School of Social Sciences, University of Adelaide, Adelaide, South Australia, Australia.
Psychol Med. 2023 Jul;53(10):4762-4771. doi: 10.1017/S0033291722001702. Epub 2022 Jul 22.
No single environmental factor is a necessary or sufficient cause of mental disorder; multifactorial and transdiagnostic approaches are needed to understand the impact of the environment on the development of mental disorders across the life course.
Using linked multi-agency administrative data for 71 932 children from the New South Wales Child Developmental Study, using logistic regression, we examined associations between 16 environmental risk factors in early life (prenatal period to <6 years of age) and later diagnoses of mental disorder recorded in health service data (from age 6 to 13 years), both individually and summed as an environmental risk score (ERS).
The ERS was associated with all types of mental disorder diagnoses in a dose-response fashion, such that 2.8% of children with no exposure to any of the environmental factors (ERS = 0), compared to 18.3% of children with an ERS of 8 or more indicating exposure to 8 or more environmental factors (ERS ⩾ 8), had been diagnosed with any type of mental disorder up to age 13-14 years. Thirteen of the 16 environmental factors measured (including prenatal factors, neighbourhood characteristics and more proximal experiences of trauma or neglect) were positively associated with at least one category of mental disorder.
Exposure to cumulative environmental risk factors in early life is associated with an increased likelihood of presenting to health services in childhood for any kind of mental disorder. In many instances, these factors are preventable or capable of mitigation by appropriate public policy settings.
没有单一的环境因素是精神障碍的必要或充分原因；需要采用多因素和跨诊断方法来理解环境对整个生命过程中精神障碍发展的影响。
利用新南威尔士儿童发育研究中 71932 名儿童的多机构行政关联数据，采用逻辑回归，我们检验了 16 种生命早期（产前至<6 岁）环境风险因素与健康服务数据中记录的后期精神障碍诊断（6 至 13 岁）之间的关联，这些因素单独和总和作为环境风险评分（ERS）进行分析。
ERS 与各种类型的精神障碍诊断呈剂量反应关系，例如，在没有任何环境因素暴露（ERS=0）的儿童中，有 2.8%的儿童在 13-14 岁时被诊断出患有任何类型的精神障碍，而在 ERS 为 8 或更高（表示暴露于 8 个或更多环境因素）的儿童中，这一比例为 18.3%。所测量的 16 个环境因素中有 13 个（包括产前因素、邻里特征和更接近的创伤或忽视经历）与至少一种精神障碍类别呈正相关。
生命早期累积环境风险因素的暴露与儿童在童年时期因任何类型的精神障碍而到卫生服务机构就诊的可能性增加有关。在许多情况下，这些因素是可以预防的，或者可以通过适当的公共政策措施加以缓解。
