认知信任和人格功能在童年不良经历与成年期创伤后应激障碍及复杂性创伤后应激障碍之间的关联中起中介作用。
Epistemic trust and personality functioning mediate the association between adverse childhood experiences and posttraumatic stress disorder and complex posttraumatic stress disorder in adulthood.
作者信息
Kampling Hanna, Kruse Johannes, Lampe Astrid, Nolte Tobias, Hettich Nora, Brähler Elmar, Sachser Cedric, Fegert Jörg M, Gingelmaier Stephan, Fonagy Peter, Krakau Lina, Zara Sandra, Riedl David
机构信息
Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.
Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany.
出版信息
Front Psychiatry. 2022 Aug 10;13:919191. doi: 10.3389/fpsyt.2022.919191. eCollection 2022.
BACKGROUND
Adverse childhood experiences (ACEs) are associated with posttraumatic and complex posttraumatic stress disorder symptoms in adulthood (PTSD/cPTSD), as well as reduced epistemic trust (trust in the authenticity and personal relevance of interpersonally transmitted information) and impaired personality functioning. The present work aims to investigate the predictive value of epistemic trust-the capacity for social learning-on the mediating effect of personality functioning in the association of ACEs and PTSD/cPTSD.
METHODS
We conducted structural equation modeling (SEM) based on representative data of the German population ( = 2,004). Personality functioning (OPD-SQS) was applied as a mediator between ACEs and PTSD/cPTSD (ITQ), while epistemic trust (ETMCQ) was added as predictor for OPD-SQS. TLI, CFI, and RMSEA (95%-CI) determined the models' fit.
RESULTS
= 477 (23.8%) participants reported at least one ACE and = 218 (10.9%) reported ≥4 ACEs. Fit indices were good for both PTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.041-0.078) and cPTSD (TLI = 0.96; CFI = 0.99; RMSEA = 0.06; 95%CI: 0.043-0.081). ACEs were significantly associated with cPTSD (β = 0.44, < 0.001) and PTSD (β = 0.29, < 0.001), explaining 20 and 8% of its variance. Adding personality functioning as a mediator increased the explained variance of cPTSD and PTSD to 47 and 19% while the direct association between ACEs and cPTSD/PTSD decreased (β = 0.21/β = 0.17), thus, indicating a partial mediation. Including epistemic trust substantially increased the explained variance for personality functioning (41%) compared to ACEs as a single predictor (16%).
CONCLUSION
We add to previous research emphasizing the association between ACEs and PTSD/cPTSD symptoms. Offering insights on underlying mechanisms, we show that epistemic trust and personality functioning are relevant mediators. Since both are modifiable by psychotherapy, knowledge about the role of these constructs can inform research on psychotherapeutic interventions and prevention.
背景
童年不良经历（ACEs）与成年后的创伤后应激障碍和复杂性创伤后应激障碍症状（PTSD/cPTSD）相关，还与认知信任降低（对人际传播信息的真实性和个人相关性的信任）以及人格功能受损有关。本研究旨在探讨认知信任（社会学习能力）在ACEs与PTSD/cPTSD关联中对人格功能中介作用的预测价值。
方法
我们基于德国人群的代表性数据（n = 2004）进行了结构方程模型（SEM）分析。人格功能（OPD-SQS）被用作ACEs与PTSD/cPTSD（ITQ）之间的中介变量，而认知信任（ETMCQ）作为OPD-SQS的预测变量被纳入模型。使用TLI、CFI和RMSEA（95%置信区间）来确定模型的拟合度。
结果
477名（23.8%）参与者报告至少有一次ACEs，218名（10.9%）报告有≥4次ACEs。PTSD模型（TLI = 0.96；CFI = 0.99；RMSEA = 0.06；95%置信区间：0.041 - 0.078）和cPTSD模型（TLI = 0.96；CFI = 0.99；RMSEA = 0.06；95%置信区间：0.043 - 0.081）的拟合指数均良好。ACEs与cPTSD（β = 0.44，p < 0.001）和PTSD（β = 0.29，p < 0.001）显著相关，分别解释了其方差的20%和8%。加入人格功能作为中介变量后，cPTSD和PTSD的解释方差增加到47%和19%，而ACEs与cPTSD/PTSD之间的直接关联降低（β = 0.21/β = 0.17），表明存在部分中介效应。与仅将ACEs作为预测变量相比，纳入认知信任后人格功能的解释方差大幅增加（41%）。
结论
我们的研究补充了先前强调ACEs与PTSD/cPTSD症状之间关联的研究。通过揭示潜在机制，我们表明认知信任和人格功能是相关的中介变量。由于两者均可通过心理治疗进行调节，了解这些构念的作用可为心理治疗干预和预防研究提供参考。
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