Hogg Bridget, Gardoki-Souto Itxaso, Valiente-Gómez Alicia, Rosa Adriane Ribeiro, Fortea Lydia, Radua Joaquim, Amann Benedikt L, Moreno-Alcázar Ana
Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, C/Llull 410, 08019, Barcelona, Spain.
Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
Eur Arch Psychiatry Clin Neurosci. 2023 Mar;273(2):397-410. doi: 10.1007/s00406-022-01495-5. Epub 2022 Oct 8.
This umbrella review is the first to systematically examine psychological trauma as a transdiagnostic risk factor across psychiatric conditions. We searched Pubmed, Scopus, and PsycNET databases from inception until 01/05/2021 for systematic reviews/meta-analyses evaluating the association between psychological trauma and at least one diagnosed mental disorder. We re-calculated the odds ratio (OR), then classified the association as convincing, highly suggestive, suggestive, or weak, based on the number of cases and controls with and without psychological trauma, random-effects p value, the 95% confidence interval of the largest study, heterogeneity between studies, 95% prediction interval, small-study effect, and excess significance bias. Additional outcomes were the association between specific trauma types and specific mental disorders, and a sensitivity analysis for childhood trauma. Transdiagnosticity was assessed using TRANSD criteria. The review was pre-registered in Prospero CRD42020157308 and followed PRISMA/MOOSE guidelines. Fourteen reviews met inclusion criteria, comprising 16,277 cases and 77,586 controls. Psychological trauma met TRANSD criteria as a transdiagnostic factor across different diagnostic criteria and spectra. There was highly suggestive evidence of an association between psychological trauma at any time-point and any mental disorder (OR = 2.92) and between childhood trauma and any mental disorder (OR = 2.90). Regarding specific trauma types, convincing evidence linked physical abuse (OR = 2.36) and highly suggestive evidence linked sexual abuse (OR = 3.47) with a range of mental disorders, and convincing evidence linked emotional abuse to anxiety disorders (OR = 3.05); there were no data for emotional abuse with other disorders. These findings highlight the importance of preventing early traumatic events and providing trauma-informed care in early intervention and psychiatric services.
本伞状综述首次系统地考察了心理创伤作为一种跨诊断危险因素在各种精神疾病中的作用。我们检索了从数据库建立至2021年5月1日的PubMed、Scopus和PsycNET数据库，以查找评估心理创伤与至少一种已诊断精神障碍之间关联的系统评价/荟萃分析。我们重新计算了优势比（OR），然后根据有和没有心理创伤的病例和对照数量、随机效应p值、最大研究的95%置信区间、研究间的异质性、95%预测区间、小研究效应和过度显著性偏差，将该关联分类为令人信服、高度提示、提示或微弱。其他结果是特定创伤类型与特定精神障碍之间的关联，以及童年创伤的敏感性分析。使用TRANSD标准评估跨诊断性。该综述已在国际系统评价注册库（Prospero）CRD42020157308中预先注册，并遵循系统评价和荟萃分析的首选报告项目（PRISMA）/观察性研究的荟萃分析（MOOSE）指南。十四项综述符合纳入标准，包括16277例病例和77586例对照。心理创伤符合TRANSD标准，可作为不同诊断标准和谱系中的跨诊断因素。有高度提示性证据表明，任何时间点的心理创伤与任何精神障碍之间存在关联（OR = 2.92），童年创伤与任何精神障碍之间也存在关联（OR = 2.90）。关于特定创伤类型，有令人信服的证据表明身体虐待（OR = 2.36）与一系列精神障碍有关，有高度提示性证据表明性虐待（OR = 3.47）与一系列精神障碍有关，有令人信服的证据表明情感虐待与焦虑症有关（OR = 3.05）；没有关于情感虐待与其他障碍的数据。这些发现凸显了预防早期创伤事件以及在早期干预和精神科服务中提供创伤知情护理的重要性。
