儿童期虐待与心理健康问题：准实验研究的系统评价和荟萃分析。
Childhood Maltreatment and Mental Health Problems: A Systematic Review and Meta-Analysis of Quasi-Experimental Studies.
机构信息
Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, University College London (Baldwin, Wang, Schoeler, Tsaligopoulou, Pingault); Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Baldwin, Pingault); Great Ormond Street Institute of Child Health, University College London (Karwatowska); Department of Computational Biology, University of Lausanne, Lausanne, Switzerland (Schoeler); Child Study Center, Yale University School of Medicine, New Haven, Conn. (Tsaligopoulou); MRC Integrative Epidemiology Unit at the University of Bristol, Bristol Medical School, University of Bristol, School of Psychological Science, University of Bristol, and NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, U.K. (Munafò).
出版信息
Am J Psychiatry. 2023 Feb 1;180(2):117-126. doi: 10.1176/appi.ajp.20220174. Epub 2023 Jan 11.
OBJECTIVE
Childhood maltreatment is associated with mental health problems, but the extent to which this relationship is causal remains unclear. To strengthen causal inference, the authors conducted a systematic review and meta-analysis of quasi-experimental studies examining the relationship between childhood maltreatment and mental health problems.
METHODS
A search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed, English-language articles from database inception until January 1, 2022. Studies were included if they examined the association between childhood maltreatment and mental health problems using a quasi-experimental method (e.g., twin/sibling differences design, children of twins design, adoption design, fixed-effects design, random-intercept cross-lagged panel model, natural experiment, propensity score matching, or inverse probability weighting).
RESULTS
Thirty-four quasi-experimental studies were identified, comprising 54,646 independent participants. Before quasi-experimental adjustment for confounding, childhood maltreatment was moderately associated with mental health problems (Cohen's d=0.56, 95% CI=0.41, 0.71). After quasi-experimental adjustment, a small association between childhood maltreatment and mental health problems remained (Cohen's d=0.31, 95% CI=0.24, 0.37). This adjusted association between childhood maltreatment and mental health was consistent across different quasi-experimental methods, and generalized across different psychiatric disorders.
CONCLUSIONS
These findings are consistent with a small, causal contribution of childhood maltreatment to mental health problems. Furthermore, the findings suggest that part of the overall risk of mental health problems in individuals exposed to maltreatment is due to wider genetic and environmental risk factors. Therefore, preventing childhood maltreatment and addressing wider psychiatric risk factors in individuals exposed to maltreatment could help to prevent psychopathology.
目的
儿童期虐待与心理健康问题有关，但这种关系的因果程度尚不清楚。为了加强因果推断，作者对评估儿童期虐待与心理健康问题之间关系的准实验研究进行了系统回顾和荟萃分析。
方法
从数据库建立之初到 2022 年 1 月 1 日，作者对 PubMed、PsycINFO 和 Embase 进行了同行评审的英文文献检索，纳入使用准实验方法（例如，双胞胎/兄弟姐妹差异设计、双胞胎儿童设计、收养设计、固定效应设计、随机截距交叉滞后面板模型、自然实验、倾向评分匹配或逆概率加权）研究儿童期虐待与心理健康问题之间关系的研究。
结果
确定了 34 项准实验研究，包含 54646 名独立参与者。在进行准实验调整混杂因素之前，儿童期虐待与心理健康问题呈中度相关（Cohen's d=0.56，95%CI=0.41，0.71）。在进行准实验调整后，儿童期虐待与心理健康问题之间仍存在较小的关联（Cohen's d=0.31，95%CI=0.24，0.37）。这种调整后的儿童期虐待与心理健康之间的关联在不同的准实验方法中是一致的，并且在不同的精神障碍中具有普遍性。
结论
这些发现与儿童期虐待对心理健康问题有小的、因果性的贡献一致。此外，这些发现表明，暴露于虐待的个体心理健康问题的总体风险的一部分归因于更广泛的遗传和环境风险因素。因此，预防儿童期虐待和解决暴露于虐待的个体更广泛的精神健康风险因素可能有助于预防精神病理学。
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