Social, Genetic and Developmental Psychiatry Centre and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom.
National and Specialist Child and Adolescent Mental Health Service Clinic for Trauma, Anxiety, and Depression, South London and Maudsley NHS Foundation Trust, London, United Kingdom.
JAMA Psychiatry. 2023 Oct 1;80(10):1009-1016. doi: 10.1001/jamapsychiatry.2023.2140.
A history of childhood maltreatment is associated with an unfavorable course of illness for emotional disorders. However, the origins and mechanisms underlying these associations are unknown.
To examine the relative associations of objective and subjective measures of childhood maltreatment and continuity in psychopathology with the course of emotional disorders in adulthood.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study followed up until age 40 years participants residing in a metropolitan county of the US Midwest with substantiated records of childhood physical and sexual abuse and/or neglect between 1967 and 1971 and a demographically matched group of participants experiencing no abuse or neglect in childhood. The collected data were analyzed between October 2021 and April 2022.
The objective experience of childhood maltreatment before age 12 years was prospectively measured through official court records, whereas the subjective experience was measured through retrospective self-report at a mean (SD) age of 29 (3.8) years. Current and previous lifetime psychopathology was also assessed at a mean age of 29 (3.8) years.
Symptoms of depression and anxiety were measured at mean (SD) ages of 39.5 (3.5) and 41.2 (3.5) years using Poisson regression models.
In a cohort of 1196 participants (582 [48.7%] female and 614 [51.3%] male) followed up to age 40 years, those with objective plus subjective measures of childhood maltreatment had a greater number of subsequent follow-up phases with depression or anxiety than controls (depression: incidence rate ratio [IRR], 2.28 [95% CI, 1.65-3.15]; anxiety: IRR, 2.30 [95% CI, 1.54-3.42]), as did those with subjective-only measures (depression: IRR, 1.49 [95% CI, 1.02-2.18]; anxiety: IRR, 1.58 [95% CI, 0.99-2.52]). In contrast, participants with objective-only measures did not have a greater number of follow-up phases with depression or anxiety (depression: IRR, 1.37 [95% CI, 0.89-2.11]; anxiety: IRR, 1.40 [95% CI, 0.84-2.31]). Current and lifetime psychopathology measured at the time the subjective experience was assessed explained its association with a later course of emotional disorders in participants with subjective-only measures but not in those with objective plus subjective measures.
In this cohort study, the associations seen between childhood maltreatment and poor course of emotional disorders over the subsequent decade were largely attributable to the subjective experience of maltreatment, which was partly explained by continuity in psychopathology. Modification of the subjective experience of childhood maltreatment could improve the longitudinal course of emotional disorders.
童年期虐待史与情感障碍的疾病进程不佳有关。然而，这些关联的起源和机制尚不清楚。
研究客观和主观的童年期虐待测量以及精神病理学的连续性与成年后情感障碍病程的相对关联。
设计、地点和参与者：这项前瞻性队列研究随访至参与者 40 岁，参与者居住在美国中西部大都市县，1967 年至 1971 年期间有确凿的身体和性虐待和/或忽视记录，以及在童年时期没有遭受虐待或忽视的在人口统计学上相匹配的一组参与者。收集的数据在 2021 年 10 月至 2022 年 4 月之间进行了分析。
12 岁之前的儿童期虐待的客观经历通过官方法庭记录前瞻性测量，而主观经历通过平均（SD）年龄为 29（3.8）岁的回顾性自我报告测量。还在平均（SD）年龄为 29（3.8）岁时评估当前和以前的终生精神病理学。
使用泊松回归模型，在平均（SD）年龄为 39.5（3.5）和 41.2（3.5）岁时测量抑郁和焦虑症状。
在 1196 名参与者（582[48.7%]名女性和 614[51.3%]名男性）的队列中，随访至 40 岁，与对照组相比，那些具有客观和主观儿童虐待测量的参与者随后出现抑郁或焦虑的随访阶段更多（抑郁：发病率比[IRR]，2.28[95%CI，1.65-3.15]；焦虑：IRR，2.30[95%CI，1.54-3.42]），那些只有主观测量的参与者也是如此（抑郁：IRR，1.49[95%CI，1.02-2.18]；焦虑：IRR，1.58[95%CI，0.99-2.52]）。相比之下，只有客观测量的参与者没有更多的抑郁或焦虑随访阶段（抑郁：IRR，1.37[95%CI，0.89-2.11]；焦虑：IRR，1.40[95%CI，0.84-2.31]）。在评估主观经历时测量的当前和终生精神病理学解释了与只有主观测量的参与者的情感障碍病程不良的关联，但不能解释与客观和主观测量都有的参与者的关联。
在这项队列研究中，童年期虐待与随后十年内情绪障碍不良病程之间的关联主要归因于虐待的主观体验，这部分归因于精神病理学的连续性。改变童年期虐待的主观体验可能会改善情绪障碍的纵向病程。
