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探讨精神障碍患者童年期虐待、社会功能和社会认知之间的关联、调节因素和中介因素:系统评价和荟萃分析。

Examining associations, moderators and mediators between childhood maltreatment, social functioning, and social cognition in psychotic disorders: a systematic review and meta-analysis.

机构信息

Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic Barcelona, Institute of Neurosciences (UBNeuro), Barcelona, Catalonia, Spain.

Department of Medicine, Faculty of Medicine and Health Sciences University of Barcelona (UB), Barcelona, Catalonia, Spain.

出版信息

Psychol Med. 2023 Oct;53(13):5909-5932. doi: 10.1017/S0033291723001678. Epub 2023 Jul 17.

Abstract

Childhood maltreatment (CM) has been related to social functioning and social cognition impairment in people with psychotic disorders (PD); however, evidence across different CM subtypes and social domains remains less clear. We conducted a systematic review and meta-analysis to quantify associations between CM, overall and its different subtypes (physical/emotional/sexual abuse, physical/emotional neglect), and domains of social functioning and social cognition in adults with PD. We also examined moderators and mediators of these associations. A PRISMA-compliant systematic search was performed on 24 November 2022 (PROSPERO CRD42020175244). Fifty-three studies ( = 13 635 individuals with PD) were included in qualitative synthesis, of which 51 studies ( = 13 260) with 125 effects sizes were pooled in meta-analyses. We found that CM was negatively associated with global social functioning and interpersonal relations, and positively associated with aggressive behaviour, but unrelated to independent living or occupational functioning. There was no meta-analytic evidence of associations between CM and social cognition. Meta-regression analyses did not identify any consistent moderation pattern. Narrative synthesis identified sex and timing of CM as potential moderators, and depressive symptoms and maladaptive personality traits as possible mediators between CM and social outcomes. Associations were of small magnitude and limited number of studies assessing CM subtypes and social cognition are available. Nevertheless, adults with PD are at risk of social functioning problems after CM exposure, an effect observed across multiple CM subtypes, social domains, diagnoses and illness stages. Maltreated adults with PD may thus benefit from trauma-related and psychosocial interventions targeting social relationships and functioning.

摘要

儿童虐待(CM)与精神病患者的社会功能和社会认知障碍有关;然而,不同 CM 亚型和社会领域的证据仍然不太清楚。我们进行了系统评价和荟萃分析,以量化 CM(身体/情感/性虐待、身体/情感忽视)及其不同亚型与精神病患者的社会功能和社会认知各个领域之间的关联,并研究了这些关联的调节因素和中介因素。我们于 2022 年 11 月 24 日(PROSPERO CRD42020175244)按照 PRISMA 指南进行了系统搜索。纳入了 53 项研究(=13635 名精神病患者)进行定性综合分析,其中 51 项研究(=13260 人)和 125 个效应量纳入荟萃分析。我们发现 CM 与整体社会功能和人际关系呈负相关,与攻击行为呈正相关,但与独立生活或职业功能无关。CM 与社会认知之间没有元分析证据的关联。元回归分析没有发现任何一致的调节模式。叙述性综合确定了性别和 CM 的时间作为潜在的调节因素,抑郁症状和适应不良的人格特征作为 CM 与社会结果之间的可能中介因素。关联的幅度较小,且评估 CM 亚型和社会认知的研究数量有限。尽管如此,暴露于 CM 后,精神病患者存在社会功能障碍的风险,这种影响在多种 CM 亚型、社会领域、诊断和疾病阶段中均可见。因此,受虐待的精神病患者可能受益于针对人际关系和功能的与创伤相关和心理社会干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a5d/10520610/7a316cd4d691/S0033291723001678_fig1.jpg

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