Leroux Pierre-Antoine, Dissaux Nolwenn, Le Reste Jean Yves, Bronsard Guillaume, Lavenne-Collot Nathalie
Service de Psychiatrie de l'Enfant et de l'Adolescent, CHRU, 29200 Brest, France.
Faculté de Médecine, Université de Bretagne Occidentale, 29200 Brest, France.
Children (Basel). 2023 Aug 3;10(8):1344. doi: 10.3390/children10081344.
Previous studies have demonstrated that children who experience maltreatment show a more elevated risk of psychopathological disorders than children from the general population. The HPA (hypothalamic-pituitary-adrenal) axis is not mature at birth and undergoes strong social regulation during the first years of life. Consequently, early exposure to stress could modify the usual adaptative response to stress. In stressful situations, perturbations in both cortisol response and cortisol circadian rhythm have been observed. Nevertheless, studies that have evaluated the links between child abuse, dysregulation of the HPA axis, and mental disorders have shown diverse results. Because of the variety of methods employed in the different studies, no formal comparisons have been made. In this systematic review, we have brought together these results.
We conducted a systematic review of studies analyzing the correlation between child abuse, mental disorders, and HPA axis activity in patients aged between 6 and 16 years. PubMed, Scopus, Cochrane, and Google Scholar were searched using relevant keywords and inclusion/exclusion criteria (from 2000 to 2020).
Fifteen studies from the 351 identified were included. Most patients were children in the child welfare system. Children who had experienced child abuse presented with more severe mental disorders (particularly in the dimensional measure) than children who had not been abused. HPA axis activity was assessed by measuring basal cortisol for some studies and cortisol reactivity for other studies. For children experiencing child abuse, there was a possible association between abuse and a decrease in the reactivity of the HPA axis. In addition, early life stress could be associated with lower matinal cortisol. However, the association between mental disorders and cortisol secretion in maltreated children did not seem obvious.
This systematic review demonstrates that mental disorders are more frequent and severe in cases where child abuse has occurred. Moreover, children who experienced child abuse seem to present changes in the reactivity of the HPA axis. Nevertheless, the potential correlation between these changes in the reactivity of the HPA axis and mental disorders in this population needs to be evaluated in further studies.
先前的研究表明，遭受虐待的儿童比普通儿童出现精神病理障碍的风险更高。下丘脑 - 垂体 - 肾上腺（HPA）轴在出生时并不成熟，在生命的最初几年会受到强烈的社会调节。因此，早期暴露于压力可能会改变对压力的正常适应性反应。在压力情境下，已观察到皮质醇反应和皮质醇昼夜节律的紊乱。然而，评估儿童虐待、HPA轴失调与精神障碍之间联系的研究结果各异。由于不同研究采用的方法多样，尚未进行正式比较。在本系统综述中，我们汇总了这些结果。
我们对分析6至16岁患者中儿童虐待、精神障碍与HPA轴活动之间相关性的研究进行了系统综述。使用相关关键词和纳入/排除标准（2000年至2020年）在PubMed、Scopus、Cochrane和谷歌学术上进行搜索。
从351项检索到的研究中纳入了15项。大多数患者是儿童福利系统中的儿童。遭受过虐待的儿童比未受虐待的儿童表现出更严重的精神障碍（特别是在维度测量方面）。一些研究通过测量基础皮质醇来评估HPA轴活动，另一些研究则通过测量皮质醇反应性来评估。对于遭受虐待的儿童，虐待与HPA轴反应性降低之间可能存在关联。此外，早期生活压力可能与晨间皮质醇水平较低有关。然而，受虐待儿童的精神障碍与皮质醇分泌之间的关联似乎并不明显。
本系统综述表明，在发生儿童虐待的情况下，精神障碍更为常见和严重。此外，遭受虐待的儿童似乎HPA轴反应性出现了变化。然而，HPA轴反应性的这些变化与该人群精神障碍之间的潜在相关性需要在进一步研究中进行评估。
