van den Heuvel Leigh Luella, Assim Ayesha, Koning Milo, Nöthling Jani, Seedat Soraya
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Dev Psychopathol. 2025 Feb;37(1):55-67. doi: 10.1017/S0954579423001414. Epub 2023 Nov 29.
Childhood maltreatment is associated with wide-ranging psychopathology at all stages of life. In the current study, we investigated whether posttraumatic stress disorder (PTSD) severity mediated the association between childhood maltreatment and internalizing and externalizing disorders among 262 South African trauma-exposed adolescents (aged 12-18 years). Childhood maltreatment and PTSD symptom severity were assessed using the Childhood Trauma Questionnaire and the Child PTSD Checklist, respectively. Psychiatric disorders were assessed utilizing the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version and were grouped into internalizing or externalizing disorders. Hierarchal logistic regression was used to assess the association of childhood maltreatment subtype with internalizing and externalizing disorders, controlling for age and gender, with PTSD symptom severity added to the final model. We found that sexual abuse was significantly associated with internalizing disorders, although this effect was no longer significant when PTSD was added to the model demonstrating that PTSD mediated the association between sexual abuse and internalizing disorders. Physical abuse, but not PTSD, was associated with externalizing disorders. Physical abuse, emotional neglect, and PTSD were associated with comorbid internalizing and externalizing disorders. These findings have implications for intervention and prevention strategies targeted at trauma-exposed adolescents with a history of childhood maltreatment.
童年期虐待与人生各阶段广泛的精神病理学相关。在本研究中，我们调查了创伤后应激障碍（PTSD）严重程度是否介导了262名南非遭受创伤的青少年（年龄在12至18岁之间）童年期虐待与内化性和外化性障碍之间的关联。分别使用儿童期创伤问卷和儿童PTSD清单评估童年期虐待和PTSD症状严重程度。利用儿童情感障碍和精神分裂症评定量表（现患和终生版）评估精神障碍，并将其分为内化性或外化性障碍。采用分层逻辑回归评估童年期虐待亚型与内化性和外化性障碍的关联，控制年龄和性别，并将PTSD症状严重程度纳入最终模型。我们发现，性虐待与内化性障碍显著相关，尽管在模型中加入PTSD后这种效应不再显著，这表明PTSD介导了性虐待与内化性障碍之间的关联。身体虐待而非PTSD与外化性障碍相关。身体虐待、情感忽视和PTSD与内化性和外化性共病障碍相关。这些发现对针对有童年期虐待史的遭受创伤青少年的干预和预防策略具有启示意义。
