Chang Zhixiong, Osman Naweed, Doll Carolin Martha, Lichtenstein Theresa Katharina, Rosen Marlene, Meisenzahl Eva, Kadel Hanna, Kambeitz Joseph, Vogeley Kai, Schultze-Lutter Frauke
Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Bergische Landstraße 2, Düsseldorf, 40629, Germany.
Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
BMC Psychiatry. 2025 Jan 7;25(1):21. doi: 10.1186/s12888-024-06435-2.
Childhood adversities and traumata (CAT) increase the risk for various mental disorders, including the clinical high-risk of psychosis (CHR-P) state and its main comorbidities, i.e., depression, and social phobia. However, these relations are likely mediated by personal coping behaviors. This cross-sectional study investigates the relationships between the main CAT domains, coping, CHR-P, depression, and social phobia.
Using path analyses, we analyzed data of 736 patients (mean age 24 years, 67% male) who presented at an early detection service between 2002 and 2013, answered questionnaires on CAT, coping, depressiveness, and social phobia, and underwent clinical examination for CHR-P according to the recommendations of the Guidance project of the European Psychiatric Association.
All path models (total sample, males and females) showed good to excellent fit to the data. In all models, higher scores on maladaptive coping mediated the negative effect of emotional abuse on mental health outcomes. Additionally, in the total sample and males, lower scores on adaptive coping mediated the negative effect of emotional abuse and neglect, and physical neglect was associated with lower scores on adaptive coping that, in turn, were linked to depression and social phobia but not CHR-P. Overall, effects of maladaptive coping were higher than those of adaptive coping, although adaptive coping was more diversely associated with CAT. Furthermore, the interrelated depression and social phobia were more widely explained by the models than CHR-P, which was not significantly associated with them.
Our findings underscore the complex interplay of the CAT domains and their relevant mediators with mental health outcomes that likely reflect underlying sex-specific psychological, social, cultural and neurobiological mechanisms. Supporting a broader view on CAT than the traditional focus on sexual abuse, results indicate an important role of emotional abuse that, descriptively, is most strongly mediated by maladaptive coping strategies on mental health outcomes. A detailed understanding of the effects of CAT will in future help to develop a multi-dimensional, holistic and sex-specific approach to the treatment of patients who have experienced CAT.
The study was registered in the German Clinical Trial Register ( https://drks.de/ ) as DRKS00024469 at 02/24/2021.
童年逆境与创伤（CAT）会增加患各种精神障碍的风险，包括精神病临床高危（CHR-P）状态及其主要共病，即抑郁症和社交恐惧症。然而，这些关系可能由个人应对行为介导。本横断面研究调查了主要CAT领域、应对方式、CHR-P、抑郁症和社交恐惧症之间的关系。
我们采用路径分析方法，分析了2002年至2013年间在一项早期检测服务中就诊的736名患者（平均年龄24岁，67%为男性）的数据。这些患者回答了关于CAT、应对方式、抑郁程度和社交恐惧症的问卷，并根据欧洲精神病学协会指导项目的建议接受了CHR-P的临床检查。
所有路径模型（总样本、男性和女性）对数据的拟合度都很好或非常好。在所有模型中，适应不良应对得分较高介导了情感虐待对心理健康结果的负面影响。此外，在总样本和男性中，适应良好应对得分较低介导了情感虐待与忽视以及身体忽视的负面影响，身体忽视与适应良好应对得分较低相关，而适应良好应对得分较低又与抑郁症和社交恐惧症相关，但与CHR-P无关。总体而言，适应不良应对的影响高于适应良好应对，尽管适应良好应对与CAT的关联更为多样。此外，与CHR-P相比，模型对相互关联的抑郁症和社交恐惧症的解释更广泛，CHR-P与它们无显著关联。
我们的研究结果强调了CAT领域及其相关中介因素与心理健康结果之间复杂的相互作用，这可能反映了潜在的性别特异性心理、社会、文化和神经生物学机制。研究结果支持对CAT采取比传统上关注性虐待更广泛的观点，表明情感虐待的重要作用，从描述上看，情感虐待在心理健康结果方面最强烈地由适应不良应对策略介导。对CAT影响的详细理解将有助于未来制定一种多维、整体且针对性别的方法来治疗经历过CAT的患者。
该研究于2021年2月24日在德国临床试验注册中心（https://drks.de/）注册，注册号为DRKS00024469。
