Famularo R, Fenton T
Boston Juvenile Court, Massachusetts Department of Mental Health.
Arch Pediatr Adolesc Med. 1994 Oct;148(10):1032-8. doi: 10.1001/archpedi.1994.02170100030007.
To determine which factors from the early developmental histories of maltreated children are associated with the risk of developing posttraumatic stress disorder (PTSD).
Retrospective cohort analytic study.
A county juvenile/family court (not a criminal court).
The sample consisted of 117 severely maltreated children, aged 5 to 12 years, whose maltreatment was so severe that they were removed from parental custody. Forty-one (35%) of these children met criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, for PTSD.
Individual developmental and temperament-independent variables were used to compare children with PTSD and the maltreated children who did not reach PTSD inclusion criteria. The child's PTSD status was the primary dependent variable.
Variables representing the three factors from the early developmental history, along with markers for sex and race (black vs other), were entered into a logistic regression, with PTSD status as the outcome variable. Indicators of five different types of child maltreatment were also entered as predictors, to control for previously discovered effects associated with the type of trauma suffered by the children. This analysis disclosed that, while we controlled for the other predictors, one of the developmental factors remained statistically significant, one was marginally significant (P = .07), and one made no contribution toward predicting the probability of PTSD. Sex did not make a significant contribution to the logistic model, but being black continued to be associated with a lower probability of developing PTSD.
We conclude that PTSD may be caused by factors discernible in the first year of life that leave a maltreated child vulnerable to this disorder. These include birth weight less than 2.25 kg, jaundice, vomiting, diarrhea, infections, sleep problems, frequent crying, poor weight gain, fussiness, jumpiness, and distress when moved. The seemingly protective effect of being black was an unexpected, although provocative, finding whose interpretation will require further investigation.
确定受虐待儿童早期发育史中的哪些因素与创伤后应激障碍（PTSD）的发生风险相关。
回顾性队列分析研究。
一个县的青少年/家庭法庭（非刑事法庭）。
样本包括117名5至12岁的受严重虐待儿童，其虐待情况非常严重，以至于他们被剥夺了父母监护权。其中41名（35%）儿童符合《精神疾病诊断与统计手册》第三版修订本中PTSD的标准。
使用个体发育和气质独立变量来比较患有PTSD的儿童和未达到PTSD纳入标准的受虐待儿童。儿童的PTSD状态是主要的因变量。
代表早期发育史中三个因素的变量，以及性别和种族（黑人与其他种族）的指标，被纳入逻辑回归分析，以PTSD状态作为结果变量。还纳入了五种不同类型儿童虐待的指标作为预测因素，以控制先前发现的与儿童所遭受创伤类型相关的影响。该分析表明，在控制了其他预测因素后，其中一个发育因素在统计学上仍然显著，一个接近显著（P = 0.07），另一个对预测PTSD的概率没有贡献。性别对逻辑模型没有显著贡献，但黑人患PTSD的概率仍然较低。
我们得出结论，PTSD可能由生命第一年中可识别的因素引起，这些因素使受虐待儿童易患这种疾病。这些因素包括出生体重低于2.25千克、黄疸、呕吐、腹泻、感染、睡眠问题、频繁哭闹、体重增加缓慢、烦躁、易惊以及移动时的痛苦。黑人的这种看似具有保护作用的结果是一个意外但引人深思的发现，其解释需要进一步研究。
