Kessler R C, Davis C G, Kendler K S
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Psychol Med. 1997 Sep;27(5):1101-19. doi: 10.1017/s0033291797005588.
Survey data are presented on the associations between retrospectively reported childhood adversities and subsequent onset and persistence of DSM-III-R disorders.
Data come from the US National Comorbidity Survey, a large survey of the US household population.
Twenty-six adversities were considered, including loss events (e.g. parental divorce), parental psychopathologies (e.g. maternal depression), interpersonal traumas (e.g. rape) and other adversities (e.g. natural disaster). These adversities were consistently associated with onset, but not persistence, of DSM-III-R mood disorders, anxiety disorders, addictive disorders and acting out disorders. Most bivariate associations with onset attenuated in models that controlled for clustering of adversities and for lifetime co-morbidities among psychiatric disorders. Multivariate effects of adversities in logistic models were additive, which means that they have multiplicative effects on probability of disorder onset. Adversities showed little specificity. An analysis of time decay showed that the effects of childhood adversities on disorder onset persist beyond childhood.
The existence of strong clustering among childhood adversities and lifetime co-morbidity among adult disorders means that caution is needed in interpreting the results of previous single-adversity single-disorder studies as documenting unique effects of specific childhood adversities on specific adult disorders. Future studies need to assess a broader range of adversities and disorders and to explore the existence and effects of commonly occurring adversity clusters. Replication is needed to verify that the effects of childhood adversities are mostly on first onset rather than on the creation of vulnerabilities that lead to increased risk of persistence.
呈现了关于回顾性报告的童年逆境与随后发生的DSM-III-R障碍及其持续存在之间关联的调查数据。
数据来自美国国家共病调查，这是一项对美国家庭人口的大规模调查。
共考虑了26种逆境，包括丧失事件（如父母离异）、父母精神病理学问题（如母亲抑郁）、人际创伤（如强奸）以及其他逆境（如自然灾害）。这些逆境与DSM-III-R情绪障碍、焦虑障碍、成瘾性障碍和行为障碍的发病始终相关，但与持续存在无关。在控制了逆境聚集和精神障碍终生共病情况的模型中，大多数与发病的双变量关联减弱。逻辑模型中逆境的多变量效应是相加的，这意味着它们对障碍发病概率有相乘效应。逆境几乎没有特异性。时间衰减分析表明，童年逆境对障碍发病的影响在童年之后仍然存在。
童年逆境之间存在强烈聚集以及成人障碍之间存在终生共病，这意味着在将先前单一逆境单一障碍研究的结果解释为特定童年逆境对特定成人障碍的独特影响时需要谨慎。未来的研究需要评估更广泛的逆境和障碍，并探索常见逆境集群的存在及其影响。需要进行重复研究以验证童年逆境的影响主要是对首次发病，而不是对导致持续风险增加的易感性的产生。
