Trauma Exposure and Externalizing Disorders in Adolescents: Results From the National Comorbidity Survey Adolescent Supplement
Trauma Exposure and Externalizing Disorders in Adolescents: Results From the National Comorbidity Survey Adolescent Supplement
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DOI：
10.1016/j.jaac.2017.06.006
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发表时间：
2017-09-01
影响因子：
13.3
通讯作者：
Keyes, Katherine M.
中科院分区：
文献类型：
--
作者：
Carliner, Hannah;Gary, Dahsan;Keyes, Katherine M.
目的：暴露于暴力和其他形式的潜在创伤性事件（PTE）是常见的青少年与外化的精神病理学。这些关联可能反映了暴露于PTE的青年发生外化问题的风险增加，以及外化障碍青年发生PTE的风险增加。在这项研究中，我们分解暴露于PTE和外化障碍发作之间的关联在一个人口代表性的样本青少年。方法：我们分析了数据，从13至18岁的参与者在全国科摩罗调查复制青少年补充（NCS-A）（N = 6,379）。加权生存模型估计对立违抗性障碍（ODD）、行为障碍（CD）和与l 'fbs相关的物质使用障碍（SUD）发作的风险比（HR），以及暴露于与既往发作的外化障碍相关的PTE的风险比。乘法相互作用测试的影响修改性别，种族/民族，和家庭income.Results：所有类型的PTE与SLID（HR = 1.29-2.21）的风险较高，而只有人际暴力（HR = 2.49）与CD的发病，只有女性。未观察到与ODD相关。相反，ODD和CD与后来暴露于人际暴力和其他/nondisdosed事件的风险升高（I-IRs = 1.45-1.75）。结论：外部化的障碍，通常开始在青春期，包括SUDs和CD，更有可能出现在青少年与以前的创伤。相反，ODD发作与创伤暴露无关，但与发育后期经历创伤的风险升高有关。CD和人际暴力暴露表现出相互关联。这些发现对针对外化和创伤相关的精神病理学的干预措施具有影响。
Objective: Exposure to violence and other forms of potentially traumatic events (PTEs) are common among youths with externalizing psychopathology. These associations likely reflect both heightened risk for the onset of externalizing problems in youth exposed to PTEs and elevated risk for experiencing PTEs among youth with externalizing disorders. In this study, we disaggregate the associations between exposure to PTEs and externalizing disorder onset in a population-representative sample of adolescents.Method: We analyzed data from 13- to 18-year-old participants in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A) (N = 6,379). Weighted survival models estimated hazard ratios (HRs) for onset of oppositional defiant disorder (ODD), conduct disorder (CD), and substance use disorders (SUDs) associated with l'fbs, and for exposure to PTEs associated with prior onset externalizing disorders. Multiplicative interaction terms tested for effect modification by sex, race/ethnicity, and household income.Results: All types of PTEs were associated with higher risk for SLID (HRs = 1.29-2.21), whereas only interpersonal violence (HR = 2.49) was associated with onset of CD and only among females. No associations were observed for ODD. Conversely, ODD and CD were associated with elevated risk for later exposure to interpersonal violence and other/nondisdosed events (I-IRs = 1.45-1.75).Conclusion: Externalizing disorders that typically begin in adolescence, including SUDs and CD, are more likely to emerge in adolescents with prior trauma. ODD onset, in contrast, is unrelated to trauma exposure but is associated with elevated risk of experiencing trauma later in development. CD and interpersonal violence exposure exhibit reciprocal associations. These findings have implications for interventions targeting externalizing and trauma related psychopathology.