Exposure to intimate partner violence and parental depression increases risk of ADHD in preschool children.
Exposure to intimate partner violence and parental depression increases risk of ADHD in preschool children.
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DOI：
10.1136/eb-2013-101411
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发表时间：
2013-11
影响因子：
5.2
通讯作者：
McLaughlin K
中科院分区：
文献类型：
--
作者：
Slopen N;McLaughlin K
问题：在生命的头3年遭受父母抑郁或亲密伴侣暴力（IPV）是否对儿童随后的心理健康有影响？人群：共有2422名儿童（52%为男孩，西班牙裔/拉丁裔45.5%，黑人40.6%，白人10.5%），从出生到3岁，年龄在37至72个月之间，通过计算机自动化改善儿童健康（CHICA）儿科初级保健系统服务的卫生中心就诊。环境：美国印第安纳州印第安纳波利斯的四个社区保健中心；2004年11月- 2012年6月。危险因素：三年内暴露于IPV和父母抑郁。这些信息是通过预先筛选表格中提出的筛选问题收集的，家长在诊所候诊室填写。为了筛查抑郁症，患者健康问卷（PHQ-2）一直使用到2010年，然后被爱丁堡产后抑郁量表（EPDS-3）的焦虑子量表所取代。IPV通过“你的伴侣踢过你、打过你或打过你吗？”和“你在家里感到安全吗？”结果：儿童心理健康诊断或接受精神药物治疗的年龄在3岁至3岁之间。使用国际疾病分类-9代码对注意缺陷多动障碍（ADHD）、破坏性行为障碍、抑郁、焦虑、睡眠障碍或适应障碍进行诊断。处方信息取自印第安纳州患者护理网络和Regenstriel医疗记录系统数据库。设计：前瞻性队列研究。随访期：3年。在孩子出生后的前3年里，1591名（65.7%）父母既没有IPV也没有抑郁，704名（29.1%）父母只报告抑郁，69名（2.8%）父母只报告IPV， 58名（2.4%）父母同时报告IPV和抑郁。3 ~ 6岁儿童中48例（2%）接受过精神药物治疗，其中80例（3.3%）被诊断为ADHD， 209例（8.7%）被诊断为破坏性行为障碍，9例（0.4%）被诊断为抑郁症，17例（0.7%）被诊断为焦虑症，7例（0.3%）被诊断为睡眠障碍，41例（1.7%）被诊断为适应障碍。暴露于父母抑郁的儿童的ADHD患病率高于未暴露于父母抑郁的儿童（4.5% vs 2.8%, p≤0.03）。与未暴露于父母抑郁的儿童相比，暴露于父母抑郁的儿童的精神药物处方更高（2.9% vs 1.6%, p≤0.03）。多因素回归分析显示，与未暴露相比，暴露于IPV和抑郁的增加与ADHD诊断风险增加相关（OR 4.0, 95% CI 1.5至10.9；见表）。暴露于父母抑郁也与儿童精神药物处方风险增加相关（OR 1.9, 95% CI 1.0 ~ 3.4）。对于任何其他精神健康状况，仅暴露于IPV或同时暴露于IPV均无显著关联。在出生后的前3年接触父母的IPV和父母的抑郁与6岁前诊断为ADHD的风险增加有关。早期暴露于父母抑郁症与精神药物处方的风险增加有关。
Question: Does exposure to parental depression or intimate partner violence (IPV) during the first 3 years of life have an effect on a child's subsequent mental health? People: A total of 2422 children (52% boys, Hispanic/ Latino 45.5%, Black 40.6%, White 10.5%) visiting health centres served by the Child Health Improvement through Computer Automation (CHICA) paediatric primary care system, from birth to age 3 years, and again when aged between 37 and 72 months. Setting: Four community health centres, Indianapolis, Indiana, USA; November 2004–June 2012. Risk factors: Exposure to IPV and parental depression within the first 3 years of life. This information was collected using screening questions presented in a prescreener form which parents completed in the clinic waiting rooms. To screen for depression, The Patient Health Questionnaire (PHQ-2) was used until 2010, and then replaced by the anxiety subscale of the Edinburgh Postnatal Depression Scale (EPDS-3). IPV was screened using the questions ‘Has your partner kicked, hit or slapped you?’ and ‘Do you feel safe in your home?’ Outcomes: Child mental health diagnosis or psychotropic drug treatment received between the ages of 3 and 3. Diagnoses were identified using International Classification of Diseases-9 codes for attention deficit hyperactivity disorder (ADHD), disruptive behaviour disorder, depression, anxiety, sleep disturbance or adjustment disorder. Prescription information was taken from the Indiana Network for Patient Care and Regenstriel Medical Record Systems databases. Design: Prospective cohort study. Follow-up period: Three years. Within the first 3 years of the child's life, 1591 (65.7%) of parents reported neither IPV nor depression, 704 (29.1%) reported depression only, 69 (2.8%) reported IPV only and 58 (2.4%) reported IPV as well as depression. Between ages 3 and 6 years, 48 (2%) of children had received psychotropic medication, 80 children (3.3%) were diagnosed with ADHD, 209 (8.7%) with disruptive behaviour disorder, 9 (0.4%) with depression, 17 (0.7%) with anxiety, 7 (0.3%) with sleep disturbance and 41 (1.7%) with adjustment disorder. Prevalence of ADHD was higher in children exposed to parental depression compared with those not exposed (4.5% vs 2.8%, p≤0.03). Psychotropic drug prescriptions were higher in children exposed to parental depression compared with those who were not exposed (2.9% vs 1.6%, p≤0.03). Multivariate regression analysis revealed that increased exposure to IPV as well as depression was associated with increased risk of ADHD diagnosis compared with non-exposure (OR 4.0, 95% CI 1.5 to 10.9; see table). Exposure to parental depression was also associated with increased risk of child psychotropic medication prescription (OR 1.9, 95% CI 1.0 to 3.4). There were no significant associations with exposure to IPV only or with both exposures for any other mental health condition. Exposure to parental IPV and parental depression within the first 3 years of life is associated with increased risk of ADHD diagnosis prior to 6 years. Early exposure to parental depression is associated with increased risk of psychotropic medication prescription.