Posttraumatic Stress Disorder Across Two Generations: Concordance and Mechanisms in a Population-Based Sample
Posttraumatic Stress Disorder Across Two Generations: Concordance and Mechanisms in a Population-Based Sample
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DOI：
10.1016/j.biopsych.2012.03.020
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发表时间：
2012-09-15
影响因子：
10.6
通讯作者：
Koenen, Karestan C.
中科院分区：
文献类型：
--
作者：
Roberts, Andrea L.;Galea, Sandro;Koenen, Karestan C.
背景资料：使用暴露于极端压力源的人的小样本进行的研究记录了父母和后代创伤后应激障碍（PTSD）之间的关联，但尚不清楚这种关联是否存在于一般人群中，以及创伤暴露是否介导了这种关联。我们试图确定母亲的创伤后应激症状是否与其年轻成年子女的创伤后应激障碍有关，以及这种联系是否由患有创伤后应激障碍的妇女的子女的较高创伤暴露介导。利用一组母亲的数据（n = 6924）及其子女的队列（n = 8453），我们计算了儿童PTSD的风险比（RR），并检查了创伤暴露的中介作用。母亲一生的创伤后应激症状与儿童的创伤后应激障碍呈剂量反应关系（母亲1-3个症状，儿童RR = 1.2;母亲4-5个症状，RR = 1.3;母亲有6-7种症状，RR = 1.6，与母亲无症状的孩子相比，p <0.001）。母亲的终身症状也与儿童的创伤暴露剂量反应的方式。在有症状的妇女的孩子中，创伤暴露的增加实质上介导了PTSD风险的增加（介导比例，74%，p <0.001）。结论：在一个大的基于人群的样本中，PTSD的代际关联明显存在。患有创伤后应激障碍的女性的孩子比没有创伤后应激障碍的女性的孩子更有可能经历创伤性事件;这在一定程度上表明了为什么这种疾病与几代人有关。治疗患有创伤后应激障碍的母亲的卫生保健提供者应该意识到他们的孩子有更高的创伤暴露和创伤后应激障碍的风险。
Background: Research conducted using small samples of persons exposed to extreme stressors has documented an association between parental and offspring posttraumatic stress disorder (PTSD), but it is unknown whether this association exists in the general population and whether trauma exposure mediates this association. We sought to determine whether mothers' posttraumatic stress symptoms were associated with PTSD in their young adult children and whether this association was mediated by higher trauma exposure in children of women with PTSD.Methods: Using data from a cohort of mothers (n = 6924) and a cohort of their children (n = 8453), we calculated risk ratios (RR) for child's PTSD and examined mediation by trauma exposure.Results: Mother's lifetime posttraumatic stress symptoms were associated with child's PTSD in dose-response fashion (mother's 1-3 symptoms, child's RR = 1.2; mother's 4-5 symptoms, RR = 1.3; mother's 6-7 symptoms, RR = 1.6, compared with children of mothers with no symptoms, p < .001 for each). Mother's lifetime symptoms were also associated with child's trauma exposure in dose-response fashion. Elevated exposure to trauma substantially mediated elevated risk for PTSD in children of women with symptoms (mediation proportion, 74%, p < .001).Conclusions: Intergenerational association of PTSD is clearly present in a large population-based sample. Children of women who had PTSD were more likely than children of women without PTSD to experience traumatic events; this suggests, in part, why the disorder is associated across generations. Health care providers who treat mothers with PTSD should be aware of the higher risk for trauma exposure and PTSD in their children.