Cumulative exposure to childhood adversity, and treated attention deficit/hyperactivity disorder: a cohort study of 543 650 adolescents and young adults in Sweden
Cumulative exposure to childhood adversity, and treated attention deficit/hyperactivity disorder: a cohort study of 543 650 adolescents and young adults in Sweden
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DOI：
10.1017/s0033291717001933
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发表时间：
2018-02-01
影响因子：
6.9
通讯作者：
Kosidou, K.
中科院分区：
文献类型：
--
作者：
Bjorkenstam, E.;Bjorkenstam, C.;Kosidou, K.
背景：虽然儿童时期的逆境(CA)与注意缺陷/多动障碍(ADHD)的风险有关，但对累积CA的影响以及是否存在与ADHD关系更密切的CA簇知之甚少。方法我们使用了1987-1991年出生的543 650人的瑞典队列。基于登记的CA包括家庭死亡、父母大量滥用药物和精神障碍、父母大量犯罪、父母分居、接受家庭公共援助和居住不稳定。从2006年开始对15-19岁的患者进行跟踪治疗ADHD，ADHD的定义是注册的ICD诊断和/或治疗ADHD的药物处方。用Logistic回归分析计算优势比(OR)，95%可信区间(CI)。结果所有CA均增加了青春期晚期和成年期早期ADHD的发病几率，其OR值从家族性死亡的1.6(95%可信区间1.5~1.8)到家庭公共救助的2.7%(95%可信区间2.6~2.9)。我们发现累积CA与ADHD之间存在剂量-反应关系；4+CA的个体患ADHD的风险显著增加(OR 5.5，95%CI 5.0-6.0)。LCA分析揭示了与ADHD相关的6种不同类别的CA，其中暴露在大多数逆境中的风险最高。结论CA是ADHD的一个强烈的危险因素，尤其是当累积时。早期和有效地检测CA对于有针对性地改善弱势儿童的长期心理健康结果具有重要意义。
Background Though childhood adversity (CA) has been associated with the risk of attention deficit/hyperactivity disorder (ADHD), little is known about the effect of cumulative CAs and whether there are clusters of CAs that are more closely related with ADHD.Methods We used a Swedish cohort of 543 650 individuals born 1987-1991. Register-based CAs included familial death, substantial parental substance abuse and psychiatric disorder, substantial parental criminality, parental separation, household public assistance recipiency, and residential instability. Individuals were followed from year 2006 when they were 15-19 years of age, for treated ADHD, defined as a registered ICD diagnosis and/or prescription of medications to treat ADHD. Logistic regression analysis was used to calculate odds ratios (OR) with 95% confidence intervals (CI). Latent Class Analyses (LCA) were used to identify clusters based on the different CAs.Results All CAs increased the odds of ADHD in late adolescence and early adulthood; ORs ranged from 1.6 (95% CI 1.5-1.8) for familial death to 2.7 (95% CI 2.6-2.9) for household public assistance. We found a dose-response relationship between cumulative CA and ADHD; individuals with 4+ CAs had a markedly increased risk for ADHD (OR 5.5, 95% CI 5.0-6.0). LCA analyses revealed six distinct classes of CA associated with ADHD, of which exposure to most adversities' entailed highest risk.Conclusion CA is a strong risk factor for ADHD, particularly when accumulated. Early and efficient detection of CA is of importance for interventions targeted to improve long-term mental health outcomes among disadvantaged children.