Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey
Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey
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DOI：
10.1017/s0033291797005588
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发表时间：
1997-09-01
影响因子：
6.9
通讯作者：
Kendler, KS
中科院分区：
文献类型：
--
作者：
Kessler, RC;Davis, CG;Kendler, KS
背景回顾性报告的儿童期逆境和随后的发病和持续的DSM-III-R障碍之间的关联的调查数据。数据来自美国全国科摩罗调查，这是一项针对美国家庭人口的大型调查。26个逆境被考虑，包括损失事件（如父母离婚），父母的精神病理学（如母亲抑郁症），人际创伤（如强奸）和其他逆境（如自然灾害）。这些不良事件与DSM-III-R心境障碍、焦虑症、成瘾性障碍和行为障碍的发病相关，但与持续性无关。大多数双变量与发病的关联在控制了精神疾病中的逆境聚集和终生共病的模型中减弱。Logistic模型中的多变量效应是加性的，这意味着它们对疾病发生概率有倍增效应。粘附显示出很小的特异性。时间衰减的分析表明，儿童期逆境对障碍发作的影响持续到儿童期之后。儿童期逆境和成人期疾病终身共病之间存在强烈的聚集性，这意味着在解释以前的单一逆境单一疾病研究的结果时需要谨慎，因为这些研究记录了特定儿童期逆境对特定成人疾病的独特影响。未来的研究需要评估更广泛的逆境和障碍，并探讨常见的逆境集群的存在和影响。需要进行复制，以证实童年逆境的影响主要是在第一次发作时，而不是在造成脆弱性，导致持续存在的风险增加时。
Background. Survey data are presented on the associations between retrospectively reported childhood adversities and subsequent onset and persistence of DSM-III-R disorders.Methods. Data come from the US National Comorbidity Survey, a large survey of the US household population.Results. 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.Conclusions. 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.