Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.
Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis.
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DOI：
10.1097/psy.0000000000000010
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发表时间：
2014-01
影响因子：
3.3
通讯作者：
Cuneo JG
中科院分区：
文献类型：
--
作者：
Afari N;Ahumada SM;Wright LJ;Mostoufi S;Golnari G;Reis V;Cuneo JG
这项荟萃分析系统地研究了报告的心理创伤和创伤后应激障碍（PTSD）与功能性躯体综合征（包括纤维肌痛、慢性广泛性疼痛、慢性疲劳综合征、颞下颌疾病和肠易激综合征）之间的关联。我们的目标是确定关联的总体效应大小并检查关系的调节因素。文献检索确定了 71 项具有对照组或比较组的研究，并检查了这些综合症与创伤事件的关联，包括童年或成年期间持续的心理、情感、性或身体虐待、战斗暴露或创伤后应激障碍 (PTSD)。使用随机效应模型来估计合并优势比和 95% CI。计划的亚组分析和元回归检查了潜在的调节因素。报告遭受过创伤的个体患功能性躯体综合征的可能性高出 2.7 倍（95% CI = 2.27 – 3.10）。这种关联对于出版偏见和普遍低质量的文献来说都是强有力的。与创伤后应激障碍（PTSD）的关联程度明显大于与性虐待或身体虐待的关联程度。与肠易激综合症或纤维肌痛相比，慢性疲劳综合症与所报告的创伤的关联更大。使用未经验证的问卷或创伤自我报告的研究报告的关联性比使用经过验证的问卷的研究更大。研究结果强调了现有文献的局限性，并强调进行前瞻性研究的重要性，进一步研究这些条件的潜在相似性和差异，并对创伤、创伤后应激障碍和功能性躯体综合征之间的联系机制进行假设驱动的研究。
This meta-analysis systematically examined the association of reported psychological trauma and posttraumatic stress disorder (PTSD) with functional somatic syndromes including fibromyalgia, chronic widespread pain, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. Our goals were to determine the overall effect size of the association and to examine moderators of the relationship. Literature searches identified 71 studies with a control or comparison group and examined the association of the syndromes with traumatic events including abuse of a psychological, emotional, sexual, or physical nature sustained during childhood or adulthood, combat exposure, or PTSD. A random effects model was used to estimate the pooled odds ratio and 95% CI. Planned subgroup analyses and meta-regression examined potential moderators. Individuals who reported exposure to trauma were 2.7 (95% CI = 2.27 – 3.10) times more likely to have a functional somatic syndrome. This association was robust against both publication bias and the generally low quality of the literature. The magnitude of the association with PTSD was significantly larger than with sexual or physical abuse. Chronic fatigue syndrome had a larger association with reported trauma than either irritable bowel syndrome or fibromyalgia. Studies using non-validated questionnaires or self-report of trauma reported larger associations than those using validated questionnaires. Findings highlight limitations of the existing literature and emphasize the importance of conducting prospective studies, further examining the potential similarities and differences of these conditions, and pursuing hypothesis-driven studies of the mechanisms underlying the link between trauma, PTSD, and functional somatic syndromes.