Mother-infant attachment and the intergenerational transmission of posttraumatic stress disorder.
Mother-infant attachment and the intergenerational transmission of posttraumatic stress disorder.
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DOI：
10.1017/s0954579413000515
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发表时间：
2014-02
影响因子：
3.3
通讯作者：
Wright RJ
中科院分区：
文献类型：
--
作者：
Bosquet Enlow M;Egeland B;Carlson E;Blood E;Wright RJ
创伤后应激障碍(PTSD)代际传播的证据在文献中有记载，尽管其潜在的机制尚不清楚。依恋理论为阐明母体创伤后应激障碍可能增加子代创伤后应激障碍易感性提供了一个框架。目前的研究利用两个独立的前瞻性数据集来检验假设：(A)母体创伤后应激障碍增加了发展不安全的母婴依恋关系的可能性，以及(B)不安全的母婴依恋关系增加了在以后的生活中暴露于创伤后患创伤后应激障碍的风险。在第一项针对城市，主要是低收入的少数民族/种族母亲和婴儿(N=45对)的研究中，6个月时母亲创伤后应激障碍症状的增加与13个月时母婴依恋关系不安全、特别是无组织的风险增加有关。在城市低收入母亲和儿童(N=96对)的第二次生育队列中，婴儿时期不安全(回避性或抵抗性)的依恋以剂量-反应方式与青春期诊断为创伤后应激障碍的终身风险增加相关。婴儿时期的无组织依恋史预测了创伤后应激障碍症状的严重程度，包括重复经历、回避、高度觉醒和总症状，17.5岁。在这两项研究中，依恋和创伤后应激障碍之间的联系并不归因于许多共同发生的风险因素。研究结果表明，在早期发展中促进积极的母子关系，特别是在创伤暴露的高危人群中，可能会减少创伤后应激障碍的发生率。
Evidence for the intergenerational transmission of posttraumatic stress disorder (PTSD) is documented in the literature, though the underlying mechanisms are poorly understood. Attachment theory provides a framework for elucidating the ways in which maternal PTSD may increase offspring PTSD vulnerability. The current study utilized two independent prospective datasets to test the hypotheses that (a) maternal PTSD increases the probability of developing an insecure mother-infant attachment relationship and (b) an insecure mother-infant attachment relationship increases the risk of developing PTSD following trauma exposure in later life. In the first study of urban, primarily low-income ethnic/racial minority mothers and infants (N = 45 dyads), elevated maternal PTSD symptoms at 6 months were associated with increased risk for an insecure, particularly disorganized, mother-infant attachment relationship at 13 months. In the second birth cohort of urban low-income mothers and children (N = 96 dyads), insecure (avoidant or resistant) attachment in infancy was associated in a dose-response manner with increased lifetime risk for a diagnosis of PTSD by adolescence. A history of disorganized attachment in infancy predicted severity of PTSD symptoms, including reexperiencing, avoidance, hyperarousal, and total symptoms, at 17.5 years. In both studies, associations between attachment and PTSD were not attributable to numerous co-occurring risk factors. The findings suggest that promoting positive mother-child relationships in early development, particularly in populations at high risk for trauma exposure, may reduce the incidence of PTSD.