Association between traumatic stress load, psychopathology, and cognition in the Philadelphia Neurodevelopmental Cohort
Association between traumatic stress load, psychopathology, and cognition in the Philadelphia Neurodevelopmental Cohort
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DOI：
10.1017/s0033291718000880
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发表时间：
2019-01-01
影响因子：
6.9
通讯作者：
Gur, Raquel E.
中科院分区：
文献类型：
--
作者：
Barzilay, Ran;Calkins, Monica E.;Gur, Raquel E.
背景童年和青春期的创伤性压力源与精神病理学有关，主要是在创伤后应激障碍（PTSD）和抑郁症的背景下进行研究。我们在一个青年社区样本中调查了创伤应激暴露与精神病理学和认知的广泛联系。费城神经发育队列研究（N = 9498）是一项在不同（56%白人，33%非洲裔美国人，11%其他）美国青年社区人群（8-21岁）中进行的临床和神经行为表型研究。参与者是通过2009-2011年儿童医院儿科（非精神科）保健网络确定的。结构化的精神评估包括终生暴露于创伤性应激源的筛查，以及神经认知成套测验。创伤性应激事件的暴露率较高（无，N = 5204; 1，N = 2182; 2，N = 1092; 3或更多，N = 830）。较高的压力负荷与评估的所有临床领域的精神病理学增加相关：情绪/焦虑（标准化β = .378）;精神病谱（β = .360）;外化行为（β = .311）;和恐惧（β = .256）（控制协变量，所有p < 0.001）。协会仍然显着控制终身PTSD和抑郁症。暴露于高压力负荷与自杀意念和大麻使用密切相关（与未暴露者相比，比值比分别为5.3和3.2，均p < 0.001）。在经历过创伤性应激的青少年中（N = 4104），攻击性创伤史与更大的精神病理学相关，在男性中，易患精神病和外化症状。压力负荷与执行功能、复杂推理和社会认知的表现呈负相关。社区非精神科求助青年的创伤性应激暴露是相当大的，并且与更严重的精神病理学和神经认知障碍有关，超越了创伤后应激障碍和抑郁症。
Background. Traumatic stressors during childhood and adolescence are associated with psychopathology, mostly studied in the context of post-traumatic stress disorder (PTSD) and depression. We investigated broader associations of traumatic stress exposure with psychopathology and cognition in a youth community sample.Methods. The Philadelphia Neurodevelopmental Cohort (N = 9498) is an investigation of clinical and neurobehavioral phenotypes in a diverse (56% Caucasian, 33% African American, 11% other) US youth community population (aged 8-21). Participants were ascertained through children's hospital pediatric (not psychiatric) healthcare network in 2009-2011. Structured psychiatric evaluation included screening for lifetime exposure to traumatic stressors, and a neurocognitive battery was administered.Results. Exposure rate to traumatic stressful events was high (none, N = 5204; one, N = 2182; two, N = 1092; three or more, N = 830). Higher stress load was associated with increased psychopathology across all clinical domains evaluated: mood/anxiety (standardized beta = .378); psychosis spectrum (beta = .360); externalizing behaviors (beta = .311); and fear (beta = .256) (controlling for covariates, all p < 0.001). Associations remained significant controlling for lifetime PTSD and depression. Exposure to high-stress load was robustly associated with suicidal ideation and cannabis use (odds ratio compared with non-exposed 5.3 and 3.2, respectively, both p < 0.001). Among youths who experienced traumatic stress (N = 4104), history of assaultive trauma was associated with greater psychopathology and, in males, vulnerability to psychosis and externalizing symptoms. Stress load was negatively associated with performance on executive functioning, complex reasoning, and social cognition.Conclusions. Traumatic stress exposure in community non-psychiatric help-seeking youth is substantial, and is associated with more severe psychopathology and neurocognitive deficits across domains, beyond PTSD and depression.