Complex Trauma Among Psychiatrically Impaired Children: A Cross-Sectional, Chart-Review Study
Complex Trauma Among Psychiatrically Impaired Children: A Cross-Sectional, Chart-Review Study
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DOI：
10.4088/jcp.08m04783
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发表时间：
2009-08-01
影响因子：
5.3
通讯作者：
Hawke, Josephine
中科院分区：
文献类型：
--
作者：
Ford, Julian D.;Connor, Daniel F.;Hawke, Josephine
目的：根据儿童暴露于虐待和其他潜在创伤应激源的历史的复杂性来确定严重精神障碍儿童的亚组，并检查复杂创伤历史与DSM-IV-TR精神病诊断的关系。方法：在397例连续住院儿童精神病患者的样本中，聚类分析被用来确定亚组的基础上的措施记录的身体或性虐待，父母的损害（逮捕，暴力，和/或物质使用），和破坏的附件（即，离家安置）。结果：共分为4个亚组，分别为1992年至2002年。两个“低创伤”亚组有罕见的虐待和家庭外安置的历史，但区分低/中度与高水平的父母损害。两个“复杂创伤”亚组的特点是历史上的身体虐待或性虐待与多个肇事者，以及广泛的家庭外安置和严重的父母损害。所有亚组的精神病诊断特征相似。复杂的创伤状态与行为问题的严重程度和较低的身体质量指数相关，超过了精神病诊断、性别和种族的影响。虽然虐待史是亚组成员的一个因素，多个户外安置变量是最一致的外部化和内部化的问题和心理社会损害的相关性。在精神病住院儿童中，可能构成复杂创伤的童年逆境与外化行为问题和心理社会障碍有关，这种联系不能完全由现有的精神病诊断来解释，性别或种族。J Clin Psychiatry 2009;70（8）：1155-1163（C）版权所有2009 Physicians Postgraduate Press，Inc.
Objective: To identify subgroups of severely psychiatrically impaired children on the basis of the complexity of their histories of exposure to abuse and other potential traumatic stressors, and to examine the relationship of complex trauma histories to DSM-IV-TR psychiatric diagnoses.Method: In a sample of 397 consecutive inpatient child psychiatry admissions, cluster analysis was used to identify subgroups on the basis of measures of documented physical or sexual abuse, parental impairment (arrest, violence, and/or substance use), and disrupted attachment (ie, out-of-home placement). Data were collected for the years 1992 through 2002.Results: Four subgroups were identified. Two "low trauma" subgroups had infrequent histories of abuse and out-of-home placement but were distinguished by low/moderate versus high levels of parental impairment. Two "complex trauma" subgroups were characterized by histories of either physical abuse or sexual abuse with multiple perpetrators, as well as extensive out-of-home placement and severe parental impairment. All subgroups had similar profiles of psychiatric diagnoses. Complex trauma status was associated with behavior problem severity and lower body mass index over and above the effects of psychiatric diagnoses, gender, and ethnicity. Although abuse history was a factor in subgroup membership, the multiple out-of-home placements variable was the most consistent correlate of externalizing and internalizing problems and psychosocial impairment.Conclusions: Childhood adversity that may constitute complex trauma was associated with externalizing behavior problems and psychosocial impairment among psychiatrically hospitalized children, and this association cannot be accounted for fully by existing psychiatric diagnoses, gender, or ethnicity. J Clin Psychiatry 2009;70(8):1155-1163 (C) Copyright 2009 Physicians Postgraduate Press, Inc.