The Burden of Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course in a National Study
The Burden of Loss: Unexpected Death of a Loved One and Psychiatric Disorders Across the Life Course in a National Study
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DOI：
10.1176/appi.ajp.2014.13081132
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发表时间：
2014-08-01
影响因子：
17.7
通讯作者：
Shear, M. Katherine
中科院分区：
文献类型：
--
作者：
Keyes, Katherine M.;Pratt, Charissa;Shear, M. Katherine
目的：亲人的意外死亡很常见，并且与随后多种形式的精神病理学症状的加重有关。确定这种经历是否可以预测精神疾病的新发作以及这些关联是否在整个生命过程中发生变化具有重要的临床意义。作者在基于人群的样本中研究了亲人的意外死亡与首次发作的常见焦虑、情绪和物质使用障碍之间的关联。方法：通过对美国普通人群中成年人的结构化访谈（分析样本量 = 27,534），评估亲人的意外死亡与一生中 DSM-IV 疾病首次发作之间的关系。模型控制了先前发生的任何疾病、其他创伤经历和人口统计学变量。结果：亲人的意外死亡是最常见的创伤经历，并且最有可能被评为受访者最糟糕的经历，无论其他创伤经历如何。在生命历程的几乎每个阶段，意外死亡后重度抑郁症、恐慌症和创伤后应激障碍的发病率都会增加。躁狂发作、恐惧症、酒精使用障碍和广泛性焦虑症的发病率增加集中在成年后年龄组。结论：丧亲期与多种精神疾病发病风险升高相关，这种情况在整个生命过程中始终如一，并且与亲人死亡的经历一致。意外死亡与包括躁狂症在内的几种疾病发作之间的新关联证实了多个病例报告和小型研究的结果，并为临床研究和实践提出了一个重要的新兴领域。
Objective: Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined associations of a loved one's unexpected death with first onset of common anxiety, mood, and substance use disorders in a population-based sample.Method: The relation between unexpected death of a loved one and first onset of lifetime DSM-IV disorders was estimated by using a structured interview of adults in the U.S. general population (analytic sample size=27,534). Models controlled for prior occurrence of any disorder, other traumatic experiences, and demographic variables.Results: Unexpected death of a loved one was the most common traumatic experience and most likely to be rated as the respondent's worst, regardless of other traumatic experiences. Increased incidence after unexpected death was observed at nearly every point across the life course for major depressive episode, panic disorder, and posttraumatic stress disorder. Increased incidence was clustered in later adult age groups for manic episode, phobias, alcohol use disorders, and generalized anxiety disorder.Conclusions: The bereavement period is associated with elevated risk for the onset of multiple psychiatric disorders, consistently across the life course and coincident with the experience of the loved one's death. Novel associations between unexpected death and onset of several disorders, including mania, confirm multiple case reports and results of small studies and suggest an important emerging area for clinical research and practice.