Do Specific Early-Life Adversities Lead to Specific Symptoms of Psychosis? A Study from the 2007 The Adult Psychiatric Morbidity Survey
Do Specific Early-Life Adversities Lead to Specific Symptoms of Psychosis? A Study from the 2007 The Adult Psychiatric Morbidity Survey
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DOI：
10.1093/schbul/sbs049
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发表时间：
2012-06-01
影响因子：
6.6
通讯作者：
Varese, Filippo
中科院分区：
文献类型：
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作者：
Bentall, Richard P.;Wickham, Sophie;Varese, Filippo
先前的研究报告了童年逆境（如失去父母、在机构护理中长大、成年人的性虐待和其他形式的虐待以及同龄人的欺凌）与成年后的精神病之间的联系。然而，这些逆境导致精神病经历的机制尚不清楚。根据与阳性症状有关的心理过程模型，可以预测，儿童时期的性虐待与成年后的幻听特别相关，而早期依恋关系的破坏和欺凌等更长期的受害形式与偏执观念特别相关。因此，我们在2007年成人精神病发病率调查中研究了性创伤、身体虐待、欺凌、在机构或地方当局护理中长大以及幻听和偏执信仰报告之间的联系。童年逆境与两种症状类型之间的所有简单关联都是显著的。儿童期强奸只与幻觉有关（比值比8.9,CI = 1.86-42.44）。在机构护理中长大的人（OR = 11.08, CI = 3.26-37.62）在共病性幻觉得到控制后与偏执特别相关。对于每种症状，观察了童年创伤次数与症状风险之间的剂量反应关系。观察到的具体联系与当前关于幻觉和偏执起源的心理学理论是一致的。需要进一步研究这些关联的心理和生物介质。
Previous studies have reported associations between childhood adversities, eg, loss of a parent, being raised in institutional care, sexual and other kinds of abuse by adults and bullying by peers, and psychosis in adulthood. However, the mechanisms by which these adversities lead to psychotic experiences are poorly understood. From models of the psychological processes involved in positive symptoms, it was predicted that childhood sexual abuse would be specifically associated with auditory hallucinations in adulthood, and that disruption of early attachment relations and more chronic forms of victimization such as bullying would be specifically associated with paranoid ideation. We therefore examined the associations between sexual trauma, physical abuse, bullying, and being brought up in institutional or local authority care and reports of auditory hallucinations and paranoid beliefs in the 2007 Adult Psychiatric Morbidity Survey. All simple associations between childhood adversities and the two symptom types were significant. Childhood rape was associated only with hallucinations (OR 8.9, CI = 1.86-42.44) once co-occurring paranoia was controlled for. Being brought up in institutional care (OR = 11.08, CI = 3.26-37.62) was specifically associated with paranoia once comorbid hallucinations had been controlled for. For each symptom, doseresponse relationships were observed between the number of childhood traumas and the risk of the symptom. The specific associations observed are consistent with current psychological theories about the origins of hallucinations and paranoia. Further research is required to study the psychological and biological mediators of these associations.