儿童期虐待、自尊、自我效能感对医学生焦虑抑郁影响的路径分析

目的:探讨医学生儿童期虐待、自尊、自我效能感与焦虑抑郁症状的关系。方法:采用整群抽样法,对某医学院262名医学生进行调查,使用儿童期虐待史自评量表(PRCA)、自尊量表(SES)、一般自我效能感(GSES)、贝克抑郁自评问卷、焦虑自评量表等问卷进行现场测试,用结构方程模型分析软件Amos7.0作路径分析。结果:儿童期虐待对焦虑、抑郁有直接正向影响(Sβ=0.342,0.389;P<0.01),对自尊、自我效能感有直接负向影响(Sβ=-0.130,-0.148;P<0.05);自尊对焦虑、抑郁有直接负向影响(Sβ=-0.061,-0.217;P<0.05),自我效能感对焦虑、抑郁有直接负向影响(Sβ=-0.133,-0.087;P<0.05)。结论:自尊、自我效能感作为中介变量调节儿童期虐待对医学生焦虑、抑郁症状的影响。     

儿童期虐待对新兵社会支持及应对方式的影响

目的研究儿童期虐待对新兵社会支持及应对方式的影响。方法对505名入伍新兵进行儿童受虐问卷（CTQ-SF）、简易应对方式问卷（SCSQ）、青少年社会支持量表评定。结果遭受儿童期虐待的新兵在应付方式选择及社会支持上显著低于无虐待组（P〈0．05）。简单相关分析显示儿童期情感虐待、情感忽视、躯体忽视及总虐待分均与积极应对呈负相关（P〈0．01）;儿童期经历过情感虐待、情感忽视、性虐待、躯体虐待、躯体忽视及虐待总分均与消极应对呈正相关（P〈0．05,P〈0．01）。儿童期情感虐待、躯体虐待、情感忽视、躯体忽视及总虐待分均与社会支持总分、客观支持、支持利用度呈负相关（P〈0．01）;儿童期经历过情感虐待、情感忽视、性虐待、躯体虐待、躯体忽视及虐待总分均与主观支持成负相关（P〈0．05,P〈0．01）。情感忽视、躯体忽视与积极应对方式呈负相关（P=0．000,P=0．003）;虐待总分、情感虐待与消极应对方式呈正相关（P=0．032,P=0．026）,与社会支持总分呈负相关（P=0．000,P=0．011）。结论儿童期遭受虐待的新兵在应对方式上往往采取消极应对,且社会支持不良。     

儿童期受虐大学生的情感痛苦特点及其心理复原力的影响因素

目的研究儿童期受虐待大学生情感痛苦的特点及其心理复原力的影响因素。方法采用整群抽样法,对803名大学生进行儿童期虐待史自评量表（PRCA）、自杀意念量表（SIS）、焦虑自评量表（SAs）、贝克抑郁自评问卷（BDI）、简式大五人格问卷（NEO—FFI—R）、社会支持评定量表（SSRS）、青少年生活事件量表（ASLEC）、人口社会经济学资料调查问卷等测试。结果逐步回归分析发现,在控制其他因素的影响后,情感痛苦与神经质、虐待、生活事件呈正相关（β值=0．152～0．409,P〈0．01）,与谨慎性、外向性、身体健康状况呈负相关（β值=-0．101～-0．141,P〈0．05）。多因素Logistic分析发现,大学生情感痛苦心理复原力的危险因素为虐待总分（0R=1．107,95％CI-1．005～1．221）、神经质（0R=1．149,95％CI=1.080～1．223）;外向性（OR=0．933,95％CI-0．872～0．999）和友善性（OR=0．911,95％CI=0．839～0．989）为保护性因素。结论儿童期受虐待大学生的情感痛苦症状与其受虐待程度、大五人格特质、生活事件有关;虐待和神经质是其心理复原力的危险因素,外向性和友善性为其保护性因素。     

儿童期虐待与成年后精神分裂症的相关性

目的 探讨儿童期虐待与成年后精神分裂症的相关性。方法 使用北京安定医院精神疾 病临床数据与生物样本库的受试者数据库（2 142 例），从中选取符合分析要求的健康对照（111 例）和精 神分裂症（82 例）受试者，通过分析比较两组儿童期虐待问卷的数据，探讨儿童期虐待与成年后精神 分裂症的关系。并将病例组按照发病次数分组（≤2次或＞2次）后进行儿童期虐待问卷分数的比较。 结果 精神分裂症组和健康对照组之间儿童期虐待问卷总分及各分量表分数（情感虐待、躯体虐待、性 虐待、情感忽视和躯体忽视）差异均有统计学意义（t’=-9.18、-10.58、-8.98、-7.39、-6.09、-7.89，均P＜ 0.05）。 精神分裂症组发作次数≤2次组与发作次数＞2次组的儿童期虐待问卷总分及各分量表分数（情感虐待、 躯体虐待、性虐待、情感忽视和躯体忽视）差异均有统计学意义（t’=13.29，13.22，7.77，8.60，12.59，9.33， 均P＜ 0.05）。结论 精神分裂症的患者儿童期虐待问卷的分数值高于正常人群，并且发作次数多的虐 待问卷分数高，提示成年后的精神分裂症患者可能存在儿童期受虐待的经历。     

单亲家庭入伍新兵儿童期虐待对心理健康状况影响的研究

目的 研究单亲家庭入伍士兵儿童期虐待情况对心理健康状况的影响.方法 采取整群抽样法对南京军区某部310名入伍新兵进行儿童受虐问卷（CTQ-SF）、症状自评量表（SCL-90）评定.结果 单亲家庭组CTQ-SF中虐待总分、情感忽视、躯体忽视评分均明显高于非单亲家庭组（P＜0.05,P＜0.01）;单亲家庭组SCL-90中精神病性因子评分明显高于非单亲家庭组（P＜0.05）;单亲家庭组儿童期虐待总分与SCL-90总分及强迫症状、人际关系敏感、忧郁、焦虑、偏执和精神病性因子存在明显正相关（P＜0.05,P＜0.01）.结论 单亲家庭的新兵儿童期遭受更多的忽视,且儿童期虐待会对心理健康状况造成影响.     

儿童期虐待对成人自杀可能性的影响

目的 了解儿童期虐待对于成年后自杀可能性的影响.方法 分层随机抽取≥18岁的天津市区居民564例,使用儿童期虐待问卷（CTQ-SF）、自制自杀态度量表作为工具进行调查.结果 男性被调查者儿童期躯体虐待评分高于女性（P＜0.01）,女性被调查者儿童期情感忽视评分高于男性（P＜0.05）.男性有自杀意念人数显著低于女性（P＜0.05）.相关分析显示儿童期躯体虐待、情感虐待、性虐待及情感忽视与被调查者的自杀意念呈负相关（P＜0.01）;儿童期躯体虐待、情感虐待及性虐待与被调查者自杀未遂呈负相关（P＜0.05,P＜0.01）;而儿童期躯体虐待、情感虐待、性虐待及情感忽视与被调查者的自杀接受程度呈正相关（P＜0.05,P＜0.01）.回归分析显示情感虐待、性虐待和情感忽视为被调查者自杀意念的独立影响因素（P＜0.05）.结论 成年人的自杀意念、自杀未遂及自杀接受态度与其儿童期虐待有关.     

某高校医学生儿童期虐待、人格、家庭关系、自尊和自我效能感及不安全感关系的调查研究

目的 考察医学生不安全感心理、儿童期虐待、人格、家庭关系、自尊和自我效能感的关系.方法 采用整群抽样法,对某医学院262例医学生进行调查,使用儿童期虐待史自评量表(PRCA)、不安全感心理自评量表(SRFIS)、简式大五人格问卷(NEO- FFI- R)、社会支持评定量表(SSRS)、自尊量表(SES)、一般自我效能感(GSES)、世界卫生组织生存质量简表(WHOQOL- BREF)、人口社会经济学资料调查问卷等进行现场测试,用结构方程模型分析软件Amos 7.0作统计学分析.结果 结果显示,儿童期虐待对不安全感、人格和家庭关系有直接影响(Sβ=0.255,-0.189,0.285;P ＜0.01);家庭关系对不安全感、人格有直接影响(Sβ=0.220,-0.221; P＜ 0.01);人格对不安全感、自尊和自我效能感有直接影响(Sβ=-0.295,P＜0.05;Sβ=0.598,P＜0.01);自尊和自我效能感对不安全感有直接影响(Sβ=-0.524,P＜0.01);家庭关系、人格、自尊和自我效能感作为中介变量调节儿童期虐待对医学生不安全感的影响.模型Ⅱ的拟合指数为x2/df ＜3.000,P＞0.05,RMSEA=0.050,PGFI=0.612、PNFI=0.655、PCFI=0.717,均大于0.500,GFI=0.956、AGFI=0.931、NFI=0.909、RFI=0.873、IFI=0.995、TLI=0.992、CFI=0.995,均大于0.900,模型拟合良好.结论 家庭关系、人格、自尊和自我效能感作为中介变量,调节着儿童期虐待对医学生不安全感的影响.     

5-羟色胺转运体基因多态性对儿童期虐待与青少年攻击行为的调节作用

目的探讨5-羟色胺转运体（5-hydroxy tryptamine transporter,5-HTT）基因多态性与儿童期虐待对青少年攻击行为的调节作用。方法使用CTQ（儿童创伤经历问卷）评定儿童期虐待,用YSR（儿童行为量表CBCL自我报告版）评定攻击行为,运用线性回归模型对600名中国青少年检验其儿童期虐待、5-HTTLPR基因多态性对攻击行为的主效应及两者问的基因-环境交互作用。结果儿童期躯体虐待,性虐待,情感虐待对攻击行为始终有预测效应（P〈0．01）,5-HTTLPR基因型无主效应（P〉0．05）;此外,男性青少年5-HTTLPR与性虐待对攻击行为有交互作用（P〈0．05）,SS基因型个体在受到性虐待后较SL、LL基因型个体更易出现攻击行为;女性则无任何交互作用。结论儿童期虐待经历与青少年攻击行为受到5-HTTLPR的调节,不同性别青少年对不同虐待类型存在敏感性差异。     

不同负性情绪与应对方式对超重／肥胖青少年情绪性进食的影响

目的：了解超重／肥胖青少年情绪性进食的现状,探索不同负性情绪及应对方式对情绪性进食的影响。方法采用进食行为问卷、抑郁－焦虑－压力量表、中学生应对方式量表对181名超重／肥胖青少年进行集体施测。结果（1）男生与女生在情绪性进食上差异无统计学意义（t ＝0．532,P ＞0．05）,高中阶段的青少年比初中阶段的青少年表现出更多的情绪性进食（t ＝3．353,P ＜0．01）。（2）情绪性进食与负性情绪各维度（r ＝0．522～0．581,P ＜0．01）及情绪指向的应对方式（r ＝0．571,P ＜0.01）均呈正相关,而与 BMI 值和问题指向的应对方式无相关性（P ＞0．05）。（3）焦虑和情绪指向的应对方式可对情绪性进食正向预测（R2＝0．45,P ＜0．01）。结论负性情绪及情绪指向的应对方式与情绪性进食存在相关性,并且焦虑和情绪指向的应对方式可以增加情绪性进食。     

儿童期虐待对大学生焦虑抑郁情绪的影响：人格、社会支持和生活事件的中介作用

目的 探讨人格、社会支持和生活事件在儿童期受虐待与大学生焦虑、抑郁情绪之间的 中介作用。方法 采用整群随机抽样法,以班级为单位选取徐州市 3 所高校的 2 420 名大学生,使用焦 虑自评量表（SAS）、贝克抑郁自评问卷（BDI）、儿童期虐待史自评量表（PRCA）、社会支持评定量表（SSRS）、 青少年生活事件量表（ASLEC）、简式大五人格问卷（NEO-FFI-R）进行评估。采用 Pearson 相关和多重线性 回归分析儿童期受虐待大学生的焦虑、抑郁与人格、社会支持、生活事件、虐待之间的关系,并构建儿 童期受虐待大学生焦虑、抑郁形成机制的结构方程模型。共发放问卷 2 420 份,回收有效问卷 2 374 份, 有效回收率为 98.1%。结果 2 374 名大学生中,有 929 名（39.1%）在儿童期遭受过虐待。儿童期受 虐待大学生的 BDI 评分、SAS 评分与 PRCA 总分、ASLEC 评分、神经质评分呈正相关（r=0.366～0.632, P＜ 0.001）,与 SSRS 总分、外向性评分、开放性评分、友善性评分和谨慎性评分呈负相关（r=-0.440～ -0.128,P＜ 0.001）。NEO-FFI-R 各分量表评分、SSRS 总分、ASLEC 评分、PRCA 总分两两之间存在相关 性（r=-0.515～-0.065、0.220～0.456;P＜ 0.05）。回归分析结果显示,儿童期受虐待对大学生人格、生活 事件、社会支持、焦虑、抑郁有直接影响（P＜ 0.05）;人格对生活事件、社会支持、焦虑、抑郁有直接影响 （P＜ 0.01）;社会支持对生活事件有直接影响（P＜ 0.01）,对焦虑、抑郁无直接影响;生活事件对焦虑、抑 郁有直接影响（P＜ 0.05）。模型的拟合指数中,卡方 / 自由度为 3.361,简约调整适配度指数为 0.648、简 约调整比较适配指数为 0.712、简约调整规准适配指数为 0.696;渐进残差均方和平方根为 0.049,适配度 指数为 0.952,调整后适配度指数为 0.930;规准适配指数为 0.925、相对适配指数为 0.900、增量拟合指数 为 0.946、非规准适配指数为 0.928、比较适配指数为 0.946,模型适配度良好。结论 儿童期受虐待大学 生容易出现焦虑、抑郁情绪,人格特质、社会支持和生活事件在儿童期虐待和大学生焦虑、抑郁情绪之 间发挥着中介效应。     

Childhood trauma and dissociation in female patients with schizophrenia spectrum disorders: an exploratory study

The few studies that have investigated the relationship between trauma and dissociative symptoms in patients with schizophrenia have not assessed the role of the severity of psychotic symptoms. The current study examined correlations among five domains of childhood trauma and dissociative symptoms in 30 female patients with schizophrenia spectrum disorders, using the Dissociative Experiences Scale and the Childhood Trauma Questionnaire. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale. Consistent with previous studies, high levels of childhood traumatic experiences were found (Childhood Trauma Questionnaire total score M = 48.5, SD = 18.3). Physical neglect and emotional abuse showed significant correlations with dissociative symptoms at admission. When patients were stabilized, about a month after admission, emotional abuse still showed a significant correlation with dissociative symptoms. However, in contrast to previous findings, Dissociative Experiences Scale findings were not stable over time. Our results confirm the relevance of childhood trauma in schizophrenic patients but also demonstrate the need to develop appropriate methodologies for measuring dissociation in this population.     

Association between childhood trauma and dissociation among patients with borderline personality disorder

OBJECTIVE: To examine the relationship between childhood trauma and dissociative experience in adulthood in patients with borderline personality disorder. METHOD: Dissociative experiences scale scores and subscale scores for the Childhood Trauma Questionnaire were correlated in 139 patients. Patients were dichotomized into high or low dissociators using the Median Dissociative Experiences Scale score as the cut-off. RESULTS: Childhood Trauma Questionnaire Subscale scores for emotional and physical abuse and emotional neglect but not sexual abuse correlated significantly with Dissociative Experiences Scale scores. High dissociators reported significantly greater levels of emotional abuse, physical abuse, emotional neglect and physical neglect but not sexual abuse than low dissociators. CONCLUSION: Patients with borderline personality disorder therefore demonstrated levels of dissociation that increased with levels of childhood trauma, supporting the hypothesis that traumatic childhood experiences engender dissociative symptoms later in life. Emotional abuse and neglect may be at least as important as physical and sexual abuse in the development of dissociative symptoms.     

Childhood abuse and dissociative symptoms in adult schizophrenia

Dissociative symptoms, occurring in many psychiatric disorders including schizophrenia, are often preceded by traumatic experience. We hypothesized that various types of childhood trauma would correlate with levels of dissociative symptomatology in adult patients. Twenty-six patients completed the Dissociative Experiences Scale (DES) and the Childhood Trauma Questionnaire (CTQ). Dissociation was significantly correlated with emotional abuse (r=0.84, one-tailed p<0.001), and physical abuse (r=0.55, p<0.01). We suggest that emotional abuse may play an important role in the etiology of dissociation in schizophrenia.     

Somatization as a predictor of suicidal ideation in dissociative disorders

Aim: This study was concerned with correlates of suicidal ideation among patients with chronic complex dissociative disorders. Method: Participants were 40 patients diagnosed as having either dissociative identity disorder or dissociative disorder not otherwise specified according to the DSM‐IV. The Dissociative Disorders Interview Schedule, the Dissociative Experiences Scale, the Somatoform Dissociation and the Childhood Trauma Questionnaires, the Spielberger Trait Anger Inventory, the Beck Suicidal Ideation Scale, and the Borderline Personality Disorder section of the Structured Clinical Interview for DSM‐IV Personality Disorders were administered to all patients. Results: Patients with suicidal ideas (n = 15) had concurrent somatization disorder more frequently than the remaining patients. Having significantly high scores on both trait and state dissociation measures, their dissociative disorder was more severe than that of the patients with no suicidal ideation. They had elevated scores for childhood emotional abuse, physical abuse and emotional neglect. Concurrent somatization disorder diagnosis was the only predictor of suicidal ideation when childhood trauma scores and borderline personality disorder diagnosis were controlled. Conclusions: Among dissociative patients, there is an association between somatization and suicidal ideation. A trauma‐related insecure attachment pattern is considered as a common basis of this symptom cluster.     

Dissociative symptoms in alcohol-dependent patients: associations with childhood trauma and substance abuse characteristics

OBJECTIVE: Inconsistent findings have been reported concerning the level of dissociative symptoms and their relationship with childhood trauma in alcohol-dependent patients. The present study aimed to further examine the level of dissociation and the trauma-dissociation relationship in a sample of alcohol-dependent patients, taking potential mediating factors into account. METHOD: A sample of 100 consecutively admitted inpatients with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were administered the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, the International Diagnostic Checklist for posttraumatic stress disorder, the European Addiction Severity Index, and an additional questionnaire assessing the age at onset of different symptoms of alcohol dependence. RESULTS: Substantial rates of childhood trauma were found. However, the mean Dissociative Experiences Scale score was low (9.0). Dissociative symptoms were significantly related to childhood emotional abuse; however, other forms of childhood trauma and posttraumatic stress disorder status were not. Younger age at onset of alcohol dependence was related to both childhood trauma and a higher level of dissociative symptoms. In a hierarchical linear regression model, emotional abuse was found to contribute to dissociation independent of potential chronic residual effects resulting from early onset of alcohol abuse as well as its chronicity or severity. CONCLUSION: The findings support the idea that (clinically significant) dissociation is relatively uncommon in alcohol-dependent patients. Yet, when it occurs, dissociation is associated with childhood emotional abuse independent of chronic alcohol abuse. In addition, patients with an earlier onset of alcohol dependence could be more similar to patients with other substance-related disorders with regard to levels of dissociation.     

The severity of Internet addiction risk and its relationship with the severity of borderline personality features,childhood traumas,dissociative experiences,depression and anxiety symptoms among Turkish University Students

The aim of this study was to investigate the relationship of Internet addiction (IA) risk with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. A total of 271 Turkish university students participated in this study. The students were assessed through the Internet Addiction Scale (IAS), the Borderline Personality Inventory (BPI), the Dissociative Experiences Scale (DES), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The rates of students were 19.9% (n=54) in the high IA risk group, 38.7% (n=105) in the mild IA risk group and 41.3% (n=112) in the group without IA risk. Correlation analyses revealed that the severity of IA risk was related with BPI, DES, emotional abuse, CTQ-28, depression and anxiety scores. Univariate covariance analysis (ANCOVA) indicated that the severity of borderline personality features, emotional abuse, depression and anxiety symptoms were the predictors of IAS score, while gender had no effect on IAS score. Among childhood trauma types, emotional abuse seems to be the main predictor of IA risk severity. Borderline personality features predicted the severity of IA risk together with emotional abuse, depression and anxiety symptoms among Turkish university students.     

Frequency of dissociative disorders among psychiatric outpatients in Turkey

The aim of this study was to determine the frequency of dissociative disorders among psychiatric outpatients in Turkey. One hundred fifty consecutive outpatients admitted to the psychiatry clinic of a university hospital were screened with the Dissociative Experiences Scale (DES). Twenty-three patients (15.3%) with a DES score greater than 30 and a comparison group selected from the same outpatient population who scored less than 10 on the scale were then interviewed with the Dissociative Disorders Interview Schedule (DDIS) in a blind fashion. According to the DDIS, 18 patients (12.0%) received a diagnosis of dissociative disorder; 83.3% (n = 15) of the dissociative patients reported neglect, 72.2% (n = 13) emotional abuse, 50.0% (n = 9) physical abuse, and 27.8% (n = 5) sexual abuse during childhood. Dissociative disorders are not rare among psychiatric outpatients. Self-rating instruments and structured interviews can be used successfully for screening dissociative disorders, which are usually underrecognized. Neglect was the most frequently reported type of childhood trauma, suggesting the importance of other childhood experiences in addition to sexual and/or physical abuse in the development of dissociative psychopathology.     

Dissociative disorders among inpatients with drug or alcohol dependency

OBJECTIVE: To determine the prevalence of dissociative disorders among inpatients with alcohol or drug dependency. METHOD: The Dissociative Experiences Scale was used to screen 215 consecutive inpatients admitted to the dependency treatment center of a large mental hospital over a 1-year period (March 1, 2003, to March 31, 2004). Patients who had scores of 30.0 or above were compared with patients who scored below 10.0 on the scale. The patients in both groups were then evaluated using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. The interviewers were blind to the Dissociative Experiences Scale scores. RESULTS: Of the patients, 36.7% had a Dissociative Experiences Scale score of 30.0 or above. The prevalence of DSM-IV dissociative disorders was 17.2% (N = 37). On average, 64.9% of these patients' dissociative experiences had started 3.6 years (SD = 2.9; range, 1.0-11.0 years) before onset of the substance use. Patients with dissociative disorders were younger, and the mean duration of their remission periods was shorter. Dissociative disorder patients tended to use more than 1 substance, and drugs were used more frequently than alcohol in this group. The frequency of borderline personality disorder, somatization disorder, history of suicide attempt, and childhood abuse and neglect occurred more frequently in the dissociative disorder group than in the nondissociative disorder group. History of suicide attempt (p = .005), female sex (p = .050), and childhood emotional abuse (p = .010) were significant predictors of a dissociative disorder diagnosis. Significantly more patients with dissociative disorders stopped their treatment prematurely (p < .001). CONCLUSION: Impact of dissociative disorders on development and treatment of substance dependency requires further study.     

Childhood emotional abuse and dissociation in patients with conversion symptoms

Aim:  The aim of the present study was to evaluate the relationship between reported childhood trauma and dissociation in patients who have a conversion symptom.
Method:  Thirty-two outpatients with a conversion symptom were evaluated using Dissociative Experiences Scale, Somatoform Dissociation Questionnaire, Childhood Trauma Questionnaire, Spielberger Trait Anxiety Inventory, Clinician-Administered Dissociative State Scale, and Dissociative Disorders Interview Schedule.
Results:  A DSM-IV dissociative disorder was diagnosed in 46.9% of the patients. Conversion patients with a dissociative disorder had borderline personality disorder more frequently than those without a dissociative disorder. Among childhood trauma types, emotional abuse was the only significant predictor of dissociation in regression analysis. None of the childhood trauma types predicted borderline personality disorder criteria.
Conclusions:  Borderline personality disorder, dissociation and reports of childhood emotional abuse refer to a subgroup among patients with conversion symptom. Dissociation seems to be a mediator between childhood trauma and borderline phenomena among these patients.