儿童期虐待与成人抑郁症

本文就儿童期虐待与成人抑郁症之间的关系 ,以及有儿童受虐史的成人抑郁症的临床特点、发生的可能机制、预后和治疗对策等加以阐述。     

惊恐障碍患者的儿童期虐待与认知功能研究

目的:研究惊恐障碍(PD)患者儿童期虐待经历与其认知功能水平的特征,并探讨儿童期虐待对PD认知功能的影响。方法:选取33例PD患者为病例组;采用儿童期虐待问卷对正常对照组筛选出伴儿童期虐待对照组31名和不伴儿童期虐待对照组38名。采用惊恐障碍严重度量表评定患者症状,威斯康星卡片分类测验(WCST)和韦氏记忆量表(WMS)评估3组的认知功能。结果:PD组与伴儿童期虐待对照组和不伴儿童期虐待对照组在儿童期情感虐待上差异均有统计学意义(P均0.05)。在认知功能得分上,PD组与不伴儿童期虐待对照组在WCST持续错误数得分(P0.05)、WMS视觉再生和理解记忆得分上差异有统计学意义(P均0.01);PD组与伴儿童期虐待对照组在WMS理解记忆分量表上差异有统计学意义(P0.05);伴与不伴儿童期虐待的两对照组在WMS4个分量表上差异均有统计学意义(P均0.05)。相关分析显示PD的症状得分与儿童期情感虐待存在较强的正相关(P均0.01);PD的WMS理解记忆得分与儿童期情感虐待呈负相关(P0.01),偏相关分析也显示两者呈负相关(P0.05)。结论:PD患者可能会具有更多的儿童期虐待,尤其是情感虐待。儿童期虐待不仅可能会影响PD患者的惊恐症状严重程度,还可能对工作记忆等认知功能产生损害。     

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。     

儿童期心理虐待对青少年抑郁障碍的影响：宽恕倾向的中介效应

目的 探讨儿童期心理虐待、宽恕倾向与青少年抑郁障碍的关系。方法 选取我院门诊或住院的青少年重性抑郁障碍患者76人作为研究组,选取80名健康青少年作为对照组,研究组和对照组施测儿童期心理虐待量表（CPMS）和Hearland宽恕量表（HFS）,以汉密尔顿抑郁量表（HAMD）评估研究组抑郁障碍严重程度。结果 研究组恐吓、贬损、干涉、纵容因子分高于对照组（P<0.05或0.01）;研究组自我宽恕和宽恕他人因子分低于对照组（P=0.000）。CPMS各因子分与HAMD大部分因子分呈正相关（P<0.05或0.01）;自我宽恕与焦虑/躯体化、体重、认知障碍、迟滞、绝望感呈负相关（P<0.05或0.01）。CPMS的恐吓、纵容对HAMD总分有预测作用（P<0.01）,可解释方差变异的39.7%;自我宽恕、宽恕他人对HAMD总分有预测作用（P=0.000）,可解释方差变异的64.2%。宽恕倾向在儿童期心理虐待与青少年抑郁严重程度之间起部分中介作用,中介效应占总效应的42.05%。结论 儿童期心理虐待、宽恕倾向是青少年抑郁障碍的预测因子,宽恕倾向是儿童期心理虐待与抑郁障碍严重程度...     

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.     

抑郁症患者与非抑郁症人群中儿童期虐待与社会支持的关系

目的 研究抑郁症患者与非抑郁症人群中儿童期虐待与社会支持的关系。方法 本研究 采用非匹配的病例对照研究，对2014 年1 月至2017 年12 月北京安定医院符合入排标准的研究对象进行 研究，共连续纳入224 例抑郁症患者及214 例非抑郁症人群。采用调查问卷（自编）收集研究对象的基本 信息（年龄、性别、婚姻状态、教育水平、工作状态、吸烟史及体质量指数）、疾病史、精神疾病家族史；采 用儿童期虐待问卷中文版（CTQ-SF）评估研究对象16 岁前的经历；采用社会支持评定量表（SSRS）评估 研究对象在过去生活状态中获得的社会支持情况，包含客观支持、主观支持和支持利用3 个维度。采 用单因素分析对抑郁症患者与非抑郁症人群进行基本资料、CTQ-SF及SSRS 评分的比较，采用多因素 Logistic 回归分析影响成年期患者抑郁发生的因素。结果 抑郁症患者中有儿童期虐待经历者（93 例， 41.52%）多于非抑郁症人群（51 例，23.8%），差异有统计学意义（χ2=15.51，P ＜ 0.01）。多因素Logistic 回 归分析显示，儿童期虐待是成年期抑郁的重要危险因素（OR=2.030，95%CI：1.302～3.164）。抑郁症患者 社会支持总分［（32.33±7.45）分］、主观支持［8（6，10）分］、客观支持［17（14，21）分］及支持利用度得分 ［6（5，8）分］均低于非抑郁症人群［分别为（36.79±6.24）、9（7， 11）、20（17， 23）、8（6， 9）分］，差异均有统 计学意义（均P＜0.01）。抑郁症患者中，有儿童期虐待者社会支持得分［（30.41±7.99）分］、主观支持得分 ［7（5，9）分］、客观支持得分［（16.57±4.78）分］均低于无儿童期虐待经历者［分别为（33.70±6.76）、9（7，10）、 （18.53±4.35）］，差异均有统计学意义（均P ＜ 0.01）；非抑郁症人群中，有儿童期虐待者主观支持得分 ［8（6，10）分］低于无儿童期虐待经历者［9（7，11）分］，差异有统计学意义（P ＜ 0.01）。结论 儿童期虐 待是成年期抑郁症及获得社会支持的重要影响因素。     

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。     

女护生儿童期虐待与情绪调节自我效能感的关系研究

目的探讨女护生情绪调节自我效能感与儿童期虐待经历的关系,为维护其心理健康采取有效的干预措施提供参考。方法采用整群抽样方法,于2016年1月在南充市3所职业卫校选取966名在校女护生,用中文版情绪调节自我效能感量表(RES)和儿童期虐待问卷(CTQ)进行评定。结果 (1)966名女护生的情感忽视、情感虐待、躯体忽视评分相对较高,分别为(11. 43±4. 94)分、(8. 61±3. 04)分、(8. 07±3. 07)分;躯体虐待和性虐待评分较低,分别为(6. 62±2. 38)分、(5. 62±1. 69)分;(2)相关分析散点图显示,RES和CTQ评分无线性关系;(3)回归分析显示,儿童期情感虐待和情感忽视对情绪调节自我效能感有负向预测作用(t=-4. 026、-3. 739,P均0. 01),总贡献率为5. 4%。结论儿童期虐待经历对女护生情绪调节自我效能感有负性预测作用,即儿童期经历的虐待越多,情绪调节自我效能感越低。     

儿童情感虐待与青少年焦虑的关系

目的　探讨儿童期情感虐待对青少年期焦虑症的影响。方法　采用整群抽样法,对河南省新乡市493 名初中生进行一般社会资料问卷,焦虑自评量表(SAS)、儿童虐待史问卷(CECA.Q) 进行评估。结果　青少年焦虑与家中是否有兄弟姐妹、父母离异和父母接受教育的程度无明显关系;青少年焦虑和情感虐待有明显的关联;Logistic 回归结果发现,控制年龄、性别因素后,情感虐待与青少年焦虑呈正相关。父亲和母亲的忽视增加青少年焦虑的风险最明显,父母的憎恶对青少年焦虑症影响较小。结论　父母的忽视是青少年焦虑的重要风险因素。     

Internalizing symptoms and rumination: The prospective prediction of familial and peer emotional victimization experiences during adolescence

Adolescence is marked by increases in stressful life events. Although research has demonstrated that depressed individuals generate stress, few studies investigate the generation of emotional victimization. The current study examined the effects of rumination and internalizing symptoms on experiences of peer victimization and familial emotional abuse.Participants were 216 adolescents (M = 14-years-old; 58% female; 47% African–American) who completed two assessments. Results showed that rumination predicted peer victimization and emotional abuse. The effect of rumination on emotional victimization is heightened for those who have higher levels of depression symptoms. That is, individuals who ruminate and who have depression symptoms experience increases in both peer emotional victimization and parental emotional abuse.This study builds upon prior research and indicates that rumination may be a stronger predictor of emotional victimization than symptoms of depression or anxiety. Identifying underlying mechanisms may yield targets for interventions aimed at addressing the chronic nature of depression.     

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.     

高危服刑人员冲动性特点与其儿童期虐待的相关研究

目的 了解高危服刑人员冲动性的特点及其影响因素,为识别服刑人员冲动性的高危因素并进行有效干预提供参考.方法 以南京市某监狱588名男性服刑人员为研究对象,按暴力犯罪案由、高冲动性、边缘型人格及反社会人格为特点将其分为四组,收集服刑人员一般人口学资料和犯罪信息,采用自编物质使用情况调查表、Barratt冲动性量表第11版...     

不同时期儿童精神分裂症早期症状比较研究

目的：探讨不同时期儿童精神分裂症早期症状的特点。方法：对1986-1992年(甲组，239例)和1996-2002年(乙组，235例)住院精神分裂症患者的病例资料进行回顾性研究，比较早期精神症状的特点。结果：在学业、与亲人的关系、情绪和躯体不适等方面，乙组发生率明显高于甲组。结论：不同时期儿童精神分裂症的早期症状具有较为明显的特点。     

Disturbed sleep in children born extremely preterm is associated with behavioural and emotional symptoms

AimTo determine whether children born extremely preterm are at increased risk for sleep disturbances and to explore relationships between extremely preterm birth, sleep and attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional symptoms.MethodEPICure2 cohort study. Parents of 165 children born ≤26 weeks' gestation (53% male) and 121 children born at term (43% male) completed the Children's Sleep Habits Questionnaire, sleep disordered breathing subscale of the Pediatric Sleep Questionnaire, the emotional problems scale of the Strengths and Difficulties Questionnaire and the ADHD Rating Scale-5 at 11 years of age.ResultsExtremely preterm children had greater habitual snoring (adjusted odds ratio 6.8; 95% confidence interval 2.3, 20.3), less frequently fell asleep within 20 minutes (Cohen's d 0.33), higher night wakings (d 0.44) and daytime sleepiness scores (d 0.40) than term-born children; there was no between-group difference in sleep duration scores. Among children without severe disability, night wakings scores partially mediated the relationship between preterm birth and inattention (additional 5% of variance explained), hyperactivity/impulsivity (13%) and emotional problems (9%). Snoring partially mediated the relationship between preterm birth, hyperactivity/impulsivity and inattention (additional 1–5% of variance).ConclusionChildren born extremely preterm are at increased risk of disturbed sleep compared to term-born children. As night wakings partially mediated the relationship between preterm birth and ADHD symptoms and emotional problems, reducing sleep disturbance may improve sleep and reduce attention and emotional problems in this population.     

Clinical characteristics and treatment outcome of depression in patients with and without a history of emotional and physical abuse

Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were initially randomized to IPT or SSRI and then augmented with the second treatment if they did not remit with monotherapy. Assessments included the SCID-I, the SCID-II for DSM-IV diagnoses, the HRSD, the QIDS and the Mood Spectrum Self-Report (MOODS-SR). Seventy-eight (25%) patients reported a history of EPA; 60 (76.9%) were women. Patients with a history of EPA did not differ from those without on HRSD scores at baseline, but showed an earlier age at onset of depression and a longer duration of illness. The two groups differed on several mood spectrum factors, namely: ‘depressivemood’ (15.6 ± 4.9 vs. 13.5 ± 5.4; p < 0.004), ‘psychomotorretardation’ (11.7 ± 4.5 vs. 9.6 ± 4.7; p < 0.001), ‘drugandillness-relateddepression’ (1.3 ± 1.3 vs. 0.6 ± 1.0; p < 0.0001), and ‘neurovegetativesymptoms’ (8.3 ± 2.6 vs. 6.9 ± 2.9; p < 0.0001). Patients with EPA had also a significantly longer time to remission (89 vs. 67 days, log-rank test, p = 0.035). The need for augmentation treatment was significantly more frequent among patients with EPA than in those without. The present study suggests that patients with a history of EPA show a subtype of depression characterized by poor treatment response and more severe neurovegetative and psychomotor symptoms.     

Prevalence of self-reported childhood abuse in psychosis: A meta-analysis of retrospective studies

There is extensive clinical literature reporting traumatic childhood experiences in patients with psychosis. A quantitative meta-analysis addressing the prevalence of self-reported childhood sexual (CSA), physical (CPA) and emotional abuse (CEA) in psychotic patients has yet to be done. We conducted, a systematic literature search to identify retrospective studies addressing self-reported childhood abuse in patients with DSM/ICD psychosis. Demographic, clinical, and methodological variables were extracted from each publication, or obtained directly from its authors. Quantitative meta-analysis of CSA, CPA, CEA in the sample of patients was performed. Statistical heterogeneity and publication bias were assessed and meta-regressions performed to control for different moderators.     

The influence of childhood abuse and adult attachment style on clinical relationships in breast cancer care

Objective

In a previous report, breast cancer patients reporting a history of childhood abuse were less likely to feel fully supported in their relationships with clinical staff than were patients who did not report an abuse history. Our aims were to replicate this effect, to test whether surgeons’ difficulties in these relationships mediated the relationship of abuse to patients feeling less supported, and to test whether patients’ attachment style mediates the influence of abuse on patients’ or surgeons’ experience of the relationship.

Method

Women with primary breast cancer (N = 100) completed self-report questionnaires around the time of surgery to assess: emotional distress; adult attachment (models of self and other); sexual, physical and emotional abuse before age 16; and childhood parental care. After consultation three weeks post-operatively patients and surgeons completed self-report questionnaires to measure, respectively, patients’ perceptions of support from the surgeon, and surgeons’ perceptions of difficulty in their relationship with the patient.

Results

Patients recalling abuse were more than seven times more likely to feel incompletely supported by the surgeon than those not recalling abuse, after controlling for emotional distress. Surgeons reported greater difficulty in relationships with patients recalling abuse than with non-abused patients. Attachment (poor model of self) mediated the relationship of abuse with patient perceptions of incomplete support, but not the relationship with surgeon ratings of difficulty.

Conclusion

The damaging effects of childhood abuse on adult relationships extend to relationships with surgeons in cancer care. While effects of abuse on attachment can explain the damage that patients experience, mediators of the difficulty that surgeons experience need further research.     

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.