童年期不良经历与青少年抑郁关系队列研究的Meta分析

目的总结童年期不良经历与青少年抑郁之间现有的队列研究证据,为预防青少年抑郁提供证据。方法通过检索万方、维普、中国知网、中国生物医学文献数据库、PubMed和Web of Science自建库到2019年2月间发表的有关童年期不良经历与青少年抑郁相关性的队列研究的中英文文献。中文检索词包括童年期不良经历、虐待、忽视、欺凌、家庭功能不全、家庭暴力、逆境、不良经历、不良事件、创伤、抑郁、前瞻性、队列、纵向、随访;英文检索词包括adverse childhood experiences,ACE,abuse,maltreat,mistreat,neglect,bully,bullying,family dysfunction,family violence,adversities,trauma,victimization,victim,adverse events,adverse experiences,longitudinal,follow-up,prospective,cohort,depression,depressive。对筛选得到的符合纳入标准的文献用Stata 11.0软件进行Meta分析。结果纳入文献12篇(11篇英文,1篇中文)。结果显示,童年期不良经历与青少年抑郁呈正相关(OR=1.75,95%CI=1.43~2.15),其中忽视对青少年抑郁的影响最大(OR=2.42,95%CI=1.31~4.46),而虐待对青少年抑郁的影响最小(OR=1.77,95%CI=1.25~2.52)。欺凌的OR值为2.09(95%CI=1.38~3.16),男生(OR=3.77,95%CI=2.31~6.15)大于女生(OR=1.44,95%CI=1.04~2.01)。漏斗图和Egger检验提示,纳入文献存在发表偏倚,敏感性分析显示Meta分析结果较为稳健。结论童年期不良经历与青少年抑郁呈正相关,忽视对青少年抑郁的影响最大,虐待对青少年抑郁的影响最小。

Association between adverse childhood experiences and adolescent depression: a Meta-analysis

Objective To summarize the existing cohort study evidence between adverse childhood experience(ACEs) and adolescent depression, to explore the influence of ACEs on adolescent depression, so as to provide evidence for the prevention of adolescent depression. Methods Chinese and English literatures on the cohort study on the correlation between ACEs and adolescent depression published by WanFang, VIP databases, CNKI, CBM, PubMed and Web of Science were searched. We only selected orginal articles that their either reported on Chinese and English retrieval words of "adverse childhood experiences""ACE""abuse""maltreat""mistreat""neglect""bully""bullying""family dysfunction""family violence""adversities""trauma""victimization""victim""adverse events""adverse experiences""longitudinal""follow-up""prospective""cohort""depression""depressive". Meta-analysis was performed on the literatures that met the inclusion criteria, and statistical analysis was conducted using Stata software.ResultsTwelve references(11 in English and 1 in Chinese) were included in the Meta-analysis, and the results showed that ACEs were positively correlated with adolescent depression(pooled OR=1.75,95%CI=1.43-2.15). Among them, The effect of neglect was most prominent(pooled OR=2.42, 95%CI=1.31-4.46) while the influence of abuse was least strong(pooled OR=1.77, 95%CI=1.25-2.52). The pooled odds ratio associated with bully was 2.09 with the 95% confidence intervals from 1.38 to 3.16. The pooled odds ratio of boys is greater than girls(boys: pooled OR=3.77, 95%CI=2.31-6.15;girls: pooled OR=1.44, 95%CI=1.04-2.01). Funnel plot and Egger test suggested publication bias in the included literatures, and the sensitivity analysis indicated that the meta analysis results were relatively stable. Conclusion The adverse childhood exprience is positively associated with adolescent depression.Adolescent depression is strongly affected by neglected,and is least affected by abuse.