童年应激与成年应激对精神健康状况的叠加影响  

Effect of match between childhood stress and adulthood stress on adulthood mental health status

作　　者：位照国[1] 戎笛声[1] 程艳[1] 杨颖佳[1] 李欣瑩 李凌江[1,2] Wei Zhaoguo;Rong Disheng;Cheng Yan;Yang Yingjia;Li Xinying;Li Lingjiang(Psychiatric Department,Shenzhen Kangning Hospital,Shenzhen,Guangdong 518020,China;Mental Health Institute,the Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]深圳市康宁医院心身医学科,518020 [2]中南大学湘雅二医院精神卫生研究所,长沙410011

出　　处：《中华行为医学与脑科学杂志》2020年第11期1001-1006,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：广东省高水平临床重点专科(深圳市配套建设经费)资助(SZGSP013);深圳市医学重点学科建设经费资助(SZXK041)。

摘　　要：目的探讨童年应激和成年应激的关系以及对成年精神健康状况的叠加影响。方法通过网络和电话访谈,采用童年创伤问卷、自编终生应激事件表、DSM-5一级跨界症状量表(DSM5-L1CCSM)和抑郁自评量表(SDS)测量成年健康志愿者(n=239)和精神障碍志愿者(n=387)的童年应激、成年应激和成年精神健康状况;依据童年-成年应激匹配情况分组:童年-成年应激阳性匹配组(n=108)、童年-成年应激阳性非匹配组(n=240)、童年应激阴性成年应激阳性组(n=100),童年应激阳性成年应激阴性组(n=79)和童年-成年应激均阴性组(n=99);比较分析不同分组的应激水平和精神健康状况差异,用Logistic回归分析和多因素协方差分析童年应激、成年应激和精神健康状况之间的关系。结果童年应激阳性比例为68.2%(427/626),成年应激阳性比例为71.6%(448/626),童年-成年应激阳性匹配比例为17.3%(108/626)。不同应激分组在除性别外的所有其他测量指标差异有统计学意义(均P<0.05)。年龄、受教育年限、童年应激阳性和情感虐待是成年应激发生的影响因素(P<0.01),成年应激阳性数与童年应激阳性数的交互作用(P<0.001)、成年应激阳性数与童年创伤因子的交互作用(P=0.001)和应激分组(P=0.002)对DSM5-L1CCSM总分和SDS总分有影响。结论童年应激对成年应激有易化作用,重复经历与童年应激同类型的成年应激会显著恶化成年精神健康预后,童年-成年应激阳性匹配是重要的不良预后因素。Objective:To explore the effect of match between childhood stress and adulthood stress on mental health status.Methods:Adult healthy volunteers(n=239)and adult mental disorder patients were examined by questionnaires or telephone interviews.Childhood trauma questionnaire(CTQ)and lifetime stress event list were used for measure of CS and AS,DSM5-level-1-cross-cutting-symptom-measure(DSM5-L1CCSM)and self-rating depression scale(SDS)for mental health outcomes.Subjects were grouped according to positive(+)/negative(-)stress events into five groups:CS+AS+Matched(n=108),CS+AS+mismatched(n=240),CS-AS+(n=100),CS+AS-(n=79),and CS-AS-(n=99).The data of stress and mental health status were compared and analyzed among stress groups.Results:The distributions of positive stress events among 626 volunteers were 68.2%with CS+,71.6% with AS+,17.3% with C+A+M+.There were differences among groups in all parameters(all P<0.05)except for gender.Age,years of education,CS and emotional abuse were influencing factors of onset of AS(P<0.01).MANCOVA analysis showed that factors about the interaction of AS and CS had attribution on DSM5-L1CCSM and SDS(P<0.01).Conclusion:CS has a facilitatory effect on AS.The match of CS-AS is an important risk factor of adulthood mental health outcomes.Re-experiencing the same type of CS in adulthood would worsen adulthood mental health status.

关 键 词：童年应激 成年应激 精神健康状况 匹配 抑郁 

分 类 号：R749.5[医药卫生—神经病学与精神病学]