{"title":"童年虐待对双重诊断精神疾病和药物使用障碍临床结果的影响：系统回顾和荟萃分析","authors":"Bruna Alvim Stocchero , Leonardo Melo Rothmann , Eduardo Tavares Portolan , Thales Guimarães Lopes , Clarissa Ferraz-Rodrigues , Miguel Gomes Garcia , Joana Corrêa de Magalhães Narvaez , Rodrigo Grassi-Oliveira , Thiago Wendt Viola","doi":"10.1016/j.chiabu.2024.107085","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Evidence suggests that the phenotypic expression of substance use disorders (SUD) may be influenced by exposure to childhood maltreatment (CM).</div></div><div><h3>Objective</h3><div>To assess how CM could impact severity (relapse, treatment dropout, withdrawal), age of substance use onset, psychiatric dual diagnosis (depression, anxiety, PTSD, distress), and self-harm behavior/suicide attempts in adults with SUD, we performed a systematic review and meta-analyses.</div></div><div><h3>Methods</h3><div>We searched PubMed, Web of Science, PsycINFO, and Embase to identify articles examining the association of maltreatment (physical, sexual, or emotional abuse or neglect) before age 18 years with clinical features and course of illness SUD. Multilevel random effects models were performed. Heterogeneity was quantified using the I<sup>2</sup> statistic. Subgroup/meta-regression analyses were employed to investigate sources of heterogeneity. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale.</div></div><div><h3>Results</h3><div>Forty-five studies were included. CM was associated with all tested outcomes, such as anxiety (OR = 1.52; 95 % CI = 1.39, 1.65), depression (OR = 1.57; 95 % CI = 1.40, 1.77), PTSD (OR = 1.67; 95 % CI = 1.40, 1.99), psychological distress (OR = 1.49; 95 % CI = 1.24, 1.78), self-harm behavior and suicidal attempts (OR = 1.70; 95 % CI = 1.47, 1.96), SUD severity (OR = 1.15; 95 % CI = 1.04, 1.26), and younger age of onset use (OR = 0.76; 95 % CI = 0.69, 0.84). However, comparisons between outcomes revealed that the association was stronger for dual diagnosis symptoms/conditions than for measures of SUD severity itself. Meta-analyses for some outcomes had large statistical heterogeneity, though these were partly addressed through additional analyses. Gender, mean age of participants, polysubstance use pattern, substance of preference, and CM subtype were found to be moderators of these associations.</div></div><div><h3>Conclusions</h3><div>The consequences of CM on individuals with SUD are more closely linked to co-occurring psychiatric manifestations than to the severity of common clinical indicators (relapse, treatment dropout, withdrawal), and this finding has important implications.</div></div><div><h3>Funding</h3><div>None.</div></div><div><h3>Systematic review registration</h3><div>PROSPERO (CRD42021245936).</div></div>","PeriodicalId":51343,"journal":{"name":"Child Abuse & Neglect","volume":"158 ","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis\",\"authors\":\"Bruna Alvim Stocchero , Leonardo Melo Rothmann , Eduardo Tavares Portolan , Thales Guimarães Lopes , Clarissa Ferraz-Rodrigues , Miguel Gomes Garcia , Joana Corrêa de Magalhães Narvaez , Rodrigo Grassi-Oliveira , Thiago Wendt Viola\",\"doi\":\"10.1016/j.chiabu.2024.107085\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Evidence suggests that the phenotypic expression of substance use disorders (SUD) may be influenced by exposure to childhood maltreatment (CM).</div></div><div><h3>Objective</h3><div>To assess how CM could impact severity (relapse, treatment dropout, withdrawal), age of substance use onset, psychiatric dual diagnosis (depression, anxiety, PTSD, distress), and self-harm behavior/suicide attempts in adults with SUD, we performed a systematic review and meta-analyses.</div></div><div><h3>Methods</h3><div>We searched PubMed, Web of Science, PsycINFO, and Embase to identify articles examining the association of maltreatment (physical, sexual, or emotional abuse or neglect) before age 18 years with clinical features and course of illness SUD. Multilevel random effects models were performed. Heterogeneity was quantified using the I<sup>2</sup> statistic. Subgroup/meta-regression analyses were employed to investigate sources of heterogeneity. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale.</div></div><div><h3>Results</h3><div>Forty-five studies were included. CM was associated with all tested outcomes, such as anxiety (OR = 1.52; 95 % CI = 1.39, 1.65), depression (OR = 1.57; 95 % CI = 1.40, 1.77), PTSD (OR = 1.67; 95 % CI = 1.40, 1.99), psychological distress (OR = 1.49; 95 % CI = 1.24, 1.78), self-harm behavior and suicidal attempts (OR = 1.70; 95 % CI = 1.47, 1.96), SUD severity (OR = 1.15; 95 % CI = 1.04, 1.26), and younger age of onset use (OR = 0.76; 95 % CI = 0.69, 0.84). However, comparisons between outcomes revealed that the association was stronger for dual diagnosis symptoms/conditions than for measures of SUD severity itself. Meta-analyses for some outcomes had large statistical heterogeneity, though these were partly addressed through additional analyses. Gender, mean age of participants, polysubstance use pattern, substance of preference, and CM subtype were found to be moderators of these associations.</div></div><div><h3>Conclusions</h3><div>The consequences of CM on individuals with SUD are more closely linked to co-occurring psychiatric manifestations than to the severity of common clinical indicators (relapse, treatment dropout, withdrawal), and this finding has important implications.</div></div><div><h3>Funding</h3><div>None.</div></div><div><h3>Systematic review registration</h3><div>PROSPERO (CRD42021245936).</div></div>\",\"PeriodicalId\":51343,\"journal\":{\"name\":\"Child Abuse & Neglect\",\"volume\":\"158 \",\"pages\":\"\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-10-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Child Abuse & Neglect\",\"FirstCategoryId\":\"102\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0145213424004757\",\"RegionNum\":2,\"RegionCategory\":\"心理学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"FAMILY STUDIES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Child Abuse & Neglect","FirstCategoryId":"102","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0145213424004757","RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"FAMILY STUDIES","Score":null,"Total":0}
引用次数: 0
摘要
背景有证据表明，药物使用障碍（SUD）的表型表现可能会受到儿童虐待（CM）的影响。为了评估儿童虐待如何影响药物使用障碍的严重程度（复发、辍学、戒断）、药物使用的发病年龄、精神疾病的双重诊断（抑郁、焦虑、创伤后应激障碍、痛苦）以及成人药物使用障碍患者的自残行为/自杀企图，我们进行了一项系统综述和荟萃分析。方法我们检索了 PubMed、Web of Science、PsycINFO 和 Embase，以确定研究 18 岁前虐待（身体虐待、性虐待、情感虐待或忽视）与 SUD 临床特征和病程关系的文章。采用多层次随机效应模型。使用 I2 统计量对异质性进行量化。采用分组/元回归分析来研究异质性的来源。采用改编版的纽卡斯尔-渥太华质量评估量表对偏倚风险进行评估。CM与所有测试结果相关，如焦虑（OR = 1.52; 95 % CI = 1.39, 1.65）、抑郁（OR = 1.57; 95 % CI = 1.40, 1.77）、创伤后应激障碍（OR = 1.67; 95 % CI = 1.40, 1.99）、心理困扰（OR = 1.49; 95 % CI = 1.24, 1.78）、自残行为和自杀企图（OR = 1.70; 95 % CI = 1.47, 1.96）、SUD 严重程度（OR = 1.15; 95 % CI = 1.04, 1.26）和较年轻的开始使用年龄（OR = 0.76; 95 % CI = 0.69, 0.84）。然而，对不同结果进行比较后发现，双重诊断症状/条件的相关性要强于药物滥用严重程度本身的相关性。某些结果的 Meta 分析存在较大的统计异质性，但通过额外的分析，这些异质性得到了部分解决。性别、参与者的平均年龄、多种药物使用模式、偏好药物和慢性阻塞性肺病亚型被认为是这些关联的调节因素。结论慢性阻塞性肺病对患有慢性阻塞性肺病的个体造成的后果与并发精神病表现的关系比与常见临床指标（复发、治疗辍学、戒断）的严重程度的关系更为密切，这一发现具有重要的意义。
The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis
Background
Evidence suggests that the phenotypic expression of substance use disorders (SUD) may be influenced by exposure to childhood maltreatment (CM).
Objective
To assess how CM could impact severity (relapse, treatment dropout, withdrawal), age of substance use onset, psychiatric dual diagnosis (depression, anxiety, PTSD, distress), and self-harm behavior/suicide attempts in adults with SUD, we performed a systematic review and meta-analyses.
Methods
We searched PubMed, Web of Science, PsycINFO, and Embase to identify articles examining the association of maltreatment (physical, sexual, or emotional abuse or neglect) before age 18 years with clinical features and course of illness SUD. Multilevel random effects models were performed. Heterogeneity was quantified using the I2 statistic. Subgroup/meta-regression analyses were employed to investigate sources of heterogeneity. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale.
Results
Forty-five studies were included. CM was associated with all tested outcomes, such as anxiety (OR = 1.52; 95 % CI = 1.39, 1.65), depression (OR = 1.57; 95 % CI = 1.40, 1.77), PTSD (OR = 1.67; 95 % CI = 1.40, 1.99), psychological distress (OR = 1.49; 95 % CI = 1.24, 1.78), self-harm behavior and suicidal attempts (OR = 1.70; 95 % CI = 1.47, 1.96), SUD severity (OR = 1.15; 95 % CI = 1.04, 1.26), and younger age of onset use (OR = 0.76; 95 % CI = 0.69, 0.84). However, comparisons between outcomes revealed that the association was stronger for dual diagnosis symptoms/conditions than for measures of SUD severity itself. Meta-analyses for some outcomes had large statistical heterogeneity, though these were partly addressed through additional analyses. Gender, mean age of participants, polysubstance use pattern, substance of preference, and CM subtype were found to be moderators of these associations.
Conclusions
The consequences of CM on individuals with SUD are more closely linked to co-occurring psychiatric manifestations than to the severity of common clinical indicators (relapse, treatment dropout, withdrawal), and this finding has important implications.
期刊介绍：
Official Publication of the International Society for Prevention of Child Abuse and Neglect. Child Abuse & Neglect The International Journal, provides an international, multidisciplinary forum on all aspects of child abuse and neglect, with special emphasis on prevention and treatment; the scope extends further to all those aspects of life which either favor or hinder child development. While contributions will primarily be from the fields of psychology, psychiatry, social work, medicine, nursing, law enforcement, legislature, education, and anthropology, the Journal encourages the concerned lay individual and child-oriented advocate organizations to contribute.
京公网安备 11010802042870号
京ICP备2023020795号-1
分享
求助内容：
应助结果提醒方式：
扫码关注我们
