目的:精神合并症提示不同诊断的症状重叠;诊断网络方法对于研究精神病理学是有价值的。儿童创伤是精神疾病的常见诊断危险因素,但是,儿童创伤和精神病理学之间的复杂关系很少使用大型横断面诊断样本进行研究。
方法:这项研究招募了869名诊断不同的患者,包括418例精神分裂症,215双相情感障碍,和236个重度抑郁症。参与者完成了精神病学访谈和自我报告问卷。我们构建了基于维度和项目级别的最小绝对收缩和选择算子(LASSO)网络,以探索童年创伤之间的关系,精神病理学,和疾病的持续时间。此外,我们构建了有向无环图(DAG),以初步阐明这些变量之间潜在的关联方向.对不同诊断组和性别分层组进行网络比较测试(NCT)。
结果:经诊断的LASSO网络显示,不同类型的儿童创伤对不同的精神病理学维度产生不同的影响。情绪虐待与抑郁症状有关,身体虐待到兴奋症状,性虐待到积极和混乱的症状,情绪忽视抑郁症状和消极症状的动机和快乐(MAP)缺陷因子,和身体忽视MAP因素。DAG的发现通常与LASSO网络一致。NCT显示了可比的网络。
结论:我们的研究结果表明,儿童创伤与不同诊断组的精神病理学发展显著相关。情感途径模型表明,对于有童年创伤史的人,需要早期识别和量身定制的干预措施。
OBJECTIVE: Psychiatric comorbidities suggest that symptoms overlap across different diagnoses; the transdiagnostic network approach is valuable for studying
psychopathology. Childhood trauma is a common transdiagnostic risk factor for psychiatric disorders, but the complex relationship between childhood trauma and
psychopathology has seldom been investigated using a large cross-sectional transdiagnostic sample.
METHODS: This study recruited 869 patients with different diagnoses, including 418 schizophrenia, 215 bipolar disorder, and 236 major depressive disorder. Participants completed psychiatric interviews and self-report questionnaires. We constructed dimension- and item-level Least Absolute Shrinkage and Selection Operator-based (LASSO) networks to explore the relationship between childhood trauma,
psychopathology, and duration of illness. Moreover, we constructed directed acyclic graphs (DAGs) to tentatively clarify the potential directions of associations among these variables. Network Comparison Tests (NCTs) were conducted for different diagnostic groups and gender-stratified groups.
RESULTS: The transdiagnostic LASSO networks showed that different types of childhood trauma exerted distinct impacts on various psychopathological dimensions. Emotional abuse was linked to depressive symptoms, physical abuse to excited symptoms, sexual abuse to positive and disorganized symptoms, emotional neglect to depressive symptoms and motivation and pleasure (MAP) deficits factor of negative symptoms, and physical neglect to MAP factor. The DAG findings generally concurred with the LASSO network. The NCT showed comparable networks.
CONCLUSIONS: Our findings suggest that childhood trauma is significantly associated with the development of
psychopathology across different diagnostic groups. The affective pathway model suggests that early identification and tailored interventions would be needed for people with a history of childhood trauma.