背景:情感不稳定代表了一个重要的,精神疾病健康和临床结局的跨诊断生物行为维度。情感不稳定的原因尚不清楚。这项系统评价和荟萃分析评估了儿童逆境暴露与精神疾病的情感不稳定相关的程度。以及哪些形式的逆境与情感不稳定最密切相关。
方法:本综述遵循已发布的方案(PROSPERO:CRD42020168676)。在Medline中搜索,Embase和PsychInfo使用儿童期逆境和情感不稳定的定量测量来确定研究,1980年1月至2023年7月出版。对每个结果分别使用随机效应荟萃分析对数据进行分析,即情感不稳定,情绪失调,快速骑自行车。采用混合方法评价工具对文献质量进行评价。
结果:搜索确定了36项研究,涉及8431名参与者。所有报告都侧重于横断面关联。我们没有发现任何前瞻性的纵向研究。分析显示很小,但儿童期逆境对情感不稳定的影响具有统计学意义(r=0.09,95%CI0.02,0.17),情绪失调(r=0.25,95%CI0.19,0.32),和快速循环(OR=1.39;95%CI1.14,1.70)。当考虑逆境亚型时,情绪虐待对情绪不稳定(r=0.16,95%CI0.07,0.24)和情绪失调(r=0.32,95%CI0.19,0.44)的影响最强。质量评估得分普遍较低。大多数研究未能控制混杂因素或为样本的代表性提供保证。
结论:研究结果表明,童年的逆境,特别是情感虐待,与成年后的情绪不稳定有关,但需要进一步的前瞻性纵向研究来证实因果关系。这些发现对预防和治疗精神疾病的情感不稳定具有重要意义。
BACKGROUND: Affective instability represents an important, transdiagnostic biobehavioural dimension of mental ill health and clinical outcome. The causes of affective instability remain unclear. This systematic review and meta-analysis evaluated the extent to which exposure to childhood adversity is associated with affective instability across psychiatric disorders, and which forms of adversity are most strongly associated with affective instability.
METHODS: The review followed a published protocol (PROSPERO: CRD42020168676). Searches in Medline, Embase and PsychInfo identified studies using quantitative measures of childhood adversity and affective instability, published between January 1980 and July 2023. Data were analysed using a random effects meta-analysis separately for each outcome, namely affective lability, emotion dysregulation, and rapid cycling. The Mixed-Methods Appraisal Tool was used to appraise the quality of the literature.
RESULTS: The search identified 36 studies involving 8431 participants. All reports focused on cross-sectional associations. We did not identify any prospective longitudinal research. The analysis showed small, but statistically significant effects of childhood adversity on affective lability (r = 0.09, 95% CI 0.02, 0.17), emotion dysregulation (r = 0.25, 95% CI 0.19, 0.32), and rapid cycling (OR = 1.39; 95% CI 1.14, 1.70). When considering adversity subtypes, emotional abuse showed the strongest effect on affective lability (r = 0.16, 95% CI 0.07, 0.24) and emotion dysregulation (r = 0.32, 95% CI 0.19, 0.44). Quality assessment scores were generally low. Most studies failed to control for confounding factors or offer assurances around the representativeness of the samples.
CONCLUSIONS: The findings suggest that childhood adversity, particularly emotional abuse, is associated emotional instability in adulthood, but further prospective longitudinal research is needed to confirm causality. The findings have implications for the prevention and treatment of affective instability across psychiatric disorders.