童年期家庭不良经历与成人期精神障碍关联的病例对照研究

发布时间：2018-04-21 17:04

  本文选题：严重精神障碍 + 童年期　； 参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的:分析童年期家庭不良经历与成人期精神障碍的相关性,为进一步探讨精神障碍的发病机制,开展早期干预提供参考。方法:采用病例对照研究设计,分别以2016年7月至9月期间,在宁夏三家精神专科医院住院治疗的严重精神障碍患者,和宁夏地区精神障碍流行病学调查中诊断的常见精神障碍患者为病例组;以宁夏地区未满足任一精神障碍的社区居民为对照组。病例组和对照组根据年龄、性别行频数匹配,三组各272例,共816例患者纳入最后分析。病例组的诊断采用ICD-10诊断标准,全部精神检查均采用临床定式精神检查完成。童年期家庭不良经历采用童年期不良经历清单(Childhood Adversed Experience Checklist,CAEC)收集相关信息,包括:家庭结构不全、躯体虐待、父母之间家庭暴力、忽视、父母犯罪坐牢、父母精神异常、父母物质滥用等七个方面内容。Logistic回归模型分析童年期家庭不良经历与重性精神障碍的相关性。结果:1.严重精神障碍患者主要以精神分裂症患者为主,占87.87%;平均年龄在严重精神障碍组、对照组和常见精神障碍组分别为36.0±10.9岁、36.7±11.1岁、36.5±1.8岁;三组在回、汉族构成上(χ2=139.63,p0.001)、文化程度构成(χ2=68.85,p0.001)上差异有显著性。2.严重精神障碍组在家庭结构不全的比例(21.5%)、童年期遭受虐待的比例(21.7%)、遭受家庭暴力的比例(26.1%)、被忽视的比例(27.6%)、父母犯罪坐牢的比例(3.1%)、父母精神异常的比例(24.0%)、父母物质滥用史阳性比例(21.0%)均高于对照组(P0.05))。多因素分析结果:采用非条件Logistic逐步回归法模型筛选变量,控制了性别、年龄、民族等一般人口学变量后,最终进入回归方程的变量包括:虐待(OR=3.06,95%CI:2.29-4.10)、忽视(OR=28.55,95%CI:10.14-80.39)、家庭暴力(OR=3.60,95%CI:2.58-5.02)、家庭结构不全(OR=11.65,95%CI:5.12-26.53)、父母物质使用障碍(OR=15.17,95%CI:5.33-43.21)、父母精神异常(OR=2.28,95%CI:1.37-3.80)、任一不良经历(OR=6.01,95%CI:3.70-9.78)、两项不良经历(OR=22.34,95%CI:11.69-42.71)。3.常见精神障碍组家庭结构不全的比例(13.2%)显著高于对照组(P0.05))。采用非条件Logistic逐步回归模型控制了性别、年龄、民族等一般人口学变量后,最终进入回归方程的变量有家庭结构不全(OR=5.97,95%CI:2.43-14.64)。结论:各项童年期家庭不良经历均与成人期严重精神障碍存在显著统计学差异;童年期家庭结构不全与成人期常见精神障碍存在显著的统计学关联;童年期家庭不良经历可能对成人期严重精神障碍的患病风险影响更为明显。
[Abstract]:Objective: to analyze the correlation between childhood family bad experience and adult mental disorder, and to provide reference for further exploring the pathogenesis of mental disorder and carrying out early intervention. Methods: a case-control study was used to study the patients with severe mental disorders who were hospitalized in three psychiatric hospitals in Ningxia from July to September 2016. The patients with common mental disorders diagnosed in the epidemiological survey of mental disorders in Ningxia region were selected as case group, and the community residents who did not satisfy any mental disorders in Ningxia area were taken as the control group. The patient group and control group were matched according to age and sex. 272 cases in each group were included in the final analysis. ICD-10 criteria were used in the diagnosis of the patients, and all psychiatric examinations were completed by clinical routine psychiatric examination. Family Bad experiences in Childhood Adversed Experience ChecklistCAECs are used to collect relevant information, including: incomplete family structure, physical abuse, domestic violence between parents, neglect, parents in prison for crimes, mental disorders of parents. Logistic regression model was used to analyze the correlation between family bad experiences and mental disorders in childhood. The result is 1: 1. The average age of the patients with severe mental disorders was 36.0 卤10.9 years old, 36.7 卤11.1 years old and 36.5 卤1.8 years old, respectively, and the mean age of the three groups was 36.0 卤10.9 years old or 36.5 卤1.8 years old, and the mean age was 36.0 卤10.9 years old or 36.7 卤11.1 years old or 36.5 卤1.8 years old respectively. There was significant difference in the composition of Han nationality (蠂 ~ (2)) (蠂 ~ (2)) (139.63) and the educational level (蠂 ~ (2) = 68.85) (P 0.001). There was a significant difference in the composition of Han nationality (蠂 ~ (2)). The proportion of severe mental disorders in the family structure is 21.50.The proportion of maltreatment in childhood is 21.7and that of domestic violence is 26.1%. The proportion of neglected mental disorders is 27.60.The proportion of parents who commit crimes in prison is 3.1%, the proportion of parents with mental disorders is 24.0%, the proportion of parents with material materials is lower than that of parents. The positive rate of abusing history (21.0%) was higher than that of control group (P 0.05). Results of multivariate analysis: the variables were screened by non-conditional Logistic stepwise regression model, and the general demographic variables such as sex, age and nationality were controlled. 鏈，

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