期刊
PSYCHOLOGICAL MEDICINE
卷 40, 期 5, 页码 847-859出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S0033291709991115
关键词
Childhood adversity; disability; functional impairment; severity
资金
- National Institute of Mental Health (NIMH) [U01-MH60220, R01 MH070884]
- National Institute on Drug Abuse (NIDA)
- Robert Wood Johnson Foundation (RWJF) [044780]
- John W. Alden Trust
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- US Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center (FIRCA) [R03-TW006481]
- Pan American Health Organization
- Ortho-McNeil Pharmaceutical, Inc.
- GlaxoSmithKline
- Bristol-Myers Squibb
- Substance Abuse and Mental Health Services Administration (SAMHSA)
- Eli Lilly Company
Background. Despite evidence that childhood adversities (CAs) are associated with increased risk of mental disorders, little is known about their associations with disorder-related impairment. We report the associations between CAs and functional impairment associated with 12-month DSM-IV disorders in a national sample. Method. We used data from the US National Comorbidity Survey Replication (NCS-R). Respondents completed diagnostic interviews that assessed 12-month DSM-IV disorder prevalence and impairment. Associations of 12 retrospectively reported CAs with impairment among cases (n = 2242) were assessed using multiple regression analysis. Impairment measures included a dichotomous measure of classification in the severe range of impairment on the Sheehan Disability Scale (SDS) and a measure of self-reported number of days out of role due to emotional problems in the past 12 months. Results. CAs were positively and significantly associated with impairment. Predictive effects of CAs on the SIDS were particularly pronounced for anxiety disorders and were significant in predicting increased clays out of role associated with mood, anxiety and disruptive behavior disorders. Predictive effects persisted throughout the life course and were not accounted for by disorder co-morbidity. CAs associated with maladaptive family functioning (MFF; parental mental illness, substance disorder, criminality, family violence, abuse, neglect) were more consistently associated with impairment than other CAs. The joint effects of co-morbid MFF CAs were significantly subadditive. Simulations suggest that CAs account for 19.6% of severely impairing disorders and 17.4% of days out of role. Conclusions. CAs predict greater disorder-related impairment, highlighting the ongoing clinical significance of CAs at every stage of the life course.
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