ABSTRACT

Background: Population-attributable risk (PAR) may help estimate the potential contribution of adverse childhood experiences (ACEs) to serious clinical presentations of depression, characterized by suicidality, previous psychiatric admissions, and episode recurrence.

Objective: To determine the PAR of ACEs for serious clinical presentations of depression (high suicide risk, previous psychiatric admissions, and recurrent depression) in outpatients with ICD-10 clinical depression.

Method: Systematic chart review of 1,013 adults who were assessed and/or treated in a mental health clinic in Santiago, Chile for a major depressive episode. Data were collected on demographics and clinical characteristics of depression. Exposure to ACEs was determined with the Brief Physical and Sexual Abuse Questionnaire, assessing seven types of ACEs. Multivariable logistic regression analysis was used to assess the association between exposure to ACEs and suicidality, previous psychiatric admissions, and recurrence. Predicted probabilities were used for calculations of PAR.

Results: Of the 1,001 study participants with complete data, 53.3% had recurrent depression, 13.5% had high suicide risk, and 5.0% had previous psychiatric admissions. Exposure to at least one ACE was recorded for 69.0% of the sample. Exposure to at least one ACE and specific types of ACEs (i.e. childhood sexual abuse and traumatic separation from caregiver) were associated with serious clinical presentations of depression. A dose-response relationship was observed between cumulative exposure to ACEs and the most serious clinical presentations of depression. ACEs were attributed to a significant proportion of disease: 61.6% of previous psychiatric admissions, 45.0% of high suicide risk, and 14.5% of recurrent depression.

Conclusions: A substantial proportion of serious clinical presentations of depression among outpatients are associated with ACEs. Early detection of depressive episodes associated with ACEs, and tailored treatment for these patients, may potentially reduce the incidence of serious complications in this population.

摘要

背景：人群归因风险 (PAR) 可能有助于估计不良童年经历 (ACE) 对抑郁症严重临床表现的潜在贡献，抑郁症的特征是自杀、既往精神病院入院和发作复发。

目的：确定 ICD-10 临床抑郁症门诊患者的严重抑郁症临床表现（高自杀风险、既往精神病院入院和复发性抑郁症）的 ACE 的 PAR。

方法：对 1,013 名在智利圣地亚哥的一家心理健康诊所接受过严重抑郁发作评估和/或治疗的成年人进行系统的图表审查。收集了关于抑郁症的人口统计学和临床​​特征的数据。暴露于 ACEs 是通过简短的身体和性虐待调查问卷来确定的，评估了七种类型的 ACEs。多变量逻辑回归分析用于评估暴露于 ACE 与自杀倾向、既往精神病院入院和复发之间的关联。预测概率用于计算 PAR。

结果：在数据完整的 1,001 名研究参与者中，53.3% 有复发性抑郁症，13.5% 有高自杀风险，5.0% 有过精神病史。69.0% 的样本记录到至少接触过一种 ACE。暴露于至少一种 ACE 和特定类型的 ACE（即儿童期性虐待和与照顾者的创伤性分离）与严重的抑郁症临床表现相关。在累积暴露于 ACE 与最严重的抑郁症临床表现之间观察到剂量反应关系。ACE 归因于相当大比例的疾病：61.6% 的先前精神病院入院、45.0% 的高自杀风险和 14.5% 的复发性抑郁症。

结论：门诊患者中相当一部分严重的抑郁症临床表现与 ACE 相关。及早发现与 ACE 相关的抑郁发作，并为这些患者量身定制治疗，可能会降低该人群严重并发症的发生率。