Background

Exposure to childhood adversity has been linked to long-term negative mental health consequences in adulthood.

Purpose

This review examined the association between exposure to the death of a family member (i.e., parent or sibling) during childhood or adolescence and the subsequent diagnosis of a substance use disorder.

Methods

Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for cohort and case-control studies in the English language. Studies were retained if it was demonstrable that exposure to death occurred before age 18, and that disorder was diagnosed subsequently. Sensitivity analyses were performed for the meta-analysis, and study quality assessed using the Newcastle-Ottawa Scale.

Results

Nine studies, seven cohort and two case-control, were retained. Due to differential metrics (hazard ratios [HRs] versus odds/risk ratios [ORs/RRs]), only one meta-analysis was possible. Individuals experiencing familial death had 1.42 (95% CI = 0.96, 2.09) times the odds of developing a substance use disorder compared to those non-exposed. Where there was a statistically significant effect in other studies, these were mostly studies using National Registers (1.4 ≤ HR ≤ 2.51).

Limitations

Meta-analysis options were limited by the variety of study designs.

Conclusions

Evidence for a significant association between familial death and subsequent disorder appears to be an artefact of the study design.

Implications of key findings. Further studies are required to better understand and estimate the association between familial death and substance use disorders.

Registration and funding. The review was pre-registered (PROSPERO Reg No: CRD42020192892) and funded by the Irish Research Council (COALESCE/2019/61).

中文翻译：

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儿童或青春期家族性死亡与随后的药物滥用障碍之间的关联：系统评价和荟萃分析

背景

患儿逆境与成年后长期的负面心理健康后果有关。

目的

这项审查审查了儿童或青少年时期家庭成员（即父母或兄弟姐妹）死亡的暴露与随后的物质使用障碍的诊断之间的关联。

方法

搜索电子数据库（Scopus，Medline（用于Ovid），EMBASE和PsychINFO），以英语进行队列研究和病例对照研究。如果可以证明死亡暴露发生在18岁之前，并且随后对该疾病进行了诊断，则保留研究。进行敏感性分析以进行荟萃分析，并使用纽卡斯尔-渥太华量表对研究质量进行评估。

结果

保留了九项研究，七个队列和两个病例对照。由于指标不同（危险比[HRs]与赔率/风险比[ORs / RRs]），因此只能进行一项荟萃分析。与未暴露者相比，发生家族性死亡的个体患物质使用障碍的几率是未发生暴露者的1.42倍（95％CI = 0.96，2.09）。在其他研究中有统计学显着影响的地方，这些大多是使用国家注册的研究（1.4≤HR≤2.51）。

局限性

荟萃分析的选择受限于研究设计的多样性。

结论

家族性死亡与随后的疾病之间存在显着关联的证据似乎是该研究设计的假象。

关键发现的含义。需要进一步的研究以更好地理解和评估家族性死亡与药物滥用疾病之间的关联。

注册和资金。审查已预先注册（PROSPERO Reg No：CRD42020192892），并由爱尔兰研究委员会（COALESCE / 2019/61）资助。