教育心理学论文

您当前的位置:学术堂 > 教育论文 > 教育心理学论文 >

元分析方法探讨儿童期虐待亚类型与抑郁的关系(4)

来源:心理学报 作者:于增艳,赵阿勐,刘爱书
发布于:2017-06-13 共14929字
  4 讨论。
  
  以往研究已证明了儿童期虐待与抑郁等情绪障碍存在密切联系, 但关于虐待亚类型与抑郁的关系研究结果并不全面, 也不尽一致。本研究是国内首次通过元分析技术来整合儿童期虐待各种形式与抑郁的相关研究, 以探讨儿童虐待亚类型对抑郁的影响, 从而全面了解儿童期虐待与抑郁等情绪障碍的关系。
  
  4.1 儿童虐待及亚类型与抑郁的关系。
  
  本研究结果表明儿童期虐待亚类型与抑郁存在密切联系, 这与以往的研究结果是一致的, 两者之间呈现出剂量?反应关系(Hovens et al., 2015;Scott et al., 2012; Spinhoven, Elzinga, van Hemert,de Rooij, & Penninx, 2016)。
  
  1本研究还发现忽视(情感忽视和身体忽视)对抑郁障碍也会产生重要影响, 这与最近的一项元分析结果是一致的(Infurna et al., 2016)。尤其是情感忽视, 它对抑郁的影响仅次于心理虐待。分析其原因,情感忽视与心理虐待很可能是儿童期虐待两种极端形式, 这两种情况都可能导致儿童的无力感并降低自尊, 从而造成以后抑郁等情绪障碍的形成(Shapero et al., 2014)。
  
  关于身体虐待、性虐待和抑郁的关系, 本研究结果有助于澄清早期研究的相关争论。以往少部分实证研究发现儿童期身体虐待(王佳慧, 刘爱书,2015)、性虐待(Weiss, Longhurst, & Mazure, 1999)与抑郁存在最紧密联系, 但在本元分析中, 相对于其他形式, 儿童期身体虐待、性虐待与抑郁的联系较弱, 这个结果与最近两项元分析研究的结论是一致的(Lindert et al., 2014; Infurna et al., 2016), 但之所以会有部分研究得出不同结论, 其原因可能是选用的被试群体、测量工具等变量的不同所导致的。总之, 我们探讨儿童期不同受虐经历与抑郁关系的研究, 强调的不是儿童期受虐的某种单独形式, 而是儿童期不良经历的差异性, 从而有利于更好的解释儿童期不良经历导致抑郁等情绪障碍的潜在路径。
  
  4.2 儿童期虐待亚类型与抑郁关系的影响因素。
  
  本研究将被试性别、年龄阶段等影响因素看作是调节变量, 探讨其对儿童期虐待亚类型与抑郁关系的影响。
  
  4.2.1 性别的作用。
  
  本研究分析发现被试的性别是儿童期虐待与抑郁关系的调节变量, 其中女性样本比男性样本在儿童心理虐待与抑郁关系上表现的更密切(p <0.05)。这个结果与现有流行病学调查显示女性抑郁发生率大约是男性的 2 倍的结论也是一致的。目前也许可以从神经生物机制来分析性别差异的原因众所周知, 长期在应激压力(如心理虐待、性虐待等虐待形式)的影响下往往会导致下丘脑?垂体?肾上腺轴(HPA 轴)的异常调节, 而 HPA 轴异常调节对引发成年期抑郁等精神障碍会产生重要影响。一些研究者(Weiss et al., 1999; Akbaba Turkoglu, Essizoglu,Kosger, & Aksaray , 2015)认为相对于男性, 女性更易受到 HPA 轴异常调节的影响, 导致神经递质和神经元信号系统的改变, 因而也更容易患抑郁症等障碍。但关于性别对儿童期虐待与抑郁关系的调节作用机制还有待于进一步探讨。
  
  另外, 本元分析中被试仅为男性研究的数量较少, 且对男性的相关测量多局限在心理虐待和身体虐待, 故在进行性别的调节效应分析时受到了较大限制。
  
  4.2.2 年龄阶段的作用。
  
  被试的年龄阶段(青少年, 成年早期、成年中期)也是儿童期虐待与抑郁之间的调节变量, 其中儿童期虐待综合指标与抑郁之间关系在青少年期表现地更加明显。这可能是因为青少年阶段与抑郁症首发的时间比较接近, 关系更加密切(La Rocque,2011)。
  
  该研究结果说明了青少年是一个敏感发展时期, 在这个阶段早期不良经历是抑郁发展的危险影响因素; 另外, 青少年还不具有成年人的自我保护能力, 在这个阶段有可能会遭受新的虐待, 故对青少年抑郁症诊断时, 其早年的不良经历有必要进行分析和评定。而虐待亚类型与抑郁的关系在年龄变量上并没有存在显着差异。以上研究结论皆来自于较小的样本, 仍需要进一步分析验证。
  
  4.3 不足与展望。
  
  本研究的不足:(1)本研究中引入元分析的大部分文献都没有报告儿童期虐待的一些相关信息, 如儿童期虐待的频率、持续时间、严重的程度, 因此无法进行相关分析; (2)本研究中不同潜在调节变量的样本较少且分配不均衡, 会在一定程度上影响分析结果; (3)本研究没有考虑到儿童虐待测量工具、抑郁的类型等因素, 这些变量可能会对儿童期虐待亚类型与抑郁的关系的效应产生影响。
  
  展望:(1)本元分析研究指出了儿童期心理虐待与忽视是抑郁的危险因素, 未来研究应进一步探讨该亚类型与其它情感障碍或行为问题之间关系。(2)未来研究应该包括更加丰富的样本群体, 如男性和老年群体。同时还应进一步探讨其他潜在调节变量,如虐待经历发生的年龄, 虐待经历持续的时间以及虐待忽视的程度, 这有助于更好的归纳儿童虐待经历导致抑郁问题的易感性条件。(3)一些研究结果可以进行临床应用。关于了解儿童虐待经历有助于识别抑郁症易感人群, 临床医师可以通过了解患者儿童期虐待经历, 有助于对抑郁症预兆性诊断。
  
  5 结论。
  
  本元分析发现儿童期受虐经历与抑郁之间存在密切的联系, 尤其是心理虐待与忽视对后期抑郁障碍的影响最大。另外, 被试的年龄阶段、性别可以影响儿童期虐待与抑郁的关系。
  
  参 考 文 献:  
  *表示元分析用到的文献。  
  Abela, J. R. Z., & Skitch, S. A. (2007)。 Dysfunctional attitudes,self-esteem, and hassles: Cognitive vulnerability to depressionin children of affectively ill parents. Behaviour Researchand Therapy, 45(6), 1127–1140.  
  Akbaba Turkoglu, S., Essizoglu, A., Kosger, F., & Aksaray, G.(2015)。 Relationship between dysfunctional attitudes andchildhood traumas in women with depression. InternationalJournal of Social Psychiatry, 61(8), 796–801.  
  *Bernet, C. Z., & Stein, M. B. (1999)。 Relationship ofchildhood maltreatment to the onset and course of majordepression in adulthood. Depression and Anxiety, 9(4),169–174.  
  Bifulco, A., Moran, P. M., Baines, R., Bunn, A., & Stanford,K. (2002)。 Exploring psychological abuse in childhood: ⅡAssociation with other abuse and adult clinical depression.
  Bulletin of the Menninger Clinic, 66, 241–258.  
  Borenstein, M., Hedges, L. V., Higgins, J. P., & Rothstein, H.R. (2009)。 Introduction to meta-analysis. New York: WileyPress.  
  Boudewyn, A. C., & Liem, J. H. (1995)。 Childhood sexualabuse as a precursor to depression and self-destructivebehavior in adulthood. Journal of Traumatic Stress, 8, 445–449.  
  *Brown, G. W., Craig, T. K. J., Harris, T. O., Handley, R. V.,Harvey, A. L., & Serido, J. (2007)。 Child-specific andfamily-wide risk factors using the retrospective ChildhoodExperience of Care & Abuse (CECA) instrument: Alife-course study of adult chronic depression-3. Journal ofAffective Disorders, 103(1-3), 225–236.  
  *Brown, J., Cohen, P., Johnson, J. G., & Smailes, E. M. (1999)。Childhood abuse and neglect: Specificity of effects onadolescent and young adult depression and suicidality.Journal of American Academy of Child & AdolescentPsychiatry, 38(12), 1490–1496.  
  Burns, E. E., Jackson, J. L., & Harding, H. G. (2010)。 Childmaltreatment, emotion regulation, and posttraumatic stress:The impact of emotional abuse. Journal of Aggression,Maltreatment & Trauma, 19(8), 801–819.  
  *Calvete, E. (2014)。 Emotional abuse as a predictor of earlymaladaptive schemas in adolescents: Contributions to thedevelopment of depressive and social anxiety symptoms.Child Abuse & Neglect, 38(4), 735–746.
  Carpenter, L. L., Tyrka, A. R., Ross, N. S., Khoury, L.,Anderson, G. M., & Price, L. H. (2009)。 Effect ofchildhood emotional abuse and age on cortisol responsivityin adulthood. Biological Psychiatry, 66(1), 69–75.  
  *Chen L. (2011)。 The related research between childhoodabuse and depression, suicidal ideation of outpatients inpsychic clinic. In The Ninth academic conferenceproceedings, Hangzhou City, Zhejiang Province, China.  
  [陈莉。 (2011)。 心理门诊病人的儿童期虐待与抑郁、自杀意念的相关研究。 见 2011 年浙江省心理卫生协会第九届学术年会论文汇编, 中国, 浙江, 杭州。]  
  *Coates, A. A., & Messman-Moore, T. L. (2014)。 A structuralmodel of mechanisms predicting depressive symptoms inwomen following childhood psychological maltreatment.Child Abuse & Neglect, 38(1), 103–113.  
  *Crow, T., Cross, D., Powers, A., & Bradley, B. (2014)。Emotion dysregulation as a mediator between childhoodemotional abuse and current depression in a low-incomeAfrican-American sample. Child Abuse & Neglect, 38(10),1590–1598.
  Cutajar, M. C., Mullen, P. E., Ogloff, J. R. P., Thomas, S. D.,Wells, D. L., & Spataro, J. (2010)。 Psychopathology in alarge cohort of sexually abused children followed up to 43years. Child Abuse & Neglect, 34(11), 813–822.  
  *Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J.,Polanczyk, G., Pariante, C. M., … Caspi, A. (2009)。Adverse childhood experiences and adult risk factors forage-related disease. Archives of Pediatrics & AdolescentMedicine, 163(12), 1135–1143.
  Dannlowski, U., Stuhrmann, A., Beutelmann, V., Zwanzger, P.,Lenzen, T., Grotegerd, D., … Kugel, H. (2012)。 Limbicscars: Long-term consequences of childhood maltreatmentrevealed by functional and structural magnetic resonanceimaging. Biological Psychiatry, 71(4), 286–293.  
  *Dunn, E. C., McLaughlin, K. A., Slopen, N., Rosand, J., &Smoller, J. W. (2013)。 Developmental timing of childmaltreatment and symptoms of depression and suicidalideation in young adulthood: Results from the NationalLongitudinal Study of Adolescent Health. Depression &Anxiety, 30, 955–964.  
  Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2008)。Exposure to childhood sexual and physical abuse andadjustment in early adulthood. Child Abuse & Neglect,32(6), 607–619.
  Fisher, H. L., Cohen-Woods, S., Hosang, G. M., Korszun, A.,Owen, M., Craddock, N., … Uher, R. (2013)。 Interactionbetween specific forms of childhood maltreatment and theserotonin transporter gene (5-HTT) in recurrent depressivedisorder. Journal of Affective Disorders, 145(1), 136–141.  
  *Gibb, B. E., Alloy, L. B., Abramson, L. Y., & Marx, B. P.(2003)。 Childhood maltreatment and maltreatment-specificinferences: A test of Rose and Abramson's (1992) extensionof the hopelessness theory. Cognition & Emotion, 17(6),917–931.  
  *Gibb, B. E., Chelminski, I., & Zimmerman, M. (2007)。Childhood emotional, physical, and sexual abuse, anddiagnoses of depressive and anxiety disorders in adultpsychiatric outpatients. Depression & Anxiety, 24(4), 256–263.  
  Hall, L. A., Peden, A. R., Rayens, M. K., & Beebe, L. H.(2004)。 Parental bonding: A key factor for mental health ofcollege women. Issues in Mental Health Nursing, 25, 277–291.  
  Harkness, K. L., & Monroe, S. M. (2002)。 Childhood adversityand the endogenous versus nonendogenous distinction inwomen with major depression. American Journal ofPsychiatry, 159, 387–393.  
  Harkonm?ki, K., Korkeila, K., Vahtera, J., Kivim?ki, M.,Suominen, S., Sillanm?ki, L., & Koskenvuo, M. (2007)。Childhood adversities as a predictor of disability retirement.Journal of Epidemiology & Community Health, 61(6), 479–484.  
  Harper, F. W. K., & Arias, I. (2004)。 The role of shame inpredicting adult anger and depressive symptoms amongvictims of child psychological maltreatment. Journal ofFamily Violence, 19, 359–367.  
  *Hill, J., Pickles, A., Burnside, E., Byatt, M., Rollinson, L.,Davis, R., & Harvey, K. (2001)。 Child sexual abuse, poorparental care and adult depression: Evidence for differentmechanisms. The British Journal of Psychiatry, 179, 104–109.  
  *Hovens, J. G., Giltay, E. J., Spinhoven, P., van Hemert, A. M.,& Penninx, B. W. (2015)。 Impact of childhood life eventsand childhood trauma on the onset and recurrence ofdepressive and anxiety disorders. The Journal of ClinicalPsychiatry, 76(7), 931–938.  
  Huedo-Medina, T. B., Sánchez-Meca, J., Marín-Martínez, F.,& Botella, J. (2006)。 Assessing heterogeneity in meta-analysis: Q statistic or I? index? Psychological Methods,11(2), 193–206.  
  Infurna, M. R., Reichl, C., Parzer, P., Schimmenti, A., Bifulco,A., & Kaess, M. (2016)。 Associations between depressionand specific childhood experiences of abuse and neglect: Ameta-analysis. Journal of Affective Disorders, 190, 47–55.  
  *Jackson, T. L. (2004)。 The relationships among childhoodpsychological maltreatment, adult psychological functioning,dating abuse, and schema (Unpublished doctorial dissertation)。University of North Dakota.  
  *Jager-Hyman, S. (2012)。 Nonsuicidal self-injury in a collegesample: Risk factors, pathways, and diagnostic correlates(Unpublished doctorial dissertation)。 Temple University.  
  Kaplan, S. J., Pelcovitz, D., & Labruna, V. (1999)。 Child andadolescent abuse and neglect research: A review of the past10 years. Part Ⅰ : Physical and emotional abuse andneglect. Journal of the American Academy of Child andAdolescent psychiatry, 38, 1214–1222.  
  La Rocque, C. L. (2011)。 Childhood maltreatment and stresssensitization in depression: Moderation by age group anddepression history (Unpublished master's thesis)。 Queen'sUniversity.  
  *Lenze, S. N., Xiong, C. J., & Sheline, Y. I. (2008)。 Childhoodadversity predicts earlier onset of major depression but notreduced hippocampal volume. Psychiatry Research:Neuroimaging, 162(1), 39–49.  
  Lindert, J., von Ehrenstein, O. S., Grashow, R., Gal, G.,Braehler, E., & Weisskopf, M. G. (2014)。 Sexual andphysical abuse in childhood is associated with depressionand anxiety over the life course: Systematic review andmeta-analysis. International Journal of Public Health, 59,359–372.  
  *Ling, Y., Yang, J., Zhong, B., Zhang, C. C., & Yao, S. Q.(2009)。 Effects of childhood traumatic experience andself-esteem on adolescents' depression. Chinese Journal ofClinical Psychology, 17(1), 54–56.  
  [凌宇, 杨娟, 钟斌, 章晨晨, 姚树桥。 (2009)。 童年创伤经历与自尊对青少年抑郁的影响。 中国临床心理学杂志,17(1), 54–56.]  
  *Lu, W. L., Mueser, K. T., Rosenberg, S. D., & Jankowski, M.K. (2008)。 Correlates of adverse childhood experiencesamong adults with severe mood disorders. PsychiatricServices, 59(9), 1018–1026.  
  *Madracki, M. (2012)。 Negative mood regulation expectancies,coping, and depression in adult survivors of childhoodabuse and neglect ( Unpublished master's thesis)。California State University.  
  *Melmed, L. R. (2012)。 Cognitive style as a mediator betweenparental psychological maltreatment and depression inadolescent boys (Unpublished doctorial dissertation)。Columbia University.  
  Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001)。 Childsexual abuse and subsequent psychopathology: Resultsfrom the National Comorbidity Survey. American Journalof Public Health, 91, 753–760.  
  *Moretti, M. M., & Craig, S. G. (2013)。 Maternal versuspaternal physical and emotional abuse, affect regulationand risk for depression from adolescence to early adulthood.Child Abuse & Neglect, 37(1), 4–13.  
  Muller, R. T., Thornback, K., & Bedi, R. (2012)。 Attachmentas a mediator between childhood maltreatment and adultsymptomatology. Journal of Family Violence, 27(3), 243–255.  
  Nanni, V., Uher, R., & Danese, A. (2012)。 ChildhoodMaltreatment predicts unfavorable course of illness andtreatment outcome in depression: A meta-analysis. AmericanJournal of Psychiatry, 169(2), 141–151.  
  *O' Mahen, H. A., Karl, A., Moberly, N., & Fedock, G. (2015)。The association between childhood maltreatment andemotion regulation: Two different mechanisms contributingto depression? Journal of Affective Disorders, 174, 287–295.  
  *Pickles, A., Aglan, A., Collishaw, S., Messer, J., Rutter, M.,& Maughan, B. (2010)。 Predictors of suicidality across thelife span: The Isle of Wight study. Psychological Medicine,40(9), 1453–1466.  
  Rose, D. T., & Abramson, L. Y. (1992)。 Developmentalpredictors of depressive cognitive style: Research andtheory. In D. Cicchetti & S. L. Toth (Eds.), Developmentalperspectives on depression (pp. 323–349)。 Rochester, NY,US: University of Rochester Press.  
  *Rudolph, S. G. (2005)。 Dimensions of perfectionism, historyof childhood maltreatment, and depression in universitystudents (Unpublished master's thesis)。 York University.  
  *Samples, T. C. (2012)。 The protective effects of resilienceagainst suicide behaviors among trauma exposed low-income African American women: A moderated mediationstudy (Unpublished doctorial dissertation)。 Fielding GraduateUniversity.  
  *Scott, K. M., McLaughlin, K. A., Smith, D. A. R., & Ellis, P.M. (2012)。 Childhood maltreatment and DSM-IV adultmental disorders: Comparison of prospective and retrospectivefindings. The British Journal of Psychiatry, 200, 469–475.  
  Shapero, B. G., Black, S. K., Liu, R. T., Klugman, J., Bender,R. E., Abramson, L. Y., & Alloy, L. B. (2014)。 Stressfullife events and depression symptoms: The effect ofchildhood emotional abuse on stress reactivity. Journal ofClinical Psychology, 70(3), 209–223.  
  Spinhoven, P., Elzinga, B. M., van Hemert, A. M., de Rooij,M., & Penninx, B. W. (2016)。 Childhood maltreatment,maladaptive personality types and level and course ofpsychological distress: A six-year longitudinal study.Journal of Affective Disorders, 191, 100–108.  
  Thomas, P. M. (2003)。 Protection, dissociation, and internalroles: Modeling and treating the effects of child abuse.Review of General Psychology, 7(4), 364–380.  
  Vajda, A., & Láng A. (2014)。 Emotional abuse, neglect ineating disorders and their relationship with emotionregulation. Procedia-Social and Behavioral Sciences, 131,386–390.  
  *Wang, J. H., & Liu, A. S. (2015)。 Mediating role ofregulatory emotional self-efficacy between childhood abuseand depression in college students. Chinese Mental HealthJournal, 29(4), 305–310  
  [王佳慧, 刘爱书。 (2015)。 大学生情绪调节自我效能感在虐待与抑郁间的中介作用。 中国心理卫生杂志, 29(4), 305–310.]  
  Weiss, E. L., Longhurst, J. G., & Mazure, C. M. (1999)。Childhood sexual abuse as a risk factor for depression inwomen: Psychosocial and neurobiological correlates.American Journal of Psychiatry, 156(6), 816–828.  
  *Widom, C. S., DuMont, K., & Czaja, S. J. (2007)。 Aprospective investigation of major depressive disorder andcomorbidity in abused and neglected children grown up.Archives of General Psychiatry, 64(1), 49–56.  
  *Wright, M. O. D., Crawford, E., & Del Castillo, D. (2009)。Childhood emotional maltreatment and later psychologicaldistress among college students: The mediating role ofmaladaptive schemas. Child Abuse & Neglect, 33(1), 59–68.  
  Yates, T. M., & Wekerle, C. (2009)。 The long-termconsequences of childhood emotional maltreatment ondevelopment: (Mal) adaptation in adolescence and youngadulthood. Child Abuse & Neglect, 33(1), 19–21.  
  Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003)。 Schematherapy: A practitioner's guide. New York: The GuilfordPress.  
  *Zhang, Y. L., Zhang, Y. L., Yang, H., & Zhang, Y. X. (2010)。Mediation of parent attachment between childhood abuseand adolescents depression. Chinese Journal of ClinicalPsychology, 18(6), 760–762.  
  [张迎黎, 张亚林, 杨峘, 张迎新。 (2010)。 亲子依恋在儿童期虐待经历与青少年抑郁间的中介作用。 中国临床心理学杂志, 18(6), 760–762.]  
  *Zhu, X. H., Zhao, H. F., Wang, C. D., Lang, G. L., Geng, D.Q., & Li, J. (2012)。 The effects of childhood abuse,self-esteem and self-efficacy on anxiety and depression ofcollege students: A path analysis. Journal Clinical Psychiatry,22(3), 155–157.  
  [朱相华, 赵后锋, 王成东, 梁光利, 耿德勤, 李娇。 (2012)。儿童期虐待、自尊、自我效能感对医学生焦虑抑郁影响的路径分析。 临床精神医学杂志, 22(3), 155–157.]
作者单位:
原文出处:于增艳,赵阿勐,刘爱书. 儿童期受虐经历与抑郁的元分析[J]. 心理学报,2017,(01):40-49.
相关内容推荐
相关标签:儿童心理学论文青少年心理健康论文
返回:教育心理学论文