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[大学生论坛]:无家可归与精神障碍

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Selene 发表于 2017-12-30 23:16:29 | 显示全部楼层 |阅读模式


Risk of psychiatric disorders in offspring of parents with a history of homelessness during childhood and adolescence in Denmark: a nationwide, register-based, cohort study

丹麦 父母无家可归的经历与其后代在童年和青春期的精神障碍风险:一项全国范围的,基于登记信息的队列研究



Summary
Background
Children and adolescents from deprived backgrounds have high rates of psychiatric problems. Parental and social factors are crucial for children's healthy and positive development, but whether psychiatric morbidity is associated with parental social marginalisation is unknown. We aimed to analyse the association between mother's and father's history of homelessness and the offspring's risk of psychiatric disorders, including substance use disorder, during childhood and adolescence.
概要
背景
有贫困背景的儿童和青少年患精神疾病的比率很高。父母和社会因素对于儿童的健康和积极发展至关重要,但精神病发病与父母社会边缘化是否相关尚不清楚。我们的目的是分析父母无家可归的经历与其后代在童年和青春期的精神障碍之间的关系,包括物质使用障碍的风险。


Methods
We did a nationwide, register-based cohort study of 1 072 882 children and adolescents aged 0–16 years, who were living or born in Denmark between Jan 1, 1999, and Dec 31, 2015. Parental homelessness was the primary exposure, data on which were obtained from the Danish Homeless Register. The Danish Civil Registration System was used to extract the population and link offspring to parental information, and the outcome, psychiatric disorders in the offspring, was obtained from the Danish Psychiatric Central Research Register and the Danish National Patient Register. We analysed the association between parental history of homelessness and risk of psychiatric disorders in offspring by survival analysis using Poisson regression and incidence rate ratios (IRRs), adjusted for year and offspring characteristics, and additionally adjusted for parental factors (age at offspring's birth and parental psychiatric disorders).
方法
我们对1999年1月1日至2015年12月31日在丹麦生活或出生的1 072 882名0-16岁儿童和青少年进行了全国范围的基于注册信息的队列研究。父母的无家可归是主要条件,从丹麦无家可归者注册处获得。丹麦的民事登记系统被用来提取人口信息,并将后代与父母的信息联系起来,后代的精神疾病信息从丹麦精神病中央研究登记处和丹麦国家患者登记处获得。我们通过使用泊松回归和发病率比率(IRR)进行生存分析,分析了有无家可归史的父母和其后代的精神障碍风险之间的关系,对年龄和后代特征进行校正,并调整了父母因素(后代出生的年龄和父母的精神障碍)。


Findings
17 238 (2%) offspring had either one or two parents with a history of homelessness, and 56 330 (5%) children and adolescents were diagnosed with any psychiatric disorder during the study period. The incidence of any psychiatric disorder was 15·1 cases per 1000 person-years (95% CI 14·4–15·8) in offspring with at least one parent with a history of homelessness, compared with 6·0 per 1000 person-years (95% CI 6·0–6·1) in those whose parents had no such history (IRR 2·5 [95% CI 2·3–2·7] for mother homeless, 2·3 [2·2–2·5] for father homeless, and 2·8 [2·4–3·2] for both parents homeless, after adjustment for year and offspring characteristics). This risk remained elevated after additional adjustment for factors including parental psychiatric disorders. IRRs in offspring were increased for most specific psychiatric disorders, with the highest risk for attachment disorder when both parents had a history of homelessness (IRR 32·5 [95% CI 24·6–42·9]) and substance use disorder when only the mother had a history of homelessness (6·9 [4·9–9·7]). In offspring whose mothers had a history of both homelessness and a psychiatric disorder, 35·9% (95% CI 27·1–44·8) had been diagnosed with a psychiatric disorder by the age of 15 years.
发现
17 238名(2%)后代的父母双方中有1到2人有无家可归的历史,在研究期间有56 330名(5%)儿童和青少年被诊断为患有精神障碍。每1000人中一年有15.1例精神障碍患者(95%CI 14.4-15.8),其至少有一位父母曾无家可归,而每千人中有6.0例精神障碍患者其母亲没有无家可归史(IRR 2.5(95%CI 2.3-2.7)],每千人中有2.3例精神障碍患者其父亲没有无家可归史(2.2 - 2.7),有2.8例精神障碍患者其双亲皆无无家可归史 [2·4-3·2]。在对包括父母精神疾病在内的因素进一步调整后,这一风险仍然升高。后代患许多特定的精神疾病的发病率比率增加,当父母双方都有无家可归史(IRR 32·5 [95%CI 24·6-42·9])时,依恋障碍的风险最高,当母亲有无家可归史时,物质使用障碍的风险最高(6·9 [4·9-9·7])。在母亲有无家可归和精神病史的后代中,15岁时被诊断为精神疾病的患者占35.9%(95%CI 27·1-44·8)。


Interpretation
Parental homelessness was associated with an increased risk of psychiatric disorders in offspring during childhood and adolescence. These findings have important implications for public health and policy because they suggest a need for improvement in the support of socially marginalised families to help prevent psychiatric illness in offspring.
解释
父母的无家可归增加了其后代在童年和青春期患精神疾病的风险。这些发现对公共卫生和政策有重要意义,因为它们表明需要加强对社会边缘化家庭的支持,以帮助其预防后代的精神疾病。


Funding
University of Copenhagen, The Lundbeck Foundation Initiative for Integrated Psychiatric Research (iPSYCH).
资金
哥本哈根大学伦德贝克综合精神病研究基金会(iPSYCH)。




作者:Sandra Feodor Nilsson, MSc'Correspondence information about the author MSc Sandra Feodor NilssonEmail the author MSc Sandra Feodor Nilsson, Prof Thomas Munk Laursen, PhD, Carsten Hjorthøj, PhD, Anne Thorup, PhD, Prof Merete Nordentoft, DMSc
期刊名称:The Lancet
发表时间: Dec. 2017
本文来自:http://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30210-4/fulltext


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