在非机构化样本中,反应性依恋障碍儿童的成年结果
Hannah K Betcher1, Tanner J Bommersbach1, Bruno A Perossa
1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
The Journal of clinical psychiatry
|October 23, 2023
概括
在社区样本中,反应性依恋障碍 (RAD) 会导致严重的成人精神问题,物质使用和不良的心理社会结果. 早期的依恋困难对长期的发展和成年后的功能有深远的影响.
科学领域:
- 儿童和青少年精神病学 儿童和青少年精神病学
- 发展心理学 发展心理学
- 心理健康研究 心理健康研究
背景情况:
- 反应性依恋障碍 (RAD) 的研究主要集中在制度化人群中,社区样本的长期结果被低估了.
- 了解RAD的自然历史对于开发有效的干预和支持系统至关重要.
研究的目的:
- 在美国社区的样本中检查反应性依恋障碍 (RAD) 的长期发展轨迹和成人结果.
- 为了比较RAD和并发症注意力缺陷/多动障碍 (ADHD) 患者与仅有ADHD患者的结果.
主要方法:
- 对于3-12岁之间被诊断患有RAD (ICD-9/ICD-10) 的个人,从第三级护理中心回顾电子病历的回顾性审查.
- 数据收集的重点是49名RAD患者的童年和成年期的精神,社会和医疗结果.
- 34名具有并发性ADHD的RAD患者的小组与102名具有ADHD但没有依恋障碍的年龄匹配对照进行了比较.
主要成果:
- 患有RAD的儿童在成人精神病诊断 (73.5%),物质使用 (42.9%),自杀未遂 (28.6%) 和精神病住院 (71.4%) 的比例很高.
- 心理社会结果很差,包括低教育程度 (34.7%的高中毕业,2.0%的大学毕业),高失业率 (26.5%) 和法律问题 (34.7%).
- 与单独患有ADHD的人相比,患有RAD和ADHD的人的成人精神病诊断率 (OR3.0),自杀企图 (OR7.5) 和住院治疗 (OR6.4) 显著更高.
结论:
- 反应性依恋障碍 (RAD) 对精神病学和心理社会功能在成年后具有显著和持久的负面影响.
- 长期的RAD负担超出了与ADHD等常见并发症相关的负担,强调了早期依恋的重要性.
- 研究结果强调了早期依恋困难对发展轨迹的持续影响,以及对RAD有针对性的干预措施的需要.
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