The consequences of childhood maltreatment on dual-diagnosis psychiatric conditions and clinical outcomes in substance use disorders: A systematic review and meta-analysis.

Autor: Stocchero BA; School of Medicine, Brain Institute of Rio Grande do Sul, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil., Rothmann LM; Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark., Portolan ET; School of Medicine, Brain Institute of Rio Grande do Sul, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil., Lopes TG; Faculty of Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil., Ferraz-Rodrigues C; School of Medicine, Brain Institute of Rio Grande do Sul, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil., Garcia MG; School of Medicine, Brain Institute of Rio Grande do Sul, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil., de Magalhães Narvaez JC; Faculty of Psychology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil. Electronic address: jcmnarvaez@ufcspa.edu.br., Grassi-Oliveira R; School of Medicine, Brain Institute of Rio Grande do Sul, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. Electronic address: rogo@clin.au.dk., Viola TW; School of Medicine, Brain Institute of Rio Grande do Sul, Developmental Cognitive Neuroscience Lab, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Electronic address: thiago.wendt@pucrs.br.
Jazyk: angličtina
Zdroj: Child abuse & neglect [Child Abuse Negl] 2024 Oct 16; Vol. 158, pp. 107085. Date of Electronic Publication: 2024 Oct 16.
DOI: 10.1016/j.chiabu.2024.107085
Abstrakt: Background: Evidence suggests that the phenotypic expression of substance use disorders (SUD) may be influenced by exposure to childhood maltreatment (CM).
Objective: To assess how CM could impact severity (relapse, treatment dropout, withdrawal), age of substance use onset, psychiatric dual diagnosis (depression, anxiety, PTSD, distress), and self-harm behavior/suicide attempts in adults with SUD, we performed a systematic review and meta-analyses.
Methods: We searched PubMed, Web of Science, PsycINFO, and Embase to identify articles examining the association of maltreatment (physical, sexual, or emotional abuse or neglect) before age 18 years with clinical features and course of illness SUD. Multilevel random effects models were performed. Heterogeneity was quantified using the I 2 statistic. Subgroup/meta-regression analyses were employed to investigate sources of heterogeneity. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale.
Results: Forty-five studies were included. CM was associated with all tested outcomes, such as anxiety (OR = 1.52; 95 % CI = 1.39, 1.65), depression (OR = 1.57; 95 % CI = 1.40, 1.77), PTSD (OR = 1.67; 95 % CI = 1.40, 1.99), psychological distress (OR = 1.49; 95 % CI = 1.24, 1.78), self-harm behavior and suicidal attempts (OR = 1.70; 95 % CI = 1.47, 1.96), SUD severity (OR = 1.15; 95 % CI = 1.04, 1.26), and younger age of onset use (OR = 0.76; 95 % CI = 0.69, 0.84). However, comparisons between outcomes revealed that the association was stronger for dual diagnosis symptoms/conditions than for measures of SUD severity itself. Meta-analyses for some outcomes had large statistical heterogeneity, though these were partly addressed through additional analyses. Gender, mean age of participants, polysubstance use pattern, substance of preference, and CM subtype were found to be moderators of these associations.
Conclusions: The consequences of CM on individuals with SUD are more closely linked to co-occurring psychiatric manifestations than to the severity of common clinical indicators (relapse, treatment dropout, withdrawal), and this finding has important implications.
Funding: None.
Systematic Review Registration: PROSPERO (CRD42021245936).
Competing Interests: Declaration of competing interest None.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
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