儿童注意缺陷多动障碍症状伴焦虑症状发生的调节中介因素研究

刘剑波; 薛振朋; 林玲; 徐建昌; 孙雨蒙; 卢建平

doi:10.7499/j.issn.1008-8830.2002121

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中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (7) : 768-773. DOI: 10.7499/j.issn.1008-8830.2002121

论著·临床研究

儿童注意缺陷多动障碍症状伴焦虑症状发生的调节中介因素研究

刘剑波¹, 薛振朋², 林玲², 徐建昌², 孙雨蒙², 卢建平²

作者信息 +

Moderated mediation analysis for symptoms of attention deficit/hyperactivity disorder with the symptoms of anxiety in children

LIU Jian-Bo¹, XUE Zhen-Peng², LIN Ling², XU Jian-Chang², SUN Yu-Meng², LU Jian-Ping²

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文章历史 +

摘要

目的探讨儿童注意缺陷多动障碍（ADHD）症状伴焦虑症状发生的调节中介因素。方法共纳入12 271名小学生，年龄8.9±1.9岁，其中男生6 743名，女生5 508名，性别缺失20名。采用心理创伤问卷（父母版）和Conners父母用量表收集学生相关资料，问卷由学生父母填写。采用单因素分析、多因素分析和调节中介分析法处理数据。结果单因素分析结果显示，总样本及男性和女性儿童的多动指数因子和儿童期创伤分别与焦虑因子呈正相关（P < 0.01），ADHD和儿童期创伤正向预测焦虑障碍（P < 0.001）。多因素分析结果显示，总样本、男性和女性儿童的多动指数因子（ADHD症状）和儿童期创伤正向预测焦虑因子得分（P < 0.001），ADHD和儿童期创伤正向预测焦虑障碍（P < 0.001）。调节中介分析结果显示，男性和女性的儿童期创伤是多动指数因子与焦虑因子间的中介因素（P < 0.05），性别在多动指数因子与焦虑因子之间起调节作用（P < 0.001）。结论 ADHD症状/ADHD与焦虑症状/焦虑障碍关系密切。儿童期创伤在ADHD症状与焦虑症状间起中介作用，性别在ADHD症状与焦虑症状间起调节作用。

Abstract

Objective To study the moderated mediation for attention deficit/hyperactivity disorder (ADHD) with the symptoms of anxiety in children. Methods A total of 12 271 students were included with an average age of 8.9±1.9 years, including 6 743 male students and 5 508 female students, and 20 students with missing data on gender. Child psychological trauma questionnaires (parents version) and Conners questionnaires (parent version) were completed by the parents of primary school students. The data was studied by univariate analysis, multivariate analysis and moderated mediation analysis. Results The results of the univariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index and childhood trauma were positively correlated with the score of anxiety (P < 0.01), and ADHD and childhood trauma positively predicted anxiety disorder (P < 0.001). The results of the multivariate analysis showed that in all subjects, boys, and girls, the scores of hyperactivity index (ADHD symptoms) and childhood trauma positively predicted the score of anxiety (P < 0.001), and both ADHD and childhood trauma positively predicted anxiety disorder (P < 0.001). The results of the moderated mediation analysis showed that childhood trauma was a mediating factor for the relationship between hyperactivity index and anxiety index in boys and girls (P < 0.05), and sex moderated the relationship between hyperactivity index and anxiety index (P < 0.001). Conclusions ADHD symptoms/ADHD are closely associated with anxiety symptoms/anxiety disorder. Childhood trauma exerts a mediating effect on the relationship between ADHD symptoms and anxiety symptoms, and sex moderates the relationship between ADHD symptoms and anxiety symptoms.

导出引用

刘剑波, 薛振朋, 林玲, 徐建昌, 孙雨蒙, 卢建平. 儿童注意缺陷多动障碍症状伴焦虑症状发生的调节中介因素研究[J]. 中国当代儿科杂志. 2020, 22(7): 768-773 https://doi.org/10.7499/j.issn.1008-8830.2002121

LIU Jian-Bo, XUE Zhen-Peng, LIN Ling, XU Jian-Chang, SUN Yu-Meng, LU Jian-Ping. Moderated mediation analysis for symptoms of attention deficit/hyperactivity disorder with the symptoms of anxiety in children[J]. Chinese Journal of Contemporary Pediatrics. 2020, 22(7): 768-773 https://doi.org/10.7499/j.issn.1008-8830.2002121

参考文献

[1] Thomas R, Sanders S, Doust J, et al. Prevalence of attention-deficit/hyperactivity disorder:a systematic review and meta-analysis[J]. Pediatrics, 2015, 135(4):e994-e1001.
[2] Liu A, Xu Y, Yan Q, et al. The prevalence of attention deficit/hyperactivity disorder among Chinese children and adolescents[J]. Sci Rep, 2018, 8(1):11169.
[3] 李福轮, 谢晴牧, 赵乾龙, 等. 中国儿童注意缺陷多动障碍患病率的Meta分析[J]. 临床荟萃, 2017, 32(12):1079-1083.
[4] 罗学荣, 汪贝妮. 注意缺陷多动障碍共患病的诊断与治疗[J]. 中国儿童保健杂志, 2018, 26(7):701-704.
[5] Yoshimasu K, Barbaresi WJ, Colligan RC, et al. Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence:a population-based birth cohort study[J]. J Child Psychol Psychiatry, 2012, 53(10):1036-1043.
[6] Inci SB, Ipci M, Akyol Ard?ç U, et al. Psychiatric comorbidity and demographic characteristics of 1,000 children and adolescents with ADHD in Turkey[J]. J Atten Disord, 2019, 23(11):1356-1367.
[7] Mohammadi MR, Zarafshan H, Khaleghi A, et al. Prevalence of ADHD and its comorbidities in a population-based sample[J]. J Atten Disord, 2019. DOI:10.1177/1087054719886372. Epub ahead of print.
[8] D'Agati E, Curatolo P, Mazzone L. Comorbidity between ADHD and anxiety disorders across the lifespan[J]. Int J Psychiatry Clin Pract, 2019, 23(4):238-244.
[9] Levy F. Synaptic gating and ADHD:a biological theory of comorbidity of ADHD and anxiety[J]. Neuropsychopharmaco-logy, 2004, 29(9):1589-1596.
[10] Fraporti TT, Contini V, Tovo-Rodrigues L, et al. Synergistic effects between ADORA2A and DRD2 genes on anxiety disorders in children with ADHD[J]. Prog Neuropsycho-pharmacol Biol Psychiatry, 2019, 93:214-220.
[11] González RA, Vélez-Pastrana MC, McCrory E, et al. Evidence of concurrent and prospective associations between early maltreatment and ADHD through childhood and adolescence[J]. Soc Psychiatry Psychiatr Epidemiol, 2019, 54(6):671-682.
[12] World Health Organization, International Society for Prevention of Child Abuse and Neglect. Preventing child maltreatment:a guide to taking action and generating evidence[EB/OL]. (2006-01-01)[2020-03-01]. https://apps.who.int/iris/bitstream/handle/10665/43499/9241594365_eng.pdf?sequence=1/.
[13] Evren C, Umut G, Bozkurt M, et al. Mediating role of childhood emotional abuse on the relationship between severity of ADHD and PTSD symptoms in a sample of male inpatients with alcohol use disorder[J]. Psychiatry Res, 2016, 239:320-324.
[14] Koyuncu A, Çelebi F, Ertekin E, et al. Attention deficit and hyperactivity in social anxiety disorder:relationship with trauma history and impulsivity[J]. J Atten Disord, 2016, 8(2):95-100.
[15] Kascakova N, Furstova J, Hasto J, et al. The unholy trinity:childhood trauma, adulthood anxiety, and long-term pain[J]. Int J Environ Res Public Health, 2020, 17(2):414.
[16] Huh HJ, Kim KH, Lee HK, et al. The relationship between childhood trauma and the severity of adulthood depression and anxiety symptoms in a clinical sample:the mediating role of cognitive emotion regulation strategies[J]. J Affect Disord, 2017, 213:44-50.
[17] Bauermeister JJ, Shrout PE, Chávez L, et al. ADHD and gender:are risks and sequela of ADHD the same for boys and girls?[J]. J Child Psychol Psychiatry, 2007, 48(8):831-839.
[18] Janssen I, Krabbendam L, Bak M, et al. Childhood abuse as a risk factor for psychotic experiences[J]. Acta Psychiatr Scand, 2004, 109(1):38-45.
[19] 汪向东. 心理卫生评定量表手册(增订版)[M]. 北京:中国心理卫生杂志社, 1993:52-53.
[20] Liu TL, Yang P, Ko CH, et al. Association between ADHD symptoms and anxiety symptoms in Taiwanese adolescents[J]. J Atten Disord, 2014, 18(5):447-455.
[21] Hopfinger L, Berking M, Bockting C, et al. Emotion regulation mediates the effect of childhood trauma on depression[J]. J Affect Disord, 2016, 198:189-197.
[22] Humphreys KL, LeMoult J, Wear JG, et al. Child maltreatment and depression:a meta-analysis of studies using the childhood trauma questionnaire[J]. Child Abuse Negl, 2020, 102:104361.
[23] Myers NS, Llera SJ. The role of childhood maltreatment in the relationship between social anxiety and dissociation:a novel link[J]. J Trauma Dissociation, 2020, 21(3):319-336.
[24] Van Voorhees E, Scarpa A. The effects of child maltreatment on the hypothalamic-pituitary-adrenal axis[J]. Trauma Violence Abuse, 2004, 5(4):333-352.
[25] Pirnia B, Khosravani V, Maleki F, et al. The role of childhood maltreatment in cortisol in the hypothalamic-pituitary-adrenal (HPA) axis in methamphetamine-dependent individuals with and without depression comorbidity and suicide attempts[J]. J Affect Disord, 2020, 263:274-281.
[26] Faravelli C, Lo Sauro C, Godini L, et al. Childhood stressful events, HPA axis and anxiety disorders[J]. World J Psychiatry, 2012, 2(1):13-25.
[27] Veer IM, Oei NY, van Buchem MA, et al. Evidence for smaller right amygdala volumes in posttraumatic stress disorder following childhood trauma[J]. Psychiatry Res, 2015, 233(3):436-442.
[28] Di Iorio CR, Carey CE, Michalski LJ, et al. Hypothalamic-pituitary-adrenal axis genetic variation and early stress moderates amygdala function[J]. Psychoneuroendocrinology, 2017, 80:170-178.
[29] Cross D, Fani N, Powers A, et al. Neurobiological development in the context of childhood trauma[J]. Clin Psychol (New York), 2017, 24(2):111-124.
[30] Davidson RJ. Anxiety and affective style:role of prefrontal cortex and amygdala[J]. Biol Psychiatry, 2002, 51(1):68-80.
[31] Park J, Moghaddam B. Impact of anxiety on prefrontal cortex encoding of cognitive flexibility[J]. Neuroscience, 2017, 345:193-202.
[32] Parfitt GM, Nguyen R, Bang JY, et al. Bidirectional control of anxiety-related behaviors in mice:role of inputs arising from the ventral hippocampus to the lateral septum and medial prefrontal cortex[J]. Neuropsychopharmacology, 2017, 42(8):1715-1728.
[33] Schilpzand EJ, Sciberras E, Alisic E, et al. Trauma exposure in children with and without ADHD:prevalence and functional impairment in a community-based study of 6-8-year-old Australian children[J]. Eur Child Adolesc Psychiatry, 2017, 27(6):811-819.
[34] Brown NM, Brown SN, Briggs RD, et al. Associations between adverse childhood experiences and ADHD diagnosis and severity[J]. Acad Pediatr, 2017, 17(4):349-355.
[35] Richard-Lepouriel H, Kung AL, Hasler R, et al. Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder[J]. J Affect Disord, 2019, 244:33-41.