{"title":"睡眠障碍作为儿童和青少年不良童年经历和精神病理学之间的跨诊断中介：一项结构方程建模荟萃分析。","authors":"Jianlin Liu, Wen Lin Teh, Rachel Hsiao Shen Tan, Yoke Boon Tan, Charmaine Tang, Nisha Chandwani, Mythily Subramaniam","doi":"10.1002/jcv2.12156","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Increasing research efforts have focused on understanding why some individuals develop severe psychopathology after exposure to adverse childhood experiences (ACEs). Sleep disturbances (insomnia, nightmares, and sleep disorders) are prevalent sequelae of ACEs and associated with psychopathology; however, there is no meta-analytic evidence on whether sleep disturbance functions as a transdiagnostic mediator in the relationship between ACEs and psychopathology (internalizing/externalizing disorders and psychosis) in children and adolescents.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 98 articles (<i>N</i> = 402,718; age range 1–17 years) and the present study used a novel two-stage meta-analytic structural equation model to investigate whether ACEs predict psychopathology through sleep disturbance. Subgroup analyses determined potential biases due to study design (cross-sectional vs. longitudinal) and geographical differences (Western vs. non-Western countries). Sensitivity analyses evaluated the influence of early childhood (<5 years old) and overlapping symptoms (i.e., nightmares and trauma symptoms) on model stability.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The pooled correlations among ACEs, sleep disturbance, and psychopathology were significant; the effect sizes ranged from moderate to high (<i>r</i> = 0.21 to <i>r</i> = 0.29). The indirect effect from ACEs via sleep disturbance to psychopathology was significant (<i>β</i> = 0.05, 95% CI [0.04, 0.06]). The direct effect of ACEs on psychopathology was significant (<i>β</i> = 0.18, 95% CI 0.13–0.24). Subgroup analyses revealed larger effects for cross-sectional studies than longitudinal studies (Δ χ<sup>2</sup> (3) = 9.71, <i>p</i> = 0.021). Sensitivity analyses revealed stable and consistent results.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The present meta-analytic results indicate that sleep disturbance is a transdiagnostic mediator in the relationship between ACEs and psychopathology among children and adolescents. Further research is required to determine the synergistic effects between sleep disturbance and other risk mechanisms, and elucidate the complex pathways that lead to disorder in the aftermath of childhood adversities.</p>\n </section>\n </div>","PeriodicalId":73542,"journal":{"name":"JCPP advances","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1002/jcv2.12156","citationCount":"2","resultStr":"{\"title\":\"Sleep disturbance as transdiagnostic mediator between adverse childhood experiences and psychopathology in children and adolescents: A structural equation modeling meta-analysis\",\"authors\":\"Jianlin Liu, Wen Lin Teh, Rachel Hsiao Shen Tan, Yoke Boon Tan, Charmaine Tang, Nisha Chandwani, Mythily Subramaniam\",\"doi\":\"10.1002/jcv2.12156\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Increasing research efforts have focused on understanding why some individuals develop severe psychopathology after exposure to adverse childhood experiences (ACEs). Sleep disturbances (insomnia, nightmares, and sleep disorders) are prevalent sequelae of ACEs and associated with psychopathology; however, there is no meta-analytic evidence on whether sleep disturbance functions as a transdiagnostic mediator in the relationship between ACEs and psychopathology (internalizing/externalizing disorders and psychosis) in children and adolescents.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 98 articles (<i>N</i> = 402,718; age range 1–17 years) and the present study used a novel two-stage meta-analytic structural equation model to investigate whether ACEs predict psychopathology through sleep disturbance. Subgroup analyses determined potential biases due to study design (cross-sectional vs. longitudinal) and geographical differences (Western vs. non-Western countries). Sensitivity analyses evaluated the influence of early childhood (<5 years old) and overlapping symptoms (i.e., nightmares and trauma symptoms) on model stability.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>The pooled correlations among ACEs, sleep disturbance, and psychopathology were significant; the effect sizes ranged from moderate to high (<i>r</i> = 0.21 to <i>r</i> = 0.29). The indirect effect from ACEs via sleep disturbance to psychopathology was significant (<i>β</i> = 0.05, 95% CI [0.04, 0.06]). The direct effect of ACEs on psychopathology was significant (<i>β</i> = 0.18, 95% CI 0.13–0.24). Subgroup analyses revealed larger effects for cross-sectional studies than longitudinal studies (Δ χ<sup>2</sup> (3) = 9.71, <i>p</i> = 0.021). 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引用次数: 2
摘要
背景：越来越多的研究工作集中在理解为什么一些人在暴露于不良童年经历（ACE）后会发展成严重的精神病理学。睡眠障碍（失眠、噩梦和睡眠障碍）是ACE的常见后遗症，与精神病理学有关；然而，没有荟萃分析证据表明睡眠障碍是否在儿童和青少年的ACE与精神病理学（内化/外化障碍和精神病）之间的关系中起到了跨诊断中介的作用。方法：在PubMed、PsycINFO和Web of Science三个数据库中进行系统搜索，共发现98篇文章（N=402718；年龄范围1-17岁），本研究使用一个新的两阶段元分析结构方程模型来研究ACE是否通过睡眠障碍预测精神病理学。亚组分析确定了研究设计（横截面与纵向）和地理差异（西方国家与非西方国家）造成的潜在偏差。敏感性分析评估了儿童早期的影响（结果：ACE、睡眠障碍和精神病理学之间的合并相关性显著；影响大小从中等到高不等（r=0.21到r=0.29）。ACE通过睡眠障碍对精神病理学的间接影响显著（β=0.05，95%CI[0.040.06]）精神病理学显著（β=0.18，95%CI 0.13-0.24）。亚组分析显示，横断面研究的影响大于纵向研究（Δχ2（3）=9.71，p=0.021）。敏感性分析显示结果稳定一致。结论：目前的荟萃分析结果表明，睡眠障碍是儿童和青少年ACE与精神病理学关系的一个跨诊断中介。需要进一步的研究来确定睡眠障碍和其他风险机制之间的协同作用，并阐明儿童逆境后导致障碍的复杂途径。
Sleep disturbance as transdiagnostic mediator between adverse childhood experiences and psychopathology in children and adolescents: A structural equation modeling meta-analysis
Background
Increasing research efforts have focused on understanding why some individuals develop severe psychopathology after exposure to adverse childhood experiences (ACEs). Sleep disturbances (insomnia, nightmares, and sleep disorders) are prevalent sequelae of ACEs and associated with psychopathology; however, there is no meta-analytic evidence on whether sleep disturbance functions as a transdiagnostic mediator in the relationship between ACEs and psychopathology (internalizing/externalizing disorders and psychosis) in children and adolescents.
Methods
Systematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 98 articles (N = 402,718; age range 1–17 years) and the present study used a novel two-stage meta-analytic structural equation model to investigate whether ACEs predict psychopathology through sleep disturbance. Subgroup analyses determined potential biases due to study design (cross-sectional vs. longitudinal) and geographical differences (Western vs. non-Western countries). Sensitivity analyses evaluated the influence of early childhood (<5 years old) and overlapping symptoms (i.e., nightmares and trauma symptoms) on model stability.
Results
The pooled correlations among ACEs, sleep disturbance, and psychopathology were significant; the effect sizes ranged from moderate to high (r = 0.21 to r = 0.29). The indirect effect from ACEs via sleep disturbance to psychopathology was significant (β = 0.05, 95% CI [0.04, 0.06]). The direct effect of ACEs on psychopathology was significant (β = 0.18, 95% CI 0.13–0.24). Subgroup analyses revealed larger effects for cross-sectional studies than longitudinal studies (Δ χ2 (3) = 9.71, p = 0.021). Sensitivity analyses revealed stable and consistent results.
Conclusions
The present meta-analytic results indicate that sleep disturbance is a transdiagnostic mediator in the relationship between ACEs and psychopathology among children and adolescents. Further research is required to determine the synergistic effects between sleep disturbance and other risk mechanisms, and elucidate the complex pathways that lead to disorder in the aftermath of childhood adversities.
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