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Drossman, Talley, & Herbison, 1996; Stein & Barrett-Connor, 2000
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- - - , Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995
- , Kendall- , Tackett et al., 1993
McCoy & Keen, 2009 #, ' Eisenberg, 1995, 1996 370
0 , $ - , - Lemieux & Coe, 1995 CRF -
HPA-axis , , Mathew, Price, & Charney, 2008 NR3C1 - - / McGowan et al., 2009
Reichardt, Tronche, Bauer, & Schutz, 2000 HPA Bradley HPA et al., 2008; Heim & Nemeroff, 2001
NR3C1 Weaver et al., 2004 Weiss, Longhurst, & Mazure, 1999
- + Caspi et al., 2003
- Gershon, Minor, & Hayward, 2008 - , WHO World Mental Health Survey Consortium, 2004
5 - - McCauley et al., 1997 - 371
- - , Maughan & Rutter, 1997; Widom & Morris, 1997; Williams, 1994
Fergusson, Kendler, Bulik, Silberg, Horwood, & Woodward, 2000
Hettema, Myers, & Prescott, 2000
- - - Kendler et al., 2000 # ## - - .1 - , , - 372
0 , $ \GZGYP
Bradley, R. G., Binder, E. B., Epstein, M. P., Tang, Y., Nair, H. P., Liu, W., Gillespie, C. F.,
Berg, T., Evces, M., Newport, D. J., Stowe, Z. N., Heim, C. M., Nemeroff, C. B.,
Schwartz, A., Cubells, J. F., & Ressler, K. J. (2008). Influence of child abuse on adult
depression: Moderation by the corticotropin-releasing hormone receptor gene. Archives
of General Psychiatry, 65, 190±200.
Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., McClay, J.,
Mill, J., Martin, J., Braithwaite, A., & Poulton, R. (2003). Influence of life stress on
depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386±389.
Chapman, D. P., Whitfield, C. L., Felitti, V. J., Dube, S. R., Edwards, V. J., & Anda, R. F.
(2004). Adverse childhood experiences and the risk of depressive disorders in adulthood.
Journal of Affective Disorders, 82, 217±225.
Drossman, D. A., Talley, N. J., Leserman, J., Olden, K. W., & Barreiro, M. A. (1995).
Sexual and physical abuse and gastrointestinal illness: Review and recommendations.
Annals of Internal Medicine, 123, 782±794.
Duncan, D. G., & Lubin, P. (1996). The use and abuse of history in compassion in dying.
Harvard Journal of Law and Public Policy, 20, 175±214.
Eisenberg, L. (1995). The social construction of the human brain. American Journal of
Psychiatry, 152, 1563±1575.
Eisenberg, L. (1996). Seed or soil: How does our garden grow? American Journal of
Psychiatry, 153, 3±5.
Fergusson, D. M., Horwood, L. J., & Woodward, L. J. (2000). The stability of child abuse
reports: A longitudinal study of the reporting behaviour of young adults. Psychological
Medicine, 30, 529-544.
Gershon, A., Minor, K., & Hayward, C. (2008). Gender, victimization, and psychiatric
outcomes. Psychological Medicine, 38, 1377±1391.
Haj-Yahia, M. M., & Tamish, S. (2001). The rates of child sexual abuse and its
psychological consequences as revealed by a study among Palestinian university
students. Child Abuse & Neglect, 25, 1303±1327.
Heim, C., & Nemeroff, C. B. (2001). The role of childhood trauma in the neurobiology of
mood and anxiety disorders: Preclinical and clinical studies. Biological Psychiatry, 49,
1023±1039.
Kaukinen, C., & Demaris, A. (2005). Age at first sexual assault and current substance use
and depression. Journal of Interpersonal Violence, 20, 1244±1270.
Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D. (1993). Impact of sexual abuse on
373
children: A review and synthesis of recent empirical studies. Psychological Bulletin, 113,
164±80.
Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000).
Childhood sexual abuse and adult psychiatric and substance use disorders in women:
An epidemiological and Cotwin control analysis. Archives of General Psychiatry, 57,
953±959.
Kessler, R. C., Davis, C. G., & Kendler, K. S. (1997). Childhood adversity and adult
psychiatric disorder in the US national comorbidity survey. Psychological Medicine, 27,
1101±1119.
Kessler, R., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. (1995). Posttraumatic
stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52,
1048±1060.
Kessler, R. C., & Ustun, T. B. (2004). The world mental health (WMH) survey
initiative version of the World Health Organization (WHO) composite international
diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research,
13, 93±121.
Kessler, R., & Ustun, T. (2008). The WHO world mental health survey: Global perspectives on
the epidemiology of mental disorders. New York: Cambridge University Press.
Lemieux, A. M., & Coe, C. L. (1995). Abuse-related posttraumatic stress disorder: Evidence
for chronic neuroendocrine activation in women. Psychosomatic Medicine, 57,
105±115.
Leserman, J., Li, Z., Drossman, D. A., Toomey, T. C., Nachman, G., & Glogau, L. (1997).
Impact of sexual and physical abuse dimensions on health status: Development of an
abuse severity measure. Psychosomatic Medicine, 59, 152±160.
Levinson, D., Levav I., Bin Nun, G., & Polakiewicz, J. (2007). Israel national health survey:
New data for planners, clinicians, researchers and the public at large. Israel Journal of
Psychiatry and Related Sciences, 44, 79±80.
Levinson, D., Paltiel, A., Nir, M., & Makovki, T. (2007). The Israel national health survey:
Issues and methods. Israel Journal of Psychiatry and Related Scences, 44, 85±93.
Macmillan, H. L., Fleming, J. E., Streiner, D. L., Lin, E., Boyle, M. H., Jamieson, E., Duku,
E. K., Walsh, C. A., Wong, M. Y., & Beardslee, W. R. (2001). Childhood abuse and
lifetime psychopathology in a community sample. American Journal of Psychiatry, 158,
1878±1883.
Mathew, S. J., Price, R. B., & Charney, D. S. (2008). Recent advances in the neurobiology of
anxiety disorders: Implications for novel therapeutics. American Journal of Medical
Genetics. Part C ± Seminars in Medical Genetics, 148, 89±98.
Maughan, B., & Rutter, M. (1997). Retrospective reporting of childhood adversity: Issues in
assessing long-term recall. Journal of Personality Disorders, 11, 19±33.
McCauley, J., Kern, D. E., Kolodner, K., Dill, L., Schroeder, A. F., DeChant, H. K.,
Ryden, J., Derogatis, L. R., & Bass, E. B. (1997). Clinical characteristics of women with
a history of childhood abuse: Unhealed wounds. Journal of the American Medical
Association, 277, 1362±1368.
McCoy, M. L., & Keen, S. T. (2009). Child abuse and neglect. New York: Psychology Press.
374
0 , $ McGowan, P.O., Sasaki, A., Huang, T.C., Unterberger, A., Suderman, M., Ernst, C.,
Meaney, M.J., Turecki, G., & Szyf, M. (2009). Promoter-wide hypermethylation of the
ribosomal RNA gene promoter in the suicide brain. PLoS ONE, 3, e2085. doi:10.1371/
journal.pone.0002085.
McLeod, J. D. (1991). Childhood parental loss and adult depression. Journal of Health and
Social Behavior, 32, 205±230.
Molnar, B. E., Buka, S. L., & Kessler, R. C. (2001). Child sexual abuse and subsequent
psychopathology: Results from the national comorbidity survey. American Journal of
Public Health, 91, 753±760.
Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1996). The
long-term impact of the physical, emotional, and sexual abuse of children: A
community study. Child Abuse & Neglect, 20, 7±21.
Osofsky, J. D. (1995). The effects of exposure to violence on young children. American
Psychologist, 50, 782±788.
Pynoos, R. S. (1993). Traumatic stress and developmental psychopathology in children and
adolescents. In J. Oldham, M. Riba, & A. Tasman (Eds.), American psychiatric review of
psychiatry, Vol. 12 (pp. 205±238). Washington, DC: American Psychiatric Press.
Reichardt, H. M., Tronche, F., Bauer, A., & Schutz, G. (2000). Molecular genetic analysis
of glucocorticoid signaling using the Cre/loxP system. Biological Chemistry, 381,
961±964.
Sachs-Ericsson, N., Blazer, D., Plant, E. A., & Arnow, B. (2005). Childhood sexual and
physical abuse and the 1-year prevalence of medical problems in the national
comorbidity survey. Health Psychology, 24, 32±40.
Sachs-Ericsson, N., Kendall-Tackett, K., & Hernandez, A. (2007). Childhood abuse,
chronic pain, and depression in the national comorbidity survey. Child Abuse & Neglect,
31, 531±547.
Shalhoub-Kevorkian, N. (2005). Disclosure of child abuse in conflict areas. Violence Against
Women, 11, 1263±91.
Shrout, P. E., Link, B. G., Dohrenwend, B. P., Skodol, A. E., Stueve, A., & Mirotznik, J.
(1989). Characterizing life events as risk factors for depression: The role of fateful loss
events. Journal of Abnormal Psychology, 98, 460±467.
Stein, M., & Barrett-Connor, E. (2000). Sexual assault and physical health: Findings from a
population-based study of older adults. Psychosomatic Medicine, 62, 838±843.
Talley, N. J., Fett, S. L., & Zinsmeister, A. R. (1995). Self-reported abuse and
gastrointestinal disease in outpatients: Association with irritable bowel-type
symptoms. American Journal of Gastroenterology, 90, 366±371.
Turner, R. J., & Lloyd, D. A. (2004). Stress burden and the lifetime incidence of psychiatric
disorder in young adults: Racial and ethnic contrasts. Archives of General Psychiatry,
61, 481±488.
UNICEF (1989). Convention on the Rights of the Child. www.unicef.org/crc/.
Weaver, I.C., Cervoni, N., Champagne, F. A., D'Alessio, A. C., Sharma, S., Seckl, J. R.,
Dymov, S., Szyf, M., & Meaney, M. J. (2004). Epigenetic programming by maternal
behavior. Nature Neuroscience, 7, 847±854.
375
Weiss, E. L., Longhurst, J. G., & Mazure, C. M. (1999). Childhood sexual abuse as a risk
factor for depression in women: Psychosocial and neurobiological correlates. American
Journal of Psychiatry, 156, 816±828.
WHO World Mental Health Survey Consortium (2004). Prevalence, severity, and unmet
need for treatment of mental disorders in the World Health Organization World Mental
Health Surveys. Journal of the American Medical Association, 292, 2581±2590.
Widom, C. S. (1999). Posttraumatic stress disorder in abused and neglected children grown
up. American Journal of Psychiatry, 156, 1223±1229.
Widom, C. S., DuMont, K., & Czaja, S. J. (2007). A prospective investigation of major
depressive disorder and comorbidity in abused and neglected children grown up.
Archives of General Psychiatry, 64, 49±56.
Widom, C. S., & Morris, S. (1997). Accuracy of adult recollections of childhood
victimization. Part 2 ± Childhood sexual abuse. Psychological Assessment, 9, 34±46.
Williams, L. M. (1994). Recall of childhood trauma: A prospective study of women's
memories of child sexual abuse. Journal of Consulting and Clinical Psychology, 62,
1167±1176.
376