汶川地震所致创伤后应激障碍患者的共病分析
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摘要
目的:了解汶川地震部分极重灾区所致创伤后应激障碍(PTSD)患者共病其他精神障碍的情况,以及影响共病的因素。方法:采用方便取样,对四川省绵阳市所辖的安县、平武县及北川县部分受灾群众进行调查,以DSM-Ⅳ-TR轴Ⅰ障碍定式临床检查(SCID-I/P)为诊断工具。结果:共138例诊断PTSD,其中90例共病其他精神障碍,共病率65.2%;42.8%患者共病重性抑郁障碍,12.3%共病特殊恐怖症,10.9%共病惊恐发作;40～59岁共病率最高为70.4%(χ2=5.94,P=0.05),有亲人死亡者共病抑郁症35例,明显高于无亲人死亡者24例,两者差异有统计学意义(χ2=4.16;P=0.04)。结论:65.2%PTSD患者共病其他精神障碍,以共病重性抑郁障碍、特殊恐怖症、惊恐发作最多见,共病率与年龄相关,地震中有亲人死亡将增加PTSD共病抑郁症风险。
Objective:To investigate comorbidity of post-traumatic stress disorder aroused by Wenchuan earthquake and related factors on comorbidity.Method:Parts of heavy victims of An County and Pingwu and Beichuan residents were interviewed by Structured Clinical Interview for DSM-Ⅳ Axis I Disorders(SCID-I/P).Results:138 people were diagnosed as PTSD,90 of whom (65.2%) had comorbidity with other mental disorder,namely,42.8% major depressive disorder,12.3% specific phobia,10.9% panic attack.People with close relatives dead in the earthquake showed higher comorbid major depressive disorder (n=35) than those without close relative dead (n=24)(χ 2=4.16,P=0.04).Conclusion:62.5% patients with PTSD show comorbidity with other mental disorder,of which major depressive disorder,specific phobia and panic attack were most.The comorbidity was associated with age,close relatives dead in the earthquake can increase the risk of comorbidity with major depressive disorder.
Objective:To investigate comorbidity of post-traumatic stress disorder aroused by Wenchuan earthquake and related factors on comorbidity.Method:Parts of heavy victims of An County and Pingwu and Beichuan residents were interviewed by Structured Clinical Interview for DSM-Ⅳ Axis I Disorders(SCID-I/P).Results:138 people were diagnosed as PTSD,90 of whom (65.2%) had comorbidity with other mental disorder,namely,42.8% major depressive disorder,12.3% specific phobia,10.9% panic attack.People with close relatives dead in the earthquake showed higher comorbid major depressive disorder (n=35) than those without close relative dead (n=24)(χ 2=4.16,P=0.04).Conclusion:62.5% patients with PTSD show comorbidity with other mental disorder,of which major depressive disorder,specific phobia and panic attack were most.The comorbidity was associated with age,close relatives dead in the earthquake can increase the risk of comorbidity with major depressive disorder.
引文
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[7]赵丞智,李俊福,王明山,等.地震后17个月受灾青少年创伤后应激障碍及其相关因素[J].中国心理卫生杂志,2001,15:145-147.
[8]Mellman TA,Knorr BR,Pigeon WR,et al.Heart rate variability during sleep and the early development of posttraumatic stress dis-order[J].Biol Psychiatry,2004,55:953-956.
[9]Kessler RC,Borges G,Walters EE.Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey[J].Arch Gen Psychiatry,1999,56:617-626.
[10]Maria MD,David A.Brent MD.Posttraumatic stress disorder comorbid with major depression:factors mediating the association with suicidal behavior[J].Am J Psychiatry,2005,162:560-566.
[11]崔利军,栗克清,徐建国,等.四川省安县灾民地震后1个月的精神状况初步调查[J].中国神经精神疾病杂志,2009,35:300-301.
[12]崔利军,栗克清,韩彦超,等.汶川地震后四个月平武县部分灾民的精神健康状况[J].中国全科医学,2010,13:85-87.
[2]卫生部疾病预防控制局编.灾难心理危机干预培训手册[M].北京:人民卫生出版社,2008:110-111.
[3]Michael B,Robert L,Miriam Gibbon;et al.Structured clinical interview for DSM-Ⅳaxis I disorders.Biometrics Research Depart-ment New York State Psychiatric Institute.U.S.A.2002.
[4]Kessler RC,Sonnega A,Bromet E,et al.Posttraumatic stress disorder in the national comorbidity survey[J].Archives of General Psy-chiatry,1995,52:1048-1060.
[5]王丽颖,杨蕴萍,创伤后应激障碍的研究进展,国外医学精神病学分册[J].2004,31:112-115.
[6]秦虹云,季建林.PTSD及其危机干预[J].中国心理卫生杂志,2003,17:614-616.
[7]赵丞智,李俊福,王明山,等.地震后17个月受灾青少年创伤后应激障碍及其相关因素[J].中国心理卫生杂志,2001,15:145-147.
[8]Mellman TA,Knorr BR,Pigeon WR,et al.Heart rate variability during sleep and the early development of posttraumatic stress dis-order[J].Biol Psychiatry,2004,55:953-956.
[9]Kessler RC,Borges G,Walters EE.Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey[J].Arch Gen Psychiatry,1999,56:617-626.
[10]Maria MD,David A.Brent MD.Posttraumatic stress disorder comorbid with major depression:factors mediating the association with suicidal behavior[J].Am J Psychiatry,2005,162:560-566.
[11]崔利军,栗克清,徐建国,等.四川省安县灾民地震后1个月的精神状况初步调查[J].中国神经精神疾病杂志,2009,35:300-301.
[12]崔利军,栗克清,韩彦超,等.汶川地震后四个月平武县部分灾民的精神健康状况[J].中国全科医学,2010,13:85-87.
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