负性生活事件、社会支持和创伤后应激障碍症状:对汶川地震后青少年的追踪研究
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摘要
创伤后应激障碍是灾难后常见的心理病理问题,灾后继发负性生活事件和社会支持是影响创伤后应激障碍症状的重要因素。该研究采用追踪设计,历时2年对汶川地震后都江堰地区1573名青少年进行3次测查,考察震后继发负性生活事件、不同类型社会支持与创伤后应激障碍症状之间的相互作用关系。研究发现:不同类型的社会支持与震后继发负性生活事件、创伤后应激障碍症状存在不同的作用关系;震后继发负性生活事件不仅直接影响个体的心理健康还对个体的社会支持系统有损害;震后负性生活事件、主观支持与创伤后应激障碍症状存在联动效应,即三者中任一方面的变化都可能引起其他方面的变化。
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder following natural disasters. A growing number of studies have reported elevated prevalence and risk factors of PTSD among adolescent survivors of earthquake, flood and hurricane. Social supports and negative life events have been identified as important influence factors of adolescents’ posttraumatic stress disorder. Studies have documented that there are complex interplays among negative life events, social supports and mental health problems. The leading theoretical models of their relations include stress prevention model, support deterioration model, reciprocity of stress and perceived support model. The present study explored and compared these models of negative life events, social supports and posttraumatic stress symptoms in a large, prospective non-clinical sample of adolescents after the 2008 Wenchuan earthquake. This study is a part of the longitudinal study of adolescents in Dujiangyan district after the 2008 Wenchuan earthquake in China. A total of 1573 adolescents were sampled from Dujiangyan district, 20 kilometer away from the epicenter. At the time of 6, 18, 24 months after the earthquake, participants were asked to complete questionnaires including Self-Rating Scale for Posttraumatic Stress Disorder, Adolescent Self-Rating Life Events Checklist, Social Support Rating Scale for Children and Adolescents, and demographics including sex, age, sibling, location, and earthquake exposure factors. One thousand and seventy-four adolescents were followed up all of the three waves. The mean age of the participants was 14.9 years (SD = 1.3) at wave 1, 42.4% were female, 30.9% resided in rural areas, and 83.2% were only child. Structural equation model was used to explore the causations of posttraumatic stress symptoms, social support and negative life events following the earthquake. The results showed a moderate continuity of posttraumatic stress symptoms, negative life events, subjective social supports, objective social supports and utilization of social supports across the three waves (b = 0.39-0.57). Reciprocal relations were founded between posttraumatic stress symptoms and negative life events. To be specific, wave 1 posttraumatic stress symptoms positively predicted wave 2 negative life events (β = 0.16), wave 2 negative life events positively predicted wave 3 posttraumatic stress symptoms (β = 0.07); wave 1 negative life events positively predicted wave 2 posttraumatic stress symptoms (β = 0.07), wave 2 posttraumatic stress symptoms positively predicted wave 3 negative life events (β = 0.10). Subjective social supports and negative life events, objective social supports and negative life events also longitudinal predicted each other across waves. Specifically, wave 1 subjective social supports predicted wave 2 negative life events negatively (β = -0.11), wave 2 subjective social supports negatively predicted wave 3 negative life events (? = -0.07), wave 1 negative life events predicted wave 2 subjective social supports negatively (β = -0.08), wave 2 negative life events negatively predicted wave 3 subjective social supports (β = -0.11); wave 1 negative life events predicted wave 2 objective social supports (β = -0.08) negatively, wave 1 objective social supports negatively predicted wave 2 negative life events (β = -0.06). In addition, wave 1 subjective social supports predicted wave 2 posttraumatic stress symptoms significantly (β = -0.07). Posttraumatic stress symptoms, negative life events and social supports influence each other. Subjective social supports, objective social supports and utilization of social supports have characteristic relations with posttraumatic stress symptoms and negative life events. Posttraumatic stress symptoms and negative life events should be assessed and prevented timely. It would be effective and meaningful to guide the survival adolescents to perceive, construct, maintain, seek and utilize their social supports.
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder following natural disasters. A growing number of studies have reported elevated prevalence and risk factors of PTSD among adolescent survivors of earthquake, flood and hurricane. Social supports and negative life events have been identified as important influence factors of adolescents’ posttraumatic stress disorder. Studies have documented that there are complex interplays among negative life events, social supports and mental health problems. The leading theoretical models of their relations include stress prevention model, support deterioration model, reciprocity of stress and perceived support model. The present study explored and compared these models of negative life events, social supports and posttraumatic stress symptoms in a large, prospective non-clinical sample of adolescents after the 2008 Wenchuan earthquake. This study is a part of the longitudinal study of adolescents in Dujiangyan district after the 2008 Wenchuan earthquake in China. A total of 1573 adolescents were sampled from Dujiangyan district, 20 kilometer away from the epicenter. At the time of 6, 18, 24 months after the earthquake, participants were asked to complete questionnaires including Self-Rating Scale for Posttraumatic Stress Disorder, Adolescent Self-Rating Life Events Checklist, Social Support Rating Scale for Children and Adolescents, and demographics including sex, age, sibling, location, and earthquake exposure factors. One thousand and seventy-four adolescents were followed up all of the three waves. The mean age of the participants was 14.9 years (SD = 1.3) at wave 1, 42.4% were female, 30.9% resided in rural areas, and 83.2% were only child. Structural equation model was used to explore the causations of posttraumatic stress symptoms, social support and negative life events following the earthquake. The results showed a moderate continuity of posttraumatic stress symptoms, negative life events, subjective social supports, objective social supports and utilization of social supports across the three waves (b = 0.39-0.57). Reciprocal relations were founded between posttraumatic stress symptoms and negative life events. To be specific, wave 1 posttraumatic stress symptoms positively predicted wave 2 negative life events (β = 0.16), wave 2 negative life events positively predicted wave 3 posttraumatic stress symptoms (β = 0.07); wave 1 negative life events positively predicted wave 2 posttraumatic stress symptoms (β = 0.07), wave 2 posttraumatic stress symptoms positively predicted wave 3 negative life events (β = 0.10). Subjective social supports and negative life events, objective social supports and negative life events also longitudinal predicted each other across waves. Specifically, wave 1 subjective social supports predicted wave 2 negative life events negatively (β = -0.11), wave 2 subjective social supports negatively predicted wave 3 negative life events (? = -0.07), wave 1 negative life events predicted wave 2 subjective social supports negatively (β = -0.08), wave 2 negative life events negatively predicted wave 3 subjective social supports (β = -0.11); wave 1 negative life events predicted wave 2 objective social supports (β = -0.08) negatively, wave 1 objective social supports negatively predicted wave 2 negative life events (β = -0.06). In addition, wave 1 subjective social supports predicted wave 2 posttraumatic stress symptoms significantly (β = -0.07). Posttraumatic stress symptoms, negative life events and social supports influence each other. Subjective social supports, objective social supports and utilization of social supports have characteristic relations with posttraumatic stress symptoms and negative life events. Posttraumatic stress symptoms and negative life events should be assessed and prevented timely. It would be effective and meaningful to guide the survival adolescents to perceive, construct, maintain, seek and utilize their social supports.
引文
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Barrera,M.(1986).Distinctions between social support concepts,measures,and models.American Journal of Community Psychology,14(4),413–445.
Beckham,J.C.,Lytle,B.L.,&Feldman,M.E.(1996).Caregiver burden in partners of Vietnam War veterans with posttraumatic stress disorder.Journal of Consulting and Clinical Psychology,64(5),1068–1072.
Byrne,C.A.,&Riggs,D.S.(1996).The cycle of trauma;relationship aggression in male Vietnam veterans with symptoms of posttraumatic stress disorder.Violence and Victims,11(3),213–225.
Compas,B.E.,Wagner,B.M.,Slavin,L.A.,&Vannatta,K.(1986).A prospective study of life events,social support,and psychological symptomatology during the transition from high school to college.American Journal of Community Psychology,14(3),241–257.
Dean,A.,&Ensel,W.M.(1982).Modelling social support,life events,competence,and depression in the context of age and sex.American Journal of Community Psychology,10(4),392–408.
Dignam,J.T.,Barrera,M.,Jr.,&West,S.G.(1986).Occupational stress,social support,and burnout among correctional officers.American Journal of Community Psychology,14(2),177–193.
Fan,F.,Liu,W.M.,Zheng,Y.H.,&Cui,M.M.(2010).Mental health problems and correlates among adolescents6months after exposed to the Wenchuan earthquake.Chinese Journal of Clinical Psychology,18(1),56–59[范方,柳武妹,郑裕鸿,崔苗苗.(2010).震后6个月都江堰地区青少年心理问题及影响因素.中国临床心理学杂志,18(1),56–59.]
Freedy,J.R.,Saladin,M.E.,Kilpatrick,D.G.,Resnick,H.S.,&Saunders,B.E.(1994).Understanding acute psychological distress following natural disaster.Journal of Traumatic Stress,7(2),257-273.
Goenjian,A.K.,Steinberg,A.M.,Najarian,L.M.,FairbanksL.A.,Tashjian,M.,&Pynoos,R.S.(2000).Prospectivestudy of posttraumatic stress,anxiety,and depressivereactions after earthquake and political violence.AmericanJournal of Community Psychology,157(6),911–916.
Kaniasty,K.,&Norris,F.H.(2008).Longitudinal linkages between perceived social support and posttraumatic stress symptoms:Sequential roles of social causation and social selection.Journal of Traumatic Stress,21(3),274–281.
King,D.W.,Taft,C.,King,L.A.,Hammond,C.,&Stone,E.R.(2006).Directionality of the association between social support and posttraumatic stress disorder:A longitudinal investigation.Journal of Applied Social Psychology,36(12),2980–2992.
La Greca,A.,Silverman,W.K.,Vernberg,E.M.,&Prinstein,M.J.(1996).Symptoms of posttraumatic stress in children after Hurricane Andrew:a prospective study.Journal of Consulting and Clinical Psychology,64(4),712-723.
Lin,N.,&Dean,A.(1984).Social support and depression.A panel study.Social Psychiatry and Psychiatric Epidemiology,19(2),83–91.
Lin,N.,&Ensel,W.M.(1984).Depression-mobility and its social etiology:The role of life events and social support.Journal of Health and Social Behavior,25(2),176–188.
Liu,X.C.,Liu,L.Q.,Yang,J.,Chai,F.X.,Wang,A.Z.,Sun,L.M.,et al.(1997).Reliability and validity of the adolescents self-rating life events checklist.Chinese Journal of Clinical Psychology,5(1),34–36.[刘贤臣,刘连启,杨杰,柴福勋,王爱祯,孙良民,等.(1997).青少年生活事件量表的信度效度检验.中国临床心理学杂志,5(1),34–36.]
Liu,X.C.,Ma,D.D.,Liu,L.Q.,Zhao,G.F.,Li,C.Q.,Yang,J.,et al.(1998).Development of the post-traumatic stress disorder self-rating scale and its reliability and validity.Chinese Journal of Behavioral Medical Science,7(2),93–96.[刘贤臣,马登岱,刘连启,赵贵芳,李传琦,杨杰,等.(1998).心理创伤后应激障碍自评量表的编制和信度效度研究.中国行为医学科学,7(2),93–96.]
Mitchell,R.E.,&Moos,R.H.(1984).Deficiencies in social support among depressed patients:Antecedents or consequences of stress?Journal of Health and Social Behavior,25(4),438–452.
Neria,Y.,Nandi,A.,&Galea,S.(2008).Post-traumatic stress disorder following disasters:A systematic review.Psychological Medicine,38(4),467–480.
Norris,F.H.,Baker,C.K.,Murphy,A.D.,&Kaniasty,K.(2005).Social support mobilization and deterioration after Mexico’s1999flood:Effects of context,gender,and time.American Journal of Community Psychology,36(1-2),15–28.
Norris,F.H.,Friedman,M.J.,&Watson,P.J.(2002).60,000disaster victims speak:Part II.Summary and implications of the disaster mental health research.Psychiatry,65(3),240–260.
Norris,F.H.,Friedman,M.J.,Watson,P.J.,Byrne,C.M.,Diaz,E.,&Kaniasty,K.(2002).60,000disaster victims speak:Part I.An empirical review of the empirical literature,1981-2001.Psychiatry,65(3),207–239.
Norris,F.H.,Tracy,M.,&Galea,S.(2009).Looking for resilience:Understanding the longitudinal trajectories of responses to stress.Social Science and Medicine,68(12),2190–2198.
Turner,R.J.(1981).Social support as a contingency in psychological well-being.Journal of Health and Social Behavior,22(4),357–367.
Wen,Z.L.,Hau,K.-T.,&Marsh,H.W.(2004).Structural equation model testing:Cutoff criteria for goodness of fit indices and chi-square test.Acta Psychologica Sinica,36(2),186–194.[温忠麟,侯杰泰,马什赫伯特.(2004).结构方程模型检验:拟合指数与卡方准则.心理学报,36(2),186–194.]
Wang,X.D.(1999).The Handbook of Mental Health Rating Scale.Beijing,China:Chinese Mental Health Journal Press,127–131.[汪向东.(1999).心理卫生评定量表手册(增订版).北京:中国心理卫生杂志社,127–131.]
Zhang,B.,Zhang,F.G.,Wang,L.P.,Yu,Z.J.,Wang,C.Q.,Wang,S.C.,et al.(2008).A cross-sectional study on current prevalence of post-traumatic stress disorder in adults orphaned by Tangshan earthquake in1976.Chinese Mental Health Journal,22(6),469–473.[张本,张凤阁,王丽萍,于振剑,王长奇,王思臣,等.(2008).30年后唐山地震所致孤儿创伤后应激障碍现患率调查.中国心理卫生杂志,22(6),469–473.]
Barrera,M.(1986).Distinctions between social support concepts,measures,and models.American Journal of Community Psychology,14(4),413–445.
Beckham,J.C.,Lytle,B.L.,&Feldman,M.E.(1996).Caregiver burden in partners of Vietnam War veterans with posttraumatic stress disorder.Journal of Consulting and Clinical Psychology,64(5),1068–1072.
Byrne,C.A.,&Riggs,D.S.(1996).The cycle of trauma;relationship aggression in male Vietnam veterans with symptoms of posttraumatic stress disorder.Violence and Victims,11(3),213–225.
Compas,B.E.,Wagner,B.M.,Slavin,L.A.,&Vannatta,K.(1986).A prospective study of life events,social support,and psychological symptomatology during the transition from high school to college.American Journal of Community Psychology,14(3),241–257.
Dean,A.,&Ensel,W.M.(1982).Modelling social support,life events,competence,and depression in the context of age and sex.American Journal of Community Psychology,10(4),392–408.
Dignam,J.T.,Barrera,M.,Jr.,&West,S.G.(1986).Occupational stress,social support,and burnout among correctional officers.American Journal of Community Psychology,14(2),177–193.
Fan,F.,Liu,W.M.,Zheng,Y.H.,&Cui,M.M.(2010).Mental health problems and correlates among adolescents6months after exposed to the Wenchuan earthquake.Chinese Journal of Clinical Psychology,18(1),56–59[范方,柳武妹,郑裕鸿,崔苗苗.(2010).震后6个月都江堰地区青少年心理问题及影响因素.中国临床心理学杂志,18(1),56–59.]
Freedy,J.R.,Saladin,M.E.,Kilpatrick,D.G.,Resnick,H.S.,&Saunders,B.E.(1994).Understanding acute psychological distress following natural disaster.Journal of Traumatic Stress,7(2),257-273.
Goenjian,A.K.,Steinberg,A.M.,Najarian,L.M.,FairbanksL.A.,Tashjian,M.,&Pynoos,R.S.(2000).Prospectivestudy of posttraumatic stress,anxiety,and depressivereactions after earthquake and political violence.AmericanJournal of Community Psychology,157(6),911–916.
Kaniasty,K.,&Norris,F.H.(2008).Longitudinal linkages between perceived social support and posttraumatic stress symptoms:Sequential roles of social causation and social selection.Journal of Traumatic Stress,21(3),274–281.
King,D.W.,Taft,C.,King,L.A.,Hammond,C.,&Stone,E.R.(2006).Directionality of the association between social support and posttraumatic stress disorder:A longitudinal investigation.Journal of Applied Social Psychology,36(12),2980–2992.
La Greca,A.,Silverman,W.K.,Vernberg,E.M.,&Prinstein,M.J.(1996).Symptoms of posttraumatic stress in children after Hurricane Andrew:a prospective study.Journal of Consulting and Clinical Psychology,64(4),712-723.
Lin,N.,&Dean,A.(1984).Social support and depression.A panel study.Social Psychiatry and Psychiatric Epidemiology,19(2),83–91.
Lin,N.,&Ensel,W.M.(1984).Depression-mobility and its social etiology:The role of life events and social support.Journal of Health and Social Behavior,25(2),176–188.
Liu,X.C.,Liu,L.Q.,Yang,J.,Chai,F.X.,Wang,A.Z.,Sun,L.M.,et al.(1997).Reliability and validity of the adolescents self-rating life events checklist.Chinese Journal of Clinical Psychology,5(1),34–36.[刘贤臣,刘连启,杨杰,柴福勋,王爱祯,孙良民,等.(1997).青少年生活事件量表的信度效度检验.中国临床心理学杂志,5(1),34–36.]
Liu,X.C.,Ma,D.D.,Liu,L.Q.,Zhao,G.F.,Li,C.Q.,Yang,J.,et al.(1998).Development of the post-traumatic stress disorder self-rating scale and its reliability and validity.Chinese Journal of Behavioral Medical Science,7(2),93–96.[刘贤臣,马登岱,刘连启,赵贵芳,李传琦,杨杰,等.(1998).心理创伤后应激障碍自评量表的编制和信度效度研究.中国行为医学科学,7(2),93–96.]
Mitchell,R.E.,&Moos,R.H.(1984).Deficiencies in social support among depressed patients:Antecedents or consequences of stress?Journal of Health and Social Behavior,25(4),438–452.
Neria,Y.,Nandi,A.,&Galea,S.(2008).Post-traumatic stress disorder following disasters:A systematic review.Psychological Medicine,38(4),467–480.
Norris,F.H.,Baker,C.K.,Murphy,A.D.,&Kaniasty,K.(2005).Social support mobilization and deterioration after Mexico’s1999flood:Effects of context,gender,and time.American Journal of Community Psychology,36(1-2),15–28.
Norris,F.H.,Friedman,M.J.,&Watson,P.J.(2002).60,000disaster victims speak:Part II.Summary and implications of the disaster mental health research.Psychiatry,65(3),240–260.
Norris,F.H.,Friedman,M.J.,Watson,P.J.,Byrne,C.M.,Diaz,E.,&Kaniasty,K.(2002).60,000disaster victims speak:Part I.An empirical review of the empirical literature,1981-2001.Psychiatry,65(3),207–239.
Norris,F.H.,Tracy,M.,&Galea,S.(2009).Looking for resilience:Understanding the longitudinal trajectories of responses to stress.Social Science and Medicine,68(12),2190–2198.
Turner,R.J.(1981).Social support as a contingency in psychological well-being.Journal of Health and Social Behavior,22(4),357–367.
Wen,Z.L.,Hau,K.-T.,&Marsh,H.W.(2004).Structural equation model testing:Cutoff criteria for goodness of fit indices and chi-square test.Acta Psychologica Sinica,36(2),186–194.[温忠麟,侯杰泰,马什赫伯特.(2004).结构方程模型检验:拟合指数与卡方准则.心理学报,36(2),186–194.]
Wang,X.D.(1999).The Handbook of Mental Health Rating Scale.Beijing,China:Chinese Mental Health Journal Press,127–131.[汪向东.(1999).心理卫生评定量表手册(增订版).北京:中国心理卫生杂志社,127–131.]
Zhang,B.,Zhang,F.G.,Wang,L.P.,Yu,Z.J.,Wang,C.Q.,Wang,S.C.,et al.(2008).A cross-sectional study on current prevalence of post-traumatic stress disorder in adults orphaned by Tangshan earthquake in1976.Chinese Mental Health Journal,22(6),469–473.[张本,张凤阁,王丽萍,于振剑,王长奇,王思臣,等.(2008).30年后唐山地震所致孤儿创伤后应激障碍现患率调查.中国心理卫生杂志,22(6),469–473.]
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