汶川地震一线救援人员灾后应激相关障碍状况分析
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摘要
目的调查汶川地震救援人员灾后半年应激相关障碍的发生率及相关危险因素。方法对参加汶川地震一线救援的1024名军校学员于震后半年采用创伤后应激障碍(PTSD)筛查量表(PCL-C)、抑郁自评量表(SDS)、焦虑自评量表(SAS)及自编救援经历调查问卷进行心理状况评估,以169名在校留守军校学员作为对照。结果救灾学员初筛PCL-C总分≥38分者21例(2.05%),最显著的3种症状为想起此事内心非常痛苦(50.30%)、脑子里无法摆脱灾害发生时的情景(36.00%)、注意力难集中(30.70%)。抑郁指数≥0.5者140例(13.67%),SAS总分≥50者26例(2.54%);救援组SAS、SDS评分均显著高于留守组(P<0.05)。经线性逐步回归分析,导致创伤后应激障碍症状发生的主要影响因素依次为:救灾中处理过遗体、灾区生活适应不良、救灾前身体状况差、对自己在救援中的表现不满意、既往创伤经历、性格内向、救灾中经历过危险事件等7个变量。结论参加过抗震救灾的军校学员半年后仍然存在抑郁,焦虑和PTSD症状,提示:对救援人员经历应激后的心理健康状况仍需高度关注。
Objective To investigate the detection rates and related risk factors of stress-related disorder among rescue cadets six months after Wenchuan earthquake.Methods PTSD Checklist-Civilian Version(PCL-C),SAS(self-rating anxiety scale),SDS(self-rating depression scale)and self-edited rescue experience questionnaire(SEQ) were administered to 1024 military cadets and another 169 students who stayed put at the school were taken as control group.Results Total PCL-C scores of 2.05% of the rescuers exceeded 38.The most common items were "Feeling very upset when something reminded you of a stressful experience from the past"(50.30%),"Repeated,disturbing memories,thoughts,or images of a stressful experience from the past"(36.00%) and "Having difficulty concentrating"(30.70%).The depression index of the 13.67% of rescuers was greater than 0.5.The total SAS and SDS scores of 2.54% of subjects were greater than 50 points.Both scores in the rescue cadets group were significantly higher than in the control group(P<0.05).Multi-linear gradual regressive analysis indicated that the number and severity of PTSD symptoms were associated with the experience of treating corpses,maladjustment,defective physical status,rescue work dissatisfaction,other trauma experiences,introversion and dangerous experiences in the disaster area.Conclusion Symptoms such as depression,anxiety and PTSD,persist six months after Wenchuan earthquake for cadets who took part in the rescue in the disaster area,which suggests that more attention has to be paid to psychological services for these cadets.
Objective To investigate the detection rates and related risk factors of stress-related disorder among rescue cadets six months after Wenchuan earthquake.Methods PTSD Checklist-Civilian Version(PCL-C),SAS(self-rating anxiety scale),SDS(self-rating depression scale)and self-edited rescue experience questionnaire(SEQ) were administered to 1024 military cadets and another 169 students who stayed put at the school were taken as control group.Results Total PCL-C scores of 2.05% of the rescuers exceeded 38.The most common items were "Feeling very upset when something reminded you of a stressful experience from the past"(50.30%),"Repeated,disturbing memories,thoughts,or images of a stressful experience from the past"(36.00%) and "Having difficulty concentrating"(30.70%).The depression index of the 13.67% of rescuers was greater than 0.5.The total SAS and SDS scores of 2.54% of subjects were greater than 50 points.Both scores in the rescue cadets group were significantly higher than in the control group(P<0.05).Multi-linear gradual regressive analysis indicated that the number and severity of PTSD symptoms were associated with the experience of treating corpses,maladjustment,defective physical status,rescue work dissatisfaction,other trauma experiences,introversion and dangerous experiences in the disaster area.Conclusion Symptoms such as depression,anxiety and PTSD,persist six months after Wenchuan earthquake for cadets who took part in the rescue in the disaster area,which suggests that more attention has to be paid to psychological services for these cadets.
引文
[1]赵高锋,杨彦春,张树森.汶川地震极重灾区780名受灾群众心理状况调查[J].中国循证医学杂志,2008,8(10):815-819.
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[3]杨晓云,杨宏爱,刘启贵,等.创伤后应激检查量表平民版的效度、信度及影响因素的研究[J].中国健康心理学杂志,2007,15(1):6-9.
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[8]赵高锋,杨彦春,张强,等.汶川地震极重灾区社区居民创伤后应激障碍发生率及影响因素[J].中国心理卫生杂志,2009,23(7):478-483.
[9]惠武利,施旺红,徐德忠,等.烟台海难援救军人PTSD发生的影响因素分析[J].中国心理卫生杂志,2001,15(3):148-149.
[10]张克让,徐勇,杨红,等.SARS患者、医务人员及疫区公众创伤后应激障碍的调查研究[J].中国行为医学科学,2006,15(4):358-360.
[11]汪向东,高岚,Naotaka S,等.灾害后的精神及行为障碍[J].中华精神科杂志,1999,32(3):186-188.
[2]高存友,甘景梨,赵兰民,等.抗震救灾官兵心理应激反应及其影响因素[J].中华行为医学与脑科学杂志,2009,18(11):1022-1024.
[3]杨晓云,杨宏爱,刘启贵,等.创伤后应激检查量表平民版的效度、信度及影响因素的研究[J].中国健康心理学杂志,2007,15(1):6-9.
[4]American Psychiatric Association.Diagnostic and statistic manualof mental disorders[M].4th ed(DSM-Ⅳ).Washington DC:American Psychiatric Association,1994:424-429.
[5]Mueser KT,Salyers MP,Rosenberg SD,et al.Psychometric evaluationof trauma and posttraumatic stress disorder assessments in personswith severe mental illness[J].Psychol Assess,2001,13(1):110-117.
[6]汪向东,王希林,马弘.心理卫生评定量表手册[M].增订版.北京:中国心理卫生杂志社,1999:235-238.
[7]王焕林,崔庶,陈继军,等.中国军人心理创伤后应激障碍的流行病学调查[J].中华神经科杂志,1996,29(2):69-72.
[8]赵高锋,杨彦春,张强,等.汶川地震极重灾区社区居民创伤后应激障碍发生率及影响因素[J].中国心理卫生杂志,2009,23(7):478-483.
[9]惠武利,施旺红,徐德忠,等.烟台海难援救军人PTSD发生的影响因素分析[J].中国心理卫生杂志,2001,15(3):148-149.
[10]张克让,徐勇,杨红,等.SARS患者、医务人员及疫区公众创伤后应激障碍的调查研究[J].中国行为医学科学,2006,15(4):358-360.
[11]汪向东,高岚,Naotaka S,等.灾害后的精神及行为障碍[J].中华精神科杂志,1999,32(3):186-188.
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