汶川地震1周年救援官兵心理应激状况及危险因素分析
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摘要
目的调查汶川地震1周年救援官兵创伤后应激障碍(post traumatic stress disorder,PTSD)的现患率并探讨其危险因素。方法采用晤谈法和自编一般情况问卷、PTSD症状清单平民版(PTSD Checklist-Civilian Version,PCL-C)、简易应对方式问卷(simple coping style questionnaire,SCSQ)、症状自评量表(SCL-90)和艾森克个性问卷(eysenck personality questionnaire,EPQ)的部分因子组成调查表,于汶川地震1周年时对1176名救援官兵进行调查。结果1周年后救援官兵PTSD现患率为3.45%,PCL-C各症状因子均分<2分;SCL-90中躯体化因子分显著高于军人常模(P<0.01),抑郁、焦虑因子分显著低于军人常模(P<0.01);EPQ中神经质(N)因子分显著低于军人常模(P<0.01),内外向(E)因子分显著高于军人常模(P<0.05);SCSQ中积极应对因子分显著高于中国陆军常模(P<0.01),消极应对因子分显著低于中国陆军常模(P<0.01);不同救援单位军人在PTSD总分、再体验、回避、抑郁、焦虑、神经质、应对方式因子分上具有显著性差异(P<0.05)。PCL-C总分与神经质、消极应对方式、负性生活事件呈显著正相关,与内外向性、积极应对等呈显著负相关。以PTSD总分为因变量,进行多元线性逐步回归分析。Logistic回归显示影响PTSD总分的主要因素由大到小依次为:焦虑、躯体化、神经质、消极应对、内外向。5个变量的决定系数为R2=0.371(Adjusted R2=0.368),F=125.624,P=0.00。结论1周年后救援官兵应激症状已趋于缓解,焦虑情绪和神经质倾向是发生PTSD的主要危险因素,对救援官兵进行积极有效的心理干预和心理素质训练能有效降低PTSD的发生。
Objective To investigate the prevalence rate and the related risk factors of post traumatic stress disorder (PTSD) in rescue troops in 1 year after Wenchuan earthquake in order to provide scientific evidences for psychological health education. Methods Interviews and questionnaire, which composed by General State of Health Questionnaire, PTSD Checklist-Civilian Version (PCL-C), Symptom Checklist-90 (SCL-90), simple coping style questionnaire(SCSQ) and Eysenck Personality Questionnaire (EPQ), were used on 1 176 officers/soldiers from rescue troops. The risk factors were analyzed with Logistic regression analysis. Result In 1 year after Wenchuan earthquake, the prevalence rate of PTSD was 3.45%, with the average score of every symptom factors less than 2. Compared with the norms of Chinese serviceman, the factors about somzatization in SCL-90, exterior/interior in EPQ and positive response in SCSQ were obviously higher (P<0.01). While anxiety and depression in SCL-90, nervousness in EPQ and negative response in SCSQ significantly were lower (P<0.01). The difference of total scores of PTSD, the factors about relive, avoidance, depression, anxious, nervousness and response among different rescue troops were significant (P<0.05). When total scores of PTSD as dependent variable, the multivariant gradual regressive analysis showed the mainly influence factors in order were anxiety, symptom, nervousness, negative response, exterior/interior (R2=0.371, F=125.624, P=0.00). Conclusion After the anniversary of earthquake, symptoms of psychological stress in rescue troops become less, and the anxiety and nervousness are the mainly risk factors of PTSD. Positive mental intervention and psychological disposition training are helpful at reducing the incidence of PTSD.
Objective To investigate the prevalence rate and the related risk factors of post traumatic stress disorder (PTSD) in rescue troops in 1 year after Wenchuan earthquake in order to provide scientific evidences for psychological health education. Methods Interviews and questionnaire, which composed by General State of Health Questionnaire, PTSD Checklist-Civilian Version (PCL-C), Symptom Checklist-90 (SCL-90), simple coping style questionnaire(SCSQ) and Eysenck Personality Questionnaire (EPQ), were used on 1 176 officers/soldiers from rescue troops. The risk factors were analyzed with Logistic regression analysis. Result In 1 year after Wenchuan earthquake, the prevalence rate of PTSD was 3.45%, with the average score of every symptom factors less than 2. Compared with the norms of Chinese serviceman, the factors about somzatization in SCL-90, exterior/interior in EPQ and positive response in SCSQ were obviously higher (P<0.01). While anxiety and depression in SCL-90, nervousness in EPQ and negative response in SCSQ significantly were lower (P<0.01). The difference of total scores of PTSD, the factors about relive, avoidance, depression, anxious, nervousness and response among different rescue troops were significant (P<0.05). When total scores of PTSD as dependent variable, the multivariant gradual regressive analysis showed the mainly influence factors in order were anxiety, symptom, nervousness, negative response, exterior/interior (R2=0.371, F=125.624, P=0.00). Conclusion After the anniversary of earthquake, symptoms of psychological stress in rescue troops become less, and the anxiety and nervousness are the mainly risk factors of PTSD. Positive mental intervention and psychological disposition training are helpful at reducing the incidence of PTSD.
引文
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[12]景璐石,黄颐,司徒明镜,等.汶川大地震后重灾区青少年创伤后应激反应和抑郁情绪的研究[J].中华行为医学与脑科学杂志,2009,18(3):193-195.
[13]侯彩兰,李凌江,贾福军,等.临床用创伤后应激障碍诊断量表[J].中国行为医学科学,2008,17(9):851-852.
[2]张理义,宋梓祥,李光耀,等.抗震救灾官兵心身健康状况及影响因素[J].中华行为医学与脑科学杂志,2009,18(3):201-203.
[3]Dobie D J,Kivlahan D R,Maynard C,et al.Screening for post-traumatic stress disorder in female Veteran’s Affairs patients:validation of the PTSD checklist[J].Gen Hosp Psychiatry,2002,24(6):367-374.
[4]汪向东,王希林,马弘.心理卫生评定量表手册(增订版)[M].北京:中国心理卫生杂志社,1999:127-131,109-115.
[5]王焕林,孙剑,余海鹰,等.我国军人症状自评量表常模的建立及其结果分析[J].中华精神科杂志,1999,32(1):38-40.
[6]李璐寰,童辉杰.创伤后应激障碍研究进展[J].社会心理学,2008,23(1):100-108.
[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学调查[J].中华神经科杂志,1996,29(2):69-72.
[8]胡光涛,李学成,王国威,等.赴北川抗震救灾某部官兵急性心理应激障碍及影响因素调查[J].第三军医大学学报,2009,31(15):1491-1494.
[9]Daud A,af-Klinteberg B,Rydelius P A.Trauma,PTSD and personal-ity:the relationship between prolonged traumatization and personality impairments[J].Scand J Caring Sci,2008,22(3):331-340.
[10]Hobfoll S E,Canetti-Nisim D,Johnson R J,et al.The association of exposure,risk,and resiliency factors with PTSD among Jews and Ar-abs exposed to repeated acts of terrorism in Israel[J].J Trauma Stress,2008,21(1):9-21.
[11]刘光雄,杨来启,许向东,等.车祸应激患者血清NO、SOD测定及人格特征的相关研究[J].中国临床心理学杂志,2002,10(3):218-219.
[12]景璐石,黄颐,司徒明镜,等.汶川大地震后重灾区青少年创伤后应激反应和抑郁情绪的研究[J].中华行为医学与脑科学杂志,2009,18(3):193-195.
[13]侯彩兰,李凌江,贾福军,等.临床用创伤后应激障碍诊断量表[J].中国行为医学科学,2008,17(9):851-852.
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