地震灾后转移伤员的创伤后应激障碍的发生及其影响因素
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摘要
目的:调查汶川地震灾后转移伤员的创伤后应激障碍的发生及其影响因素。方法:采用PTSD症状自评(PTSD Checklist-Civilian Version,PCL-C)和DSM-IV-TR轴I障碍用临床定式检查(Structured Clin-ical Interviewfor DSM-IV-TR Axis Ⅰ Disorders-Patient,SCID-I/P)进行诊断,在地震灾后40天对按照多级整群抽样方法抽取转移到重庆市11所医院的386名伤员进行调查,回收有效问卷354份,分析影响创伤后应激障碍(Post Trau matic Stress Disorder,PTSD)发生的相关因素。结果:354名转移伤员中共检出PTSD患者82例,检出率为23.2%,其中男性27例(17.5%),女性55例(27.5%)。女性的检出率明显高于男性,差异有统计学意义。多因素logistic回归分析显示其主要影响因素是女性(OR=2.364,95%CI:1.159～4.823),地震中被掩埋(OR=2.171,95%CI:1.088～4.333),目睹有人在地震中受伤(OR=0.338,95%CI:0.150～0.761)。结论:经历地震灾后被转移到重庆的伤员中有近1/4的灾民存在PTSD症状。其中女性、被掩埋等暴露因素是PTSD发生的危险因素。
Objective:To investigate the occurrence of post traumatic stress disorder and its related factors in the transfer of wounded persons ofter Wenchuan earthquake.Methods:With the post traumatic stress disorder symptoms self-assessment scale(PTSD Chaklist-Civilian Version PCL-C) and Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient(SCID-I/P) as diagnostic tools,386 wounded persons from 11 hospitals who were transferred to Chongqing were extracted 40 days after disaster by multi-stage cluster sampling method.Altogether 354 valid questionnaires were returned to analyze the related factors of post traumatic stress disorder(PTSD).Results: Among 354(154 males,200 females) transferred patients,82 patients(23.2%) were identified as PTSD,including 27 males(17.5 %) and 55 females(27.5%).The rate of females was statistically higher than that of males.Logistic regression analysis showed that gender(OR=2.364,95%CI=1.159~4.823),being buried in the quake(OR=2.171,95%CI=1.088~4.333),and seeing people be injured in the quake(OR=0.338,95%CI=0.150~0.761) were the main related factors.Conclusion:PTSD symptoms are detected among a quarter of the victims who have been transferred to Chongqing after the earthquake.Several factors such as female,being buried are the possible risk factors of PTSD.
Objective:To investigate the occurrence of post traumatic stress disorder and its related factors in the transfer of wounded persons ofter Wenchuan earthquake.Methods:With the post traumatic stress disorder symptoms self-assessment scale(PTSD Chaklist-Civilian Version PCL-C) and Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient(SCID-I/P) as diagnostic tools,386 wounded persons from 11 hospitals who were transferred to Chongqing were extracted 40 days after disaster by multi-stage cluster sampling method.Altogether 354 valid questionnaires were returned to analyze the related factors of post traumatic stress disorder(PTSD).Results: Among 354(154 males,200 females) transferred patients,82 patients(23.2%) were identified as PTSD,including 27 males(17.5 %) and 55 females(27.5%).The rate of females was statistically higher than that of males.Logistic regression analysis showed that gender(OR=2.364,95%CI=1.159~4.823),being buried in the quake(OR=2.171,95%CI=1.088~4.333),and seeing people be injured in the quake(OR=0.338,95%CI=0.150~0.761) were the main related factors.Conclusion:PTSD symptoms are detected among a quarter of the victims who have been transferred to Chongqing after the earthquake.Several factors such as female,being buried are the possible risk factors of PTSD.
引文
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[17]刘兵,陈建红,李映章,等.广州大学生对急性传染性非典型肺炎认知状况调查[J].中国神经精神疾病杂志,2004,3O(3):225.
[18]Wang XD,Gao L,Shinfuku N,et a1.Long itudinal studyof earthquake.related PTSD in a randomly selected commu-nity sample in north China[J].Am J Psychiatry,2000,157:1260-1266.
[19]赵丞智,李俊福,王明山,等.地震后17个月受灾青少年PTSD及其相关因素[J].中国心理卫生杂志,2001,15(3):145-147.
[20]Green BL,Lindy JD,Grace MC,et a1.Chronic post trau-matic stress disorder and diagnostic CO morbidity in a disas-ter sample[J].J Nerv Ment Dis,1992,180(6):760.
[21]Mecke V.Two years later the prolonged traumatic impact offire disaster[J].Arch Gen Psychiatry,1990,47(12):1032.
[22]陈树林,高雪屏,李凌江,等.PTSD症状自评量表的信效度初步评价[J].中国心理卫生杂志,2005,l9(6):373-376.
[23]First MB,Gibbon M,Spitzer RL,et al.Structured clinicalinterview for DSM-IV axis disorders[M].成都:四川大学精神卫生中心,2001:78-85.
[24]Walker EA,Newman E,Dobie DJ,et al.Validation of thePTSD checklist in an HMO sample of women[J].2002,24(6):365-380.
[25]汪向东,赵丞智,新福尚隆,等.震后创伤性应激障碍的发生率及影响因素[J].中国心理卫生杂志,1999,13(1):28-30.
[26]Kessler HS,Kilpatrick DG,Dansky BS,et a1.Posttraum-atic stress disorder in the national CO morbidity survey[J].Arch Gen Psychiatry,1995,52(12):1048.
[27]Breslau N.Outcomes of posttraumatic stress disorder[J].J Clin Psychiatry,2001,62(suppl 17):55-59.
[28]伍志刚,刘爱忠,谭红专,等.洪灾区成人PTSD及其危险因素的研究[J].中国临床心理学杂志,2003,11(3):173-175.
[29]张本,王学义,孙贺祥,等.唐山大地震心理创伤后应激障碍的抽样调查研究.中华精神科杂志,1999,32(2):106-108.
[30]姜佐宁.现代精神病学[M].第2版.北京:科学出版社,2004:455-461.
[31]Resnick HS,Kilpatric DG,Dansky BS,et a1.Prevalenceof civilian trauma and posttraumatic stress disorder in a rep-resentational national sample of women[J].J Cons ClinPsychol,1993,61:984-991.
[32]Murray J,Kelly B,Raphael B,et al.Psychological respon-ses to malignant melanoma:an investigation of traumaticstress reactions to life-threatening illness[J].Gen HospPsychiatry,1995,7:126-134.
[33]Perrin MA,DiGrande L,Wheeler K,et al.Differences inPTSD Prevalence and Associated Risk Factors Among WorldTrade Center Disaster Rescue and Recovery Workers[J].Am J Psychiatry,2007,164:1385-1394.
[2]Fullerton CS,Ursano RJ,Wang L.Acute stress disorder,posttraumatic.stress disorder,and depression in disaster orrescue workers[J].Am J Psychiatry,2004,161:1370-1376.
[3]Epstein RS,Fullerton CS,Ursano RJ.Posttraumatic stressdisorder following an air disaster:a prospective study[J].Am J Psychiatry,1998,155:934-938.
[4]Ozen S,Aytekin S.Frequency of PTSD in a group of searchand rescue workers two months after 2003 Bingol(Turkey)earthquake[J].J Nerv Ment Dis,2004,192:573-575.
[5]Guo U,Chen C,Lu M,et al.Posttraumatic stress disorderamong professional and non-professional rescuers involved inan earthquake in Taiwan[J].Psychiatry Res,2004,127:35-41.
[6]North CS,Tivis L,McMillen JC,et al.Psychiatric disor-ders in rescue workers after the Oklahoma City bombing[J].Am J Psychiatry,2002,159:857-859.
[7]Chang C,Lee L,Connor KM,et al.Posttraumatic distressand coping strategies among rescue workers after an earth-quake[J].J Nerv Ment Dis,2003,191:391-398.
[8]Marmar CR,Weiss DS,Metzler TJ,et al.Stress responsesof emergency services personnel to the Loma Prieta earth-quake interstate 880 freeway collapse and control traumaticincidents[J].J Trauma Stress,1996,9:63-85.
[9]Dyregrov A,Kristoffersen JI,Gjestad R.Voluntary and pro-fessional disaster-workers:similarities and differences in re-actions[J].J Trauma Stress,1996,9:541-555.
[10]Fullerton CS,Ursano RJ,Reeves J,et al.Perceived safetyin disaster workers following 9/11[J].J Nerv Ment Dis,2006,194:61-63.
[11]Smith RP,Katz CL,Holmes A,et al.Mental health statusof World Trade Center rescue and recovery workers and vol-unteers-New York City,July2002-Aug2004[J].MMWR2004,53:812-815.
[12]Johnson SB,Langlieb AM,Teret SP,et al.Rethinking firstresponse:ffects of the clean up and recovery effort on work-ers at the World Trade Center disaster site[J].J OccupEnviron Med,2005,47:386-391.
[13]周建初,金初林,张世奎,等.巫溪县岩崩、吊桥事件后精神反应调查报告[J].中国心理卫生杂志,1988,2(2):72.
[14]何鸣,吴仁刚,章晓冬,等.翻车事故幸存者中精神创伤后应激障碍[J].中国心理卫生杂志,1993,7(4):148-151.
[15]陈新华,彭化生,朱明.洪涝灾害事件与脑血管疾病发病关系研究.中国神经精神疾病杂志,2001,27(3):217.
[16]刘光雄,杨来启,许向东,等.车祸事件后创伤后应激障碍的研究[J].中国心理卫生杂志,2002,16(1):18.
[17]刘兵,陈建红,李映章,等.广州大学生对急性传染性非典型肺炎认知状况调查[J].中国神经精神疾病杂志,2004,3O(3):225.
[18]Wang XD,Gao L,Shinfuku N,et a1.Long itudinal studyof earthquake.related PTSD in a randomly selected commu-nity sample in north China[J].Am J Psychiatry,2000,157:1260-1266.
[19]赵丞智,李俊福,王明山,等.地震后17个月受灾青少年PTSD及其相关因素[J].中国心理卫生杂志,2001,15(3):145-147.
[20]Green BL,Lindy JD,Grace MC,et a1.Chronic post trau-matic stress disorder and diagnostic CO morbidity in a disas-ter sample[J].J Nerv Ment Dis,1992,180(6):760.
[21]Mecke V.Two years later the prolonged traumatic impact offire disaster[J].Arch Gen Psychiatry,1990,47(12):1032.
[22]陈树林,高雪屏,李凌江,等.PTSD症状自评量表的信效度初步评价[J].中国心理卫生杂志,2005,l9(6):373-376.
[23]First MB,Gibbon M,Spitzer RL,et al.Structured clinicalinterview for DSM-IV axis disorders[M].成都:四川大学精神卫生中心,2001:78-85.
[24]Walker EA,Newman E,Dobie DJ,et al.Validation of thePTSD checklist in an HMO sample of women[J].2002,24(6):365-380.
[25]汪向东,赵丞智,新福尚隆,等.震后创伤性应激障碍的发生率及影响因素[J].中国心理卫生杂志,1999,13(1):28-30.
[26]Kessler HS,Kilpatrick DG,Dansky BS,et a1.Posttraum-atic stress disorder in the national CO morbidity survey[J].Arch Gen Psychiatry,1995,52(12):1048.
[27]Breslau N.Outcomes of posttraumatic stress disorder[J].J Clin Psychiatry,2001,62(suppl 17):55-59.
[28]伍志刚,刘爱忠,谭红专,等.洪灾区成人PTSD及其危险因素的研究[J].中国临床心理学杂志,2003,11(3):173-175.
[29]张本,王学义,孙贺祥,等.唐山大地震心理创伤后应激障碍的抽样调查研究.中华精神科杂志,1999,32(2):106-108.
[30]姜佐宁.现代精神病学[M].第2版.北京:科学出版社,2004:455-461.
[31]Resnick HS,Kilpatric DG,Dansky BS,et a1.Prevalenceof civilian trauma and posttraumatic stress disorder in a rep-resentational national sample of women[J].J Cons ClinPsychol,1993,61:984-991.
[32]Murray J,Kelly B,Raphael B,et al.Psychological respon-ses to malignant melanoma:an investigation of traumaticstress reactions to life-threatening illness[J].Gen HospPsychiatry,1995,7:126-134.
[33]Perrin MA,DiGrande L,Wheeler K,et al.Differences inPTSD Prevalence and Associated Risk Factors Among WorldTrade Center Disaster Rescue and Recovery Workers[J].Am J Psychiatry,2007,164:1385-1394.
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