地震现场救援军人吸烟与创伤后应激障碍的相关性
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摘要
目的:了解吸烟与创伤暴露、创伤后应激障碍(PTSD)之间的关系。方法:共1125名地震现场救援军人在四川汶川地震6个月后纳入调查。调查工具包括一般人口学资料、Davidson创伤量表(DTS)及烟草依赖情况调查表。结果:实查1056人,共检出PTSD患者69例,PTSD患病率6.53%。调查发现:①PTSD组吸烟率76.81%(53例)显著高于非PTSD组吸烟率59.98%(592例)(χ2=7.686,P=0.009),吸烟为PTSD发生的危险因素(OR=2.210,95%CI=1.252～3.901);②创伤暴露未对吸烟产生不利影响,而PTSD对吸烟有显著影响。PTSD与非PTSD相比较,PTSD可增加创伤暴露后初始吸烟的危险性(χ2=4.394,P=0.036)和吸烟量增多(χ2=17.127,P=0.000);③多元Logistic回归分析表明,军龄长、服役满意度低、创伤暴露后患PTSD、DTS评分高以及地震经历总分高等因素是地震现场救援军人创伤暴露后吸烟行为增加的显著危险因素。结论:创伤暴露对吸烟无明显影响。吸烟主要与PTSD有关,吸烟会增加创伤暴露后产生PTSD的危险,而患PTSD后又会增加吸烟的危险。
Objective:To study the association between smoking and trauma exposure as well as post traumatic stress disorder(PTSD).Method:1 125 rescue soldiers in earthquake spots were enrolled in the investigation after 6 months of earthquake in Wenchuan,Sichuan province.The investigation tools included general demography data,Davidson trauma scale(DTS) and nicotine dependence screening scale.Results:The final subjects were 1 056,with 69 patients suffered from PTSD and the incidence of PTSD 6.53%.The results of the investigation showed that smoking rate in PTSD group(n=53) was obviously higher than in non-PTSD group(n=592)76.81% vs 59.98%(χ2=7.686,P=0.009).Smoking was a risk factor for the onset of PTSD(OR=2.210,95%CI=1.252~3.901).Trauma exposure didn't have unfavorable effect on smoking.However,PTSD had significant influence on smoking.Compared with non-PTSD,PTSD can increase the risk of smoking beginning and the smoking amounts after trauma exposure(χ2=4.394,P=0.036;χ2=17.127,P=0.000).According to the Logistic regression multianalysis,the obvious risk factors for smoking increase in rescue soldiers in earthquake spots were longer duration in military,lower satisfaction for service in military,PTSD suffered from trauma exposure,higher score in DTS and higher score in earthquake experience.Conclusion:There was no significant influence of trauma exposure on smoking.Smoking was mainly related to PTSD.Smoking can increase the risk of suffering from the onset of PTSD,and vice versa.
Objective:To study the association between smoking and trauma exposure as well as post traumatic stress disorder(PTSD).Method:1 125 rescue soldiers in earthquake spots were enrolled in the investigation after 6 months of earthquake in Wenchuan,Sichuan province.The investigation tools included general demography data,Davidson trauma scale(DTS) and nicotine dependence screening scale.Results:The final subjects were 1 056,with 69 patients suffered from PTSD and the incidence of PTSD 6.53%.The results of the investigation showed that smoking rate in PTSD group(n=53) was obviously higher than in non-PTSD group(n=592)76.81% vs 59.98%(χ2=7.686,P=0.009).Smoking was a risk factor for the onset of PTSD(OR=2.210,95%CI=1.252~3.901).Trauma exposure didn't have unfavorable effect on smoking.However,PTSD had significant influence on smoking.Compared with non-PTSD,PTSD can increase the risk of smoking beginning and the smoking amounts after trauma exposure(χ2=4.394,P=0.036;χ2=17.127,P=0.000).According to the Logistic regression multianalysis,the obvious risk factors for smoking increase in rescue soldiers in earthquake spots were longer duration in military,lower satisfaction for service in military,PTSD suffered from trauma exposure,higher score in DTS and higher score in earthquake experience.Conclusion:There was no significant influence of trauma exposure on smoking.Smoking was mainly related to PTSD.Smoking can increase the risk of suffering from the onset of PTSD,and vice versa.
引文
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[2]Koenen KC,Hitsman B,Lyons MJ,et al.A twin registry study of the relationship between posttraumatic stress disorder and nicotine dependence in men[J].Arch Gen Psychiatry,2005,62:1258.
[3]Fu SS,McFall M,Saxon AJ,et al.Post-traumatic stress disorder and smoking:a systematic review[J].Nicotine Tob Res,2007,9:1071.
[4]Feldner MT,Babson KA,Zvolensky MJ.Smoking,traumatic event exposure,and post-traumatic stress disorder:A critical review of the empirical literature[J].Clinical Psychology Review,2007,27:14.
[5]Nandi A,Galea S,Ahern J,et al.Probable cigarette dependence,PTSD,and depression after an urban disaster:results from a population survey of New York City residents4months after September 11,2001[J].Psychiatry,2005,68:311.
[6]Hapke U,Schumann A,Rumpf HJ,et al.Association of smoking and nicotine dependence with trauma and posttraumatic stress disorder in a general population sample[J].J Nerv Ment Dis,2005,193:843.
[7]Amstadter AB,Nuqent NR,Koenen KC.Association between COMT,PTSD,and increased smoking following hurricane exposure in an epidemiologic sample[J].Psychiatry,2009,72:360.
[8]Parslow RA,Jorm AF.Tobacco use after experiencing a major natural disaster:analysis of a longitudinal study of2063young adults[J].Addiction,2006,101:1044.
[9]Cook J,Jakupcak M,Rosenheck R,et al.Influence of PTSD symptom cluster on smoking status among help-seeking Iraq and Afghanistan veterans[J].Nicotine Tob Res,2009,11:1189.
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