震区医务工作者半年后创伤后应激障碍发病情况研究
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摘要
目的:调查5.12地震后半年震区医务工作者的创伤后应激障碍(PTSD)发病率、症状特点及影响因素。方法:地震后半年,应用德国埃森创伤问卷(ETI)对四川什邡地区各医院一线医务工作者进行调查,总结医务工作者PTSD的发病率及各症状群特点,并考察各因素对PTSD的影响。结果:①所调查群体PTSD发病率为5.50%。因创伤性事件引起的情绪困扰最严重。②PTSD特征性症状群中,高激惹症状最突出。女性PTSD总分与男性无显著差别,但高激惹症状群和睡眠问题得分显著高于男性。③根据被试的工作地区将总被试群体分为高暴露组和低暴露组,高暴露组PTSD总分和所有特征症状得分均较低暴露组高,且其闯入症状较低暴露组更突出。④应用一般线性模型进行多因素方差分析显示,所考察的7个变量中,创伤负荷、高/低暴露组及独生/非独生对PTSD症状得分主效应显著。性别的主效应不显著,但与独生/非独生因素的交互效应显著。结论:震区医务工作者PTSD最突出的症状是高激惹症状。初始暴露程度不同对闯入症状的影响最明显。创伤负荷高,初始暴露程度重,来自多子女家庭的女性,都是PTSD发病的危险因素。
Objective:To investigate the incidence rate,characteristics of the symptoms and influencing factors of the posttraumatic stress disorder (PTSD) among medical staff at half a year after the Wenchuan Earthquake. Methods: A cross-section survey was administered among the medical personnels working in the earthquake region at 6 months following the earthquake. Special attentions were paid not only to the incidence rate of PTSD,but also to the characteristics of the symptom clusters. Influencing factors were examined in terms of their impact on the severity of PTSD. Results: The incidence rate was 5.50%. Among all the 23 symptoms,emotional upset was the most prominent one. Out of the four symptom clusters,hyper-arousal was the most complained one. Women were more likely to suffer hyper-arousal and sleeping disorders than men,although there was no significant difference between both genders in the total PTSD score. The "higher exposure" and "lower exposure" groups were defined according to the distance to the epicenter. The former one had higher scores in PTSD total score and symptom scores,while intrusive symptom clusters were the most influencing one. The applied General Linear Model (GLM) of the Analysis of Variance showed that 3 out of 7 factors had significant main effects to the PTSD score: traumatic load,higher/lower exposure,and siblings. Further,an interaction effect of siblings and genders contributed to the PTSD score significantly although genders showed no significant main effect individually. Conclusion: Among medical staff in the earthquake region,hyper-arousal is the most prominent symptom cluster. Different degree of initial exposure has a substantial influence on the cluster of intrusive symptoms. Higher traumatic load,higher initial exposure,and women from the multiple-child family are the risk factors of PTSD in the sample.
Objective:To investigate the incidence rate,characteristics of the symptoms and influencing factors of the posttraumatic stress disorder (PTSD) among medical staff at half a year after the Wenchuan Earthquake. Methods: A cross-section survey was administered among the medical personnels working in the earthquake region at 6 months following the earthquake. Special attentions were paid not only to the incidence rate of PTSD,but also to the characteristics of the symptom clusters. Influencing factors were examined in terms of their impact on the severity of PTSD. Results: The incidence rate was 5.50%. Among all the 23 symptoms,emotional upset was the most prominent one. Out of the four symptom clusters,hyper-arousal was the most complained one. Women were more likely to suffer hyper-arousal and sleeping disorders than men,although there was no significant difference between both genders in the total PTSD score. The "higher exposure" and "lower exposure" groups were defined according to the distance to the epicenter. The former one had higher scores in PTSD total score and symptom scores,while intrusive symptom clusters were the most influencing one. The applied General Linear Model (GLM) of the Analysis of Variance showed that 3 out of 7 factors had significant main effects to the PTSD score: traumatic load,higher/lower exposure,and siblings. Further,an interaction effect of siblings and genders contributed to the PTSD score significantly although genders showed no significant main effect individually. Conclusion: Among medical staff in the earthquake region,hyper-arousal is the most prominent symptom cluster. Different degree of initial exposure has a substantial influence on the cluster of intrusive symptoms. Higher traumatic load,higher initial exposure,and women from the multiple-child family are the risk factors of PTSD in the sample.
引文
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[11]Alden LE,Regambal MJ,Laposa J M.The Effects of Direct Versus Witnessed Threat on Emergency Depart ment Healthcare Workers:I mplications for PTSD Criterion A[J].J Anxiety Disord(S0887-6185),2008,22(8):1337-1346.
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[14]王玉龙,谢伟,杨智辉,等.PTSD在中国的研究进展[J].应用心理学,2005,11(2):176-180.
[15]Bernard-Bonnin AC,Hbert M,Daignault IV,et al.Disclosure of Sexual Abuse,and Personal and Familial Factors as Predictors of Post-trau-matic Stress Disorder Symptoms in School-aged Girls[J].Paediatr Child Health(S1205-7088),2008,13(6):479-486.
[2]Figley C.R.Secondary Traumatic Stress:Self-care Issues for Clinicians,Researchers,and Ed-ucators[M].Second Edition.Balti more:The Sidran Press,1999:3-28.
[3]Jonsson A,Segesten K,Mattsson B.Post-traumatic Stress among Swedish Ambulance Personnel[J].Emerg Med J(S1472-0205),2003,20(1):79-84.
[4]Weinige CF,Shalev AY,Ofek H,et al.Postt-raumatic Stress Disorder among Hospital Surgi-cal Physicians Exposedto Victi ms of Terror:A Prospective,Controlled Questionnaire Survey[J].J Clin Psychaitry(S0160-6689),2006,67(6):890-896.
[5]Tagay S,Eri m Y,Stoelk B,et al.Das Essener Trauma-Inventar(ETI)-Ein Screeninginstru-ment Zur Identifikation Traumatischer Er-eignisse und Posttraumatischer St rungen[J].Zeitschrift fr Psychotraumato-logie,Psycho-therapiewissenschaft,Psychologische Medizin,2007,1:75-89.
[6]周娟,周肖榕,李航,等.埃森创伤问卷中文版的信、效度研究[J].中华物理医学与康复杂,2010,32(2):121-124.
[7]Wu P,Fang Y,Guan Z,et al.The Psychologi-cal Impact of the SARS Epidemic on Hospital Employees in China:Exposure,Risk Percep-tion,and Altruistic Acceptance of Risk[J].Can J Psychiatry(S0706-7437),2009,54(5):302-311.
[8]Koren D,Caspi Y,Leiba R,et al.Acute Stress Reactions among Medical and Non-medical Per-sonnel in a General Hospital Under Missile At-tacks[J].Depression Anxiety,2009,26(2):123-128.
[9]赵丞智,汪向东,高岚,等.张北尚义地震后创伤后应激障碍随访研究[J].中国心理卫生杂志,2000,14(6):361-363.
[10]徐唯,宋瑛,梁爱民,等.特大爆炸事故幸存者创伤后应激障碍的初步研究[J].中国心理卫生杂志,2003,17(9):603-606.
[11]Alden LE,Regambal MJ,Laposa J M.The Effects of Direct Versus Witnessed Threat on Emergency Depart ment Healthcare Workers:I mplications for PTSD Criterion A[J].J Anxiety Disord(S0887-6185),2008,22(8):1337-1346.
[12]潘晓鸥,仇剑蓥.创伤后应激谱系障碍[J].上海精神医学,2006,8(5):300-301,318.
[13]汪向东,姜经纬.创伤后应激障碍的流行病学特点及危险因素[J].中华流行病学杂志,2002,10(23):334-337.
[14]王玉龙,谢伟,杨智辉,等.PTSD在中国的研究进展[J].应用心理学,2005,11(2):176-180.
[15]Bernard-Bonnin AC,Hbert M,Daignault IV,et al.Disclosure of Sexual Abuse,and Personal and Familial Factors as Predictors of Post-trau-matic Stress Disorder Symptoms in School-aged Girls[J].Paediatr Child Health(S1205-7088),2008,13(6):479-486.
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