四川汶川地震安置点灾民急性和创伤后应激症状及相关因素分析
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摘要
目的评估四川汶川地震后第2周转移安置点灾民的急性和创伤后应激症状。方法223名随机抽样地震灾民完成自编调查问卷,用斯坦福急性应激反应问卷(SASRQ)测评的急性应激症状,用创伤后应激障碍(PTSD)症状清单平民版(PCL-C)测评创伤后应激症状。结果①12.9%的被调查者存在自杀观念,46.7%有中度以上的烦扰,61.2%体验到不同程度的绝望,58.1%最糟糕的感觉持续3 d以上。②SASRQ结果显示:急性应激障碍(ASD)阳性率为7.17%,分离症状的69人(30.94%),有创伤再体验症状的98人(43.95%),有回避症状的70人(31.39%),有焦虑或醒觉性增高症状的117人(52.47%)。③PTSD筛查问卷PCL-C结果显示,筛查PTSD阳性29人(13.0%)。最常见的是再体验症状,发生率为77.9%;其次是高警觉症状,发生率为60.8%;回避麻木症状发生率为42.6%。④SASRQ和PCL-C量表均显示:56~65岁灾民均分最高,36~55岁次之。回归分析显示PCL-C总分与绝望感、最糟糕天数、烦扰程度存在回归关系(回归模型方差分析F=91.312,P<0.001)。结论灾民在地震发生后一周存在明显急性和创伤后应激症状。心理干预应减轻焦虑、警觉性增高和创伤再体验症状;尤其要关注中老年人、有绝望感、最糟糕天数多和烦扰程度重的人群。
Objective To investigate the acute stress disorder(ASD) and post-traumatic stress disorder(PTSD) of victims and related factors after Wenchuan Earthquake in temporary settlements.Methods A total of 223 victims in temporary settlements in Jiangyou City of Sichuan Province were randomly selected and interviewed.A self-designed questionnaire,PTSD Checklist-Civilian Version(PCL-C) and Stanford Acute Stress Reaction Questionnaire(SASRQ) were used as assessment instruments.Results ①12.9% of the participants reported suicide ideation;46.7% reported middle degree of disturbing;61.2% experienced different degrees of hopelessness;51.8% reported three or more days experiencing the worst symptoms of distress.② A prevalence of ASD was 7.17%.There were 69 cases(30.94%)with dissociative symptoms,98 cases(43.95%)with re-experiencing trauma,70 cases(31.39%)with avoidance and 117 cases(52.47%)with arousal/anxiety.③ A prevalence of PTSD was 13.0%.The most common PTSD symptom was re-experiencing trauma,with the incidence of 77.9%,followed by the symptom of high alert(60.8%) and avoidance(42.6%).④ People aged 56-65 years showed highest average scores in SASRQ and PCL-C,followed by people aged 35-55 years.The linear regression was performed and "disturbing degree","days experiencing the worst symptoms of distress" and " hopelessness feeling" entered equation(regression model ANOVA F=91.312,P<0.001).Conclusion During the second week after Wenchuan Earthquake,a portion of victims in temporary settlements suffered from serious acute stress symptom and post-traumatic stress symptom.Psychological intervention should pay full attention to alleviate arousal/anxiety,re-experiencing trauma,especially in people aged 35-65 years,and hopelessness feelings,more days experiencing the worst symptoms of distress and higher disturbing degree.
Objective To investigate the acute stress disorder(ASD) and post-traumatic stress disorder(PTSD) of victims and related factors after Wenchuan Earthquake in temporary settlements.Methods A total of 223 victims in temporary settlements in Jiangyou City of Sichuan Province were randomly selected and interviewed.A self-designed questionnaire,PTSD Checklist-Civilian Version(PCL-C) and Stanford Acute Stress Reaction Questionnaire(SASRQ) were used as assessment instruments.Results ①12.9% of the participants reported suicide ideation;46.7% reported middle degree of disturbing;61.2% experienced different degrees of hopelessness;51.8% reported three or more days experiencing the worst symptoms of distress.② A prevalence of ASD was 7.17%.There were 69 cases(30.94%)with dissociative symptoms,98 cases(43.95%)with re-experiencing trauma,70 cases(31.39%)with avoidance and 117 cases(52.47%)with arousal/anxiety.③ A prevalence of PTSD was 13.0%.The most common PTSD symptom was re-experiencing trauma,with the incidence of 77.9%,followed by the symptom of high alert(60.8%) and avoidance(42.6%).④ People aged 56-65 years showed highest average scores in SASRQ and PCL-C,followed by people aged 35-55 years.The linear regression was performed and "disturbing degree","days experiencing the worst symptoms of distress" and " hopelessness feeling" entered equation(regression model ANOVA F=91.312,P<0.001).Conclusion During the second week after Wenchuan Earthquake,a portion of victims in temporary settlements suffered from serious acute stress symptom and post-traumatic stress symptom.Psychological intervention should pay full attention to alleviate arousal/anxiety,re-experiencing trauma,especially in people aged 35-65 years,and hopelessness feelings,more days experiencing the worst symptoms of distress and higher disturbing degree.
引文
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[13]温盛霖,王相兰,陶炯,等.四川江油太平镇安置点北川、平武地震灾民一周后心理症状分析〔J〕.中国神经精神疾病杂志,2008,34(9):525-527.
[2]Mcnally RJ,Bryant RA,Ehlers A.Does early psychological inter-vention promote recovery from posttraumatic stress〔J〕.Psych Sci-ence Public Interest,2003,4(2):45-79
[3]Carde a E,Koopman C,Classen C,et al.Psychometric proper-ties of the Stanford Acute Stress Reaction Questionnaire(SAS-RQ):a valid and reliable measure of acute stress〔J〕.J TraumaStress,2000,13(4):719-734.
[4]Blanchard EB,Jones-alexander J,Buckley TC,et al.Psychomet-ric properties of the PTSD checklist(PCL)〔J〕.Behav Res Ther,1996,34(8):669-673.
[5]庞天鉴,译.DSM-分类与诊断标准〔S〕.美国精神科学会,2001:170-172.
[6]Demir T,Demir DE,Alkas L.Some clinical characteristics ofchildren who survived the Marmara earthquakes〔J〕.Eur ChildAdolesc Psychiatry,2009(1):12-16.
[7]Staab JP,Grieger TA,Fullerton CS,et al.Acute stress disorder,subsequent posttraumatic stress disorder and depression after a se-ries of typhoons〔J〕.Anxiety,1996,2(5):219-225.
[8]McKibben JB,Bresnick MG,Wiechman Askay SA,et al.Acutestress disorder and posttraumatic stress disorder:a prospective studyof prevalence,course,and predictors in a sample with major burninjuries〔J〕.J Burn Care Res,2008,29(1):22-35.
[9]Jordan NN,Hoge CW,Tobler SK,et al.Mental health impact of9/11 Pentagon attack:validation of a rapid assessment tool〔J〕.Am J Prev Med,2004,26(4):284-293.
[10]Ehlers A,Clark DM,Hackmann A,et al.Arandomized controlledtrial of cognitive therapy,a self-help booklet,and repeated as-sessments as early interventions for posttraumatic stress disorder〔J〕.Arch Gen Psychiat,2003,60(10):1024-1032.
[11]唐宏宇,郭延庆,译.Oxford Handbook of Psychiatry〔M〕.北京:人民卫生出版社,2006:305-315.
[12]Chen CH,Tan HK,Liao LR,et al.Long-termpsychological out-come of 1999 Taiwan earthquake survivors:a survey of a high-risksample with property damage〔J〕.Compr Psychiatry,2007,48(3):269-275.
[13]温盛霖,王相兰,陶炯,等.四川江油太平镇安置点北川、平武地震灾民一周后心理症状分析〔J〕.中国神经精神疾病杂志,2008,34(9):525-527.
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