汶川地震救援军人创伤后应激障碍两年随访及影响因素分析
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摘要
目的跟踪研究"5.12"汶川地震救援军人创伤后应激障碍(PTSD)的发生率及病程转归,分析PTSD相关危险因素。方法采用流行病学调查初筛与精神科临床确诊相结合的方法,于震后半年随机整群抽样1024名军人,使用自编救援经历量表(REQ)、急性应激状况调查表(SRQ-20)及PTSD筛查量表(PCL-C)进行初筛,由精神科医师依据DSM-Ⅳ轴Ⅰ障碍用临床定式检查(SCID-Ⅰ)对初筛结果高于划界分者进行一对一晤谈确定诊断,并对其中470名军人连续随访2年。结果 6个月时点确诊PTSD患者35例,患病率为3.42%,其中56.25%在24个月仍未痊愈;24个月时点随访,PTSD患病率为2.13%,其中90%为6个月时已确诊PTSD患者;以是否患PTSD为因变量,进行多重Logistic回归分析,进入方程变量为急性应激障碍(ASD),现场搜救、处理遗体等重任务,PCL-C总分,SDS总分,救援经历和任务对自己心理的影响等7个因素。结论 "5.12"抗震救援军事人员PTSD患病率较平时PTSD患病率显著增高,病程迁延且自然缓解率低,应当在充分关注同时加强心理干预与对症治疗。本研究还探讨了PTSD相关危险因素,为今后构建军人心理应激损伤防护策略提供了科学依据。
Objective To investigate the prevalence and related impact factors of post-traumatic stress disorder(PTSD)among military rescuers 6 months after "5·12" Wenchuan earthquake.Methods All the 1024 military rescuers were assessed by the rescue experience questionaire(REQ),self-report questionaire-20(SRQ-20) and PTSD checklist-civilian version(PCL-C) as preliminary screening.Clinical interviews were used to make a definite diagnosis by psychiatrists according to structured clinical interview Ⅰfor DSM-Ⅳ(SCID-Ⅰ).A total of 470 rescuers were surveyed over a two-year follow-up period.Results The prevalence of PTSD was 3.42% at 6 months and 2.13% at 24 months after the earthquake.A total of 9(56.23%) of the original 16 PTSD subjects were identified as PTSD at the two-year post-earthquake follow-up.Logistic regression analysis showed that ASD,rescue missons,PCL-C score,SDS score and effect on one's psychology et al were the impact factors of PTSD.Conclusion The prevalence of PTSD among the rescuers is significantly increased than in normal situations.The course of disease is relatively long and the remission rate is relatively low.The result of the present study shows significant predictors of PTSD,contributing to psychological protection and crisis intervention.
Objective To investigate the prevalence and related impact factors of post-traumatic stress disorder(PTSD)among military rescuers 6 months after "5·12" Wenchuan earthquake.Methods All the 1024 military rescuers were assessed by the rescue experience questionaire(REQ),self-report questionaire-20(SRQ-20) and PTSD checklist-civilian version(PCL-C) as preliminary screening.Clinical interviews were used to make a definite diagnosis by psychiatrists according to structured clinical interview Ⅰfor DSM-Ⅳ(SCID-Ⅰ).A total of 470 rescuers were surveyed over a two-year follow-up period.Results The prevalence of PTSD was 3.42% at 6 months and 2.13% at 24 months after the earthquake.A total of 9(56.23%) of the original 16 PTSD subjects were identified as PTSD at the two-year post-earthquake follow-up.Logistic regression analysis showed that ASD,rescue missons,PCL-C score,SDS score and effect on one's psychology et al were the impact factors of PTSD.Conclusion The prevalence of PTSD among the rescuers is significantly increased than in normal situations.The course of disease is relatively long and the remission rate is relatively low.The result of the present study shows significant predictors of PTSD,contributing to psychological protection and crisis intervention.
引文
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[20]栗克清,崔泽,崔利军,等.河北省精神障碍的现况调查[J].中华精神科杂志,2007,40(1):36-40.
[21]贺岭峰,高旭辰,田彬.军事心理学:临床与作战中的应用[M].上海:华东师范大学出版社,2008:185.
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[24]Breslau N,Kessler RC,Chilcoat HD,et al.Trauma and posttrau-matic stress disorder in the community:the 1996 Detroit area sur-vey of trauma[J].Arch Gen Psychiatry,1998,55(7):626-632.
[25]李洁.灾害与精神卫生问题[J].临床精神医学杂志,2009,19(1):59.
[26]陈文军,浦金辉,徐志鹏,等.地震救援部队早期心理状况分析[J].华南国防医学杂志,2008,22(6):38-40.
[27]沈兴华,黄俊龙,刘伟志,等.茂县城区百姓与救灾部队震后7～9周创伤后应激障碍症状比较[J].中国健康心理学杂志,2009,17(9):1136-1138.
[28]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.
[2]Naira Y,Nandi A,Galea S.Post-traumatic stress disorder follow-ing disasters:a systematic review[J].Psychol Med,2008,38(4):467-480.
[3]刘爱忠,谭红专.洪灾区儿童创伤性应激障碍的流行病学研究[J].中国公共卫生,2003,19(4):447.
[4]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.
[5]张本,张凤阁,王丽萍,等.30年后唐山地震所致孤儿创伤后应激障碍现患率调查[J].中国心理卫生杂志,2008,22(6):469-473.
[6]Galea S,Nandi A,Vlahov D.The epidemiology of post-traumaticstress disorder after disasters[J].Epidemiol Rev,2005,27(1):78-91.
[7]惠武利,施旺红,徐德忠,等.烟台海难援救军人PTSD发生的影响因素分析[J].中国心理卫生杂志,2001,15(3):148-149.
[8]张克让,徐勇杨.SARS患者、医务人员及疫区公众创伤后应激障碍的调查研究[J].中国行为医学科学,2006,15(4):358.
[9]Beusenberg M,Orleg J.A user's guide to the self reporting ques-tionnaire(SRQ)[M].Geneva,Switzerland:Division of MentalHealth World Health Organization,1994:26-27.
[10]杨晓云,杨宏爱,徐德忠,等.创伤后应激检查量表平民版的效度、信度及影响因素的研究[J].中国健康心理学杂志,2007,15(1):6-9.
[11]Mueser KT,Salyers MP,Rosenberg SD,et al.Psychometric eval-uation of trauma and posttraumatic stress disorder assessments inpersons with severe mental illness[J].Psychol Assess,2001,13(1):110-117.
[12]胡光涛,李学成,李敏,等.汶川地震1周年救援官兵心理应激状况及危险因素分析[J].第三军医大学学报,2010,32(6):607-610.
[13]Wang H,Jin H,Nunnink SE,et al.Identification of posttraumat-ic stress disorder and risk factors in military first responders 6months after Wen Chuan earthquake in China[J].J Affect Disor-der,2011,130(2):213-219.
[14]刘庆峰,郭小朝,苏芳,等.地震救援军人创伤后应激症状发生的相关因素[J].中国心理卫生杂志,2009,23(7):484-486.
[15]安飞,王家同.汶川地震救援军人创伤后应激障碍发生与人格特征的相关研究[J].第四军医大学学报,2009,30(24):3169-3172.
[16]许爱萍,孙丽云,曾光,等.某部地震救援人员创伤后心理应激障碍调查[J].人民军医,2009,52(4):195-196.
[17]覃家浪,李春祥.汶川大地震中530名救援官兵的心理状况分析及对策[J].广西医学,2009,31(5):726-727.
[18]Kang HK,Natelson BH,Mahan CM,et al.Post-traumatic stress dis-order and chronic fatigue syndrome-like illness among Gulf War vet-eran:a population-based survey of 30 000 veterans[J].J Epidemi-ol,2003,157(1):141-148.
[19]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病学调查[J].中华神经科杂志,1996,29(2):69-72.
[20]栗克清,崔泽,崔利军,等.河北省精神障碍的现况调查[J].中华精神科杂志,2007,40(1):36-40.
[21]贺岭峰,高旭辰,田彬.军事心理学:临床与作战中的应用[M].上海:华东师范大学出版社,2008:185.
[22]Breslau N,Davis GC,Peterson EL,et al.A second look at comor-bidity in victims of trauma:the posttraumatic stress disorder majordepression connection[J].Biol Psychiatry,2000,48(9):902-909.
[23]Kessler RC,Sonnega A,Bromet E,et al.Posttraumatic stress dis-order in the national comorbidity survey[J].Arch Gen Psychiatry,1995,52(12):1048-1060.
[24]Breslau N,Kessler RC,Chilcoat HD,et al.Trauma and posttrau-matic stress disorder in the community:the 1996 Detroit area sur-vey of trauma[J].Arch Gen Psychiatry,1998,55(7):626-632.
[25]李洁.灾害与精神卫生问题[J].临床精神医学杂志,2009,19(1):59.
[26]陈文军,浦金辉,徐志鹏,等.地震救援部队早期心理状况分析[J].华南国防医学杂志,2008,22(6):38-40.
[27]沈兴华,黄俊龙,刘伟志,等.茂县城区百姓与救灾部队震后7～9周创伤后应激障碍症状比较[J].中国健康心理学杂志,2009,17(9):1136-1138.
[28]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.
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