汶川地震灾民创伤后应激反应的影响因素分析
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摘要
目的调查地震灾民创伤后应激反应的影响因素。方法汶川地震后第12天开始调查337名灾民的人口学背景、受灾情况等,应用创伤后应激反应筛查表(PTSS20)进行心理评估。采用非参数检验和多元线性回归等筛出应激反应的影响因素。结果从PTSS20总分来看,女性比男性高;青、中年组比儿童或青少年组高;视听觉刺激极重组比中度组及无刺激组高;有亲人死亡组比无亲人死亡组高;调查时间30 d以上组比15 d及以下组或16～30 d组高(均有显著差异);以PTSS20总分为因变量进行逐步回归,性别、调查时间、对领导救灾满意度、亲人死亡、家庭关系、年龄进入回归方程。结论女性、青中年、有亲人死亡者、视听觉刺激极重者、受重伤者是危机干预的重点对象。调查时间在30 d以上、对领导救灾满意度低、家庭关系差是创伤后应激反应的危险因素。
Objective To examine the influencing factors of post-traumatic stress reaction in earthquake victims in Wenchuan.Methods337 Wenchuan earthquake victims were investigated about their demographic backgrounds,stricken conditions and were assessed with the post-traumatic stress reaction screening scale(PTSS20) from the 12th day after the earthquake.Non-parametric test and multiple linear regression were used to explore the influencing factors of post-traumatic stress reaction.ResultsIn terms of the median of PTSS20 total scores(MPTSs),MPTSs of female was higher than male,MPTSs of young or middleaged objects was higher than children or adolescents,MPTSs of objects experienced severe audio-visual stimulus was higher than those experienced moderate audio-visual stimulus or those without audio-visual stimulus.MPTSs of objects with bereavement in the earthquake was higher than those without bereavement.MPTSs of objects who was investigated above thirty days after earthquake was higher than those investigated earlier.Six influencing factors including gender,investigate-point,satisfactory extent to leader's relief,bereavement,family relation, age entered the stepwise regression model of PTSS20 total score.ConclusionCrisis intervention should pay much attention to females,young or middle-aged objects,the bereaved,objects experienced severe audio-visual stimulus and seriously injured objects.Risk factors of post-traumatic stress reaction consist of investigative time greater than thirty days,low satisfaction to leader's relief and poor family relation.
Objective To examine the influencing factors of post-traumatic stress reaction in earthquake victims in Wenchuan.Methods337 Wenchuan earthquake victims were investigated about their demographic backgrounds,stricken conditions and were assessed with the post-traumatic stress reaction screening scale(PTSS20) from the 12th day after the earthquake.Non-parametric test and multiple linear regression were used to explore the influencing factors of post-traumatic stress reaction.ResultsIn terms of the median of PTSS20 total scores(MPTSs),MPTSs of female was higher than male,MPTSs of young or middleaged objects was higher than children or adolescents,MPTSs of objects experienced severe audio-visual stimulus was higher than those experienced moderate audio-visual stimulus or those without audio-visual stimulus.MPTSs of objects with bereavement in the earthquake was higher than those without bereavement.MPTSs of objects who was investigated above thirty days after earthquake was higher than those investigated earlier.Six influencing factors including gender,investigate-point,satisfactory extent to leader's relief,bereavement,family relation, age entered the stepwise regression model of PTSS20 total score.ConclusionCrisis intervention should pay much attention to females,young or middle-aged objects,the bereaved,objects experienced severe audio-visual stimulus and seriously injured objects.Risk factors of post-traumatic stress reaction consist of investigative time greater than thirty days,low satisfaction to leader's relief and poor family relation.
引文
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2 Te-Jen Lai,Chia-Ming Chang,Kathryn M.Connor,et al.Full and partial PTSD among earthquake survivors in ruralTaiwan[J].Journal of Psychiatric Research,2004,38:313-322
3王丽萍,张本,姜涛,等.唐山大地震所致慢性创伤后应激障碍临床研究[J].中国心理卫生杂志,2005,9(8):517-520
4 Raphael B,Lundin T,Weisaeth L.A research method for thestudy of psychological and psychiatric aspects of disaster[J].Acta Psychiatr Scand,1989:80(Suppl 353):1-75
5国际华人医学家心理学家联合会(IACMPS).四川“5.12”灾后心理援助手册[J].国际中华应用心理学杂志,2008,5(14):98
6 Richard A.Bryant,Allison G.Harvey.Gender differences in therelationship between acute stress disorder and posttraumaticstress disorder following motor vehicle accidents[J].Australianand New Zealand Journal of Psychiatry,2003,37:226-229
7高岚,汪向东,沈渔邨,等.对受洪灾群体创伤后应激反应的调查[J].中华精神科杂志,2000,33(2):107-110
8高新学,况利,艾明,等.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[J].中国心理卫生杂志,2009,23(4):259-263
9 Kessler RC,Sonnega A,Bromet E,et a1.Posttraumatic stressdisorder in the national comorbidity survey[J].Arch GenPsychiatry,1995,52:1048-1060
10马磊,王家同,谭庆荣,等.应激障碍的危险因素分析[J].临床精神医学杂志,2004,14(5):257-258
11 Fullerton CS,Ursano RJ,Epstein RS,et al.Gender differencesin posttraumatic stress disorder after motor vehicle accidents[J].American Journal of Psychiatry,2001,158:1486-1491
12 Karanci NA,Alkan N,Aksit B,et al.Gender differences inpsychological distress,coping,social support,and relatedvariables following the 1995 Dinal(Turkey)earthquake[J].North American Journal of Psychology,1999,1:189-204
13 Goenjian AK,Najarian LM,Pynons RS,et al.Posttraumaticstress disorder in elderly and younger adults after the 1988earthquake in Armania[J].Am J Psychiatry,1994,151:895-901
14陶炯,温盛霖,张晋碚,等.汶川地震安置点灾民急性应激障碍及影响因素分析[J].中国神经精神疾病杂志,2008,34(10):618-620
15向莹君,熊国玉,袁萍,等.汶川地震灾区1960名中学生创伤后应激障碍症状调查[J].中国心理卫生杂志,2010,24(1):17-20
16李勇,贺丹军,吴玉琴,等.汶川大地震受灾者创伤后应激症状及危险因素[J].中国康复医学杂志,2008,23(l0):868-871
17 Bo Wang,Chunping Ni,Yongping Yan,et al.Posttraumaticstress disorder one month after 2008 earthquake in China:Wenchuan earthquake survey[J].Psychiatry Research,2009[2009-6-24].http://dx.doi.org/10.1016/j.psychres.2009.07.001
18陈树林,李凌江,卢原,等.火灾灾民创伤后应激障碍的发生及其影响因素[J].中国神经精神疾病杂志,2005,31(3):198-201
19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
20 David N.Sattler,Ana Maria Glower de Alvarado and NormaBlandon de Castro,Robert Van Male,et al.El Salvadorearthquakes:Relationships among acute Stress disordersymptoms,depression,traumatic event exposure,and resourceloss[J].Journal of Traumatic Stress,2006,19(6):879-893
21王友平.生活事件、应激与疾病[J].中国社会医学,1989,2(21):57
22 Yen Kuang Yang,Tzung Lieh Yeh,Chwen cheng chen,et al.Psychiatric morbidity and posttraumatic symptoms amongearthquake victims in primary care clinics[J].GeneralHospital Psychiatry,2003,25:253-261
23 Schnurr PP,Friedman MJ,Bernardy NC,et al.Research onposttraumatic stress disorder:epidemiology,pathophysiologyand assessment[J].J Clin Psychol,2002,58(8):877-889
24黄河清,杨惠琴,韩布新.汶川地震后不同灾情地区老年人创伤后应激障碍发生率及影响因素[J].中国老年学杂志,2009,29(10):1275-1277
25 Richard J.Shaw,Thomas Deblois,Linda Ikuta,et al.Acutestress disorder among parents of Infants in the neonatalintensive care nursery[J].Psychosomatics,2006,47:206-212
2 Te-Jen Lai,Chia-Ming Chang,Kathryn M.Connor,et al.Full and partial PTSD among earthquake survivors in ruralTaiwan[J].Journal of Psychiatric Research,2004,38:313-322
3王丽萍,张本,姜涛,等.唐山大地震所致慢性创伤后应激障碍临床研究[J].中国心理卫生杂志,2005,9(8):517-520
4 Raphael B,Lundin T,Weisaeth L.A research method for thestudy of psychological and psychiatric aspects of disaster[J].Acta Psychiatr Scand,1989:80(Suppl 353):1-75
5国际华人医学家心理学家联合会(IACMPS).四川“5.12”灾后心理援助手册[J].国际中华应用心理学杂志,2008,5(14):98
6 Richard A.Bryant,Allison G.Harvey.Gender differences in therelationship between acute stress disorder and posttraumaticstress disorder following motor vehicle accidents[J].Australianand New Zealand Journal of Psychiatry,2003,37:226-229
7高岚,汪向东,沈渔邨,等.对受洪灾群体创伤后应激反应的调查[J].中华精神科杂志,2000,33(2):107-110
8高新学,况利,艾明,等.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[J].中国心理卫生杂志,2009,23(4):259-263
9 Kessler RC,Sonnega A,Bromet E,et a1.Posttraumatic stressdisorder in the national comorbidity survey[J].Arch GenPsychiatry,1995,52:1048-1060
10马磊,王家同,谭庆荣,等.应激障碍的危险因素分析[J].临床精神医学杂志,2004,14(5):257-258
11 Fullerton CS,Ursano RJ,Epstein RS,et al.Gender differencesin posttraumatic stress disorder after motor vehicle accidents[J].American Journal of Psychiatry,2001,158:1486-1491
12 Karanci NA,Alkan N,Aksit B,et al.Gender differences inpsychological distress,coping,social support,and relatedvariables following the 1995 Dinal(Turkey)earthquake[J].North American Journal of Psychology,1999,1:189-204
13 Goenjian AK,Najarian LM,Pynons RS,et al.Posttraumaticstress disorder in elderly and younger adults after the 1988earthquake in Armania[J].Am J Psychiatry,1994,151:895-901
14陶炯,温盛霖,张晋碚,等.汶川地震安置点灾民急性应激障碍及影响因素分析[J].中国神经精神疾病杂志,2008,34(10):618-620
15向莹君,熊国玉,袁萍,等.汶川地震灾区1960名中学生创伤后应激障碍症状调查[J].中国心理卫生杂志,2010,24(1):17-20
16李勇,贺丹军,吴玉琴,等.汶川大地震受灾者创伤后应激症状及危险因素[J].中国康复医学杂志,2008,23(l0):868-871
17 Bo Wang,Chunping Ni,Yongping Yan,et al.Posttraumaticstress disorder one month after 2008 earthquake in China:Wenchuan earthquake survey[J].Psychiatry Research,2009[2009-6-24].http://dx.doi.org/10.1016/j.psychres.2009.07.001
18陈树林,李凌江,卢原,等.火灾灾民创伤后应激障碍的发生及其影响因素[J].中国神经精神疾病杂志,2005,31(3):198-201
19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
20 David N.Sattler,Ana Maria Glower de Alvarado and NormaBlandon de Castro,Robert Van Male,et al.El Salvadorearthquakes:Relationships among acute Stress disordersymptoms,depression,traumatic event exposure,and resourceloss[J].Journal of Traumatic Stress,2006,19(6):879-893
21王友平.生活事件、应激与疾病[J].中国社会医学,1989,2(21):57
22 Yen Kuang Yang,Tzung Lieh Yeh,Chwen cheng chen,et al.Psychiatric morbidity and posttraumatic symptoms amongearthquake victims in primary care clinics[J].GeneralHospital Psychiatry,2003,25:253-261
23 Schnurr PP,Friedman MJ,Bernardy NC,et al.Research onposttraumatic stress disorder:epidemiology,pathophysiologyand assessment[J].J Clin Psychol,2002,58(8):877-889
24黄河清,杨惠琴,韩布新.汶川地震后不同灾情地区老年人创伤后应激障碍发生率及影响因素[J].中国老年学杂志,2009,29(10):1275-1277
25 Richard J.Shaw,Thomas Deblois,Linda Ikuta,et al.Acutestress disorder among parents of Infants in the neonatalintensive care nursery[J].Psychosomatics,2006,47:206-212
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