汶川地震极重灾区社区居民创伤后应激障碍发生率及影响因素
摘要
目的:调查汶川地震后,极重灾区社区居民创伤后应激障碍发生率及影响因素,为进一步开展灾后心理卫生服务提供依据。方法:采用整群随机抽样的方法,从安县京安小区、什邡红白镇两个临时安置点社区居民2685人中,随机抽取820名社区居民登记人口学背景、受灾状况,并使用PTSD检查量表平民版(PTSD Checklist-Civilian Version,PCL-C)和领悟社会支持量表(Perceived Social Support Scale,PSSS)进行评估,依据DSM-Ⅳ中PTSD的诊断标准确诊PTSD患者。结果:在完成的820份调查评估资料中,785份PCL-C和PSSS问卷有效。男女比例为1∶1.41;平均年龄(43±18)岁;26.0%患有躯体疾病,28.4%有地震前饮酒习惯,23.6%有震后饮酒行为。不同年龄居民PSSS总分及2因子分差异均无统计学意义(P>0.05)。PTSD的临床检出率为12.4%(97/785),女性PTSD发生率高于男性(15.3%vs.8.3%,P=0.003),地震中有曾被掩埋经历者PTSD发生率高于无被掩埋经历者(26.3%vs.11.6%,P=0.018),有丧亲者的PTSD发生率高于无丧亲者(18.7%vs.11.1%,P=0.015)。以PTSD诊断是否成立为因变量,一般资料为自变量进行Logistic回归分析显示:女性(OR=2.070,95%CI:1.274~3.365)、有曾被掩埋经历者(OR=2.806,95%CI:1.249~6.306)、亲人丧失(OR=1.537,95%CI:1.087~2.173)及PSSS评分偏低(OR=0.960,95%CI:0.941~0.979)是PTSD发生的危险因素。结论:在灾后社区重建过程中,临时安置点社区居民存在较高的创伤后应激障碍的发生率,女性、有曾被掩埋经历、亲人丧失及个人感受到的社会支持偏低是PTSD发生的危险因素。
Objective:To investigate the prevalence and related factors of post-traumatic stress disorder(PTSD) among community residents after the Wenchuan Earthquake,and to provide the information for the psychological and medical intervention.Methods:A total of 820 community residents aged 12 years or older were randomly selected from 2 large communities in Anxian and Shifang cities.The demographic situation and health state were collected the subjects were assessed with the PTSD Checklist-Civilian Version(PCL-C) and Perceived Social Support Scale(PSSS).The diagnosis of PTSD were made with the Diagnostic and Statistical Mental Disorders(IV Edition) criteria.Results:Among the 820 retrieved questionnaires,785 were valid.In the 785 questionnaires,male to female ratio was 1:1.41,and the mean age was(43±18)years;26.0% of subjects suffered from physical diseases,28.4% had drinking habits before the earthquake,and 23.6% had drinking behavior after earthquake.The mean score of PSSS was(61.05±10.54),and there were no significant differences in PSSS score between different age groups.The prevalence of PTSD in this sample was 12.4%(97/785).Logistic regression analysis showed that female(OR=2.070,95% CI:1.274～3.365),experience of being buried(OR=2.806,95%CI:1.249 ～6.306),losing relatives(OR=1.537,95%CI:1.087～2.173),and low PSSS score(OR=0.961,95%CI:0.941～0.979) were the risk factors for PTSD.Conclusion:In the post-disaster reconstruction process,the community residents suffer from the psychological problems after the earthquake.Female,experience of being buried,losing relatives,and low PSSS score may be the risk factors for PTSD and should be paid more attention.
Objective:To investigate the prevalence and related factors of post-traumatic stress disorder(PTSD) among community residents after the Wenchuan Earthquake,and to provide the information for the psychological and medical intervention.Methods:A total of 820 community residents aged 12 years or older were randomly selected from 2 large communities in Anxian and Shifang cities.The demographic situation and health state were collected the subjects were assessed with the PTSD Checklist-Civilian Version(PCL-C) and Perceived Social Support Scale(PSSS).The diagnosis of PTSD were made with the Diagnostic and Statistical Mental Disorders(IV Edition) criteria.Results:Among the 820 retrieved questionnaires,785 were valid.In the 785 questionnaires,male to female ratio was 1:1.41,and the mean age was(43±18)years;26.0% of subjects suffered from physical diseases,28.4% had drinking habits before the earthquake,and 23.6% had drinking behavior after earthquake.The mean score of PSSS was(61.05±10.54),and there were no significant differences in PSSS score between different age groups.The prevalence of PTSD in this sample was 12.4%(97/785).Logistic regression analysis showed that female(OR=2.070,95% CI:1.274～3.365),experience of being buried(OR=2.806,95%CI:1.249 ～6.306),losing relatives(OR=1.537,95%CI:1.087～2.173),and low PSSS score(OR=0.961,95%CI:0.941～0.979) were the risk factors for PTSD.Conclusion:In the post-disaster reconstruction process,the community residents suffer from the psychological problems after the earthquake.Female,experience of being buried,losing relatives,and low PSSS score may be the risk factors for PTSD and should be paid more attention.
引文
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[15]Chou FH,Chou P,Su TT,et al.Survey of quality of life and related risk factors for a Taiwanese village population21months after an earthquake[J].Aust NZ J Psychiatry,2004a,38:358-364.
[16]Chou FH,Chou P,Lin C,et al.The relationship between quality of life and psychiatric impairment for a Taiwanese community post earthquake[J].Qual Life Res,2004b,13:1089-1097.
[17]Wang XD,Gao L,Shinfuku N,et al.Longitudinal Study of Earthquake-Related PTSD in a Randomly Selected Com-munity Sample in North China[J].Am J Psychiatry,2000b,57(8):1260-1266.
[18]Galea S,Vlahov D,Resnic H,et al.Trends of probable posttraumatic stress disorder in New York City after the September11terrorist attacks[J].Am J Epidemiol,,2003,158:514-524.
[19]Foa FB.Street GP.Women and traumatic events[J].J Clin Psychiatry,2001,62(suppl17):29-34.
[20]赵承智,李俊福,王明山,等.地震后17个月受灾青少年PTSD及其相关因素[J].中国心理卫生杂志,2001,15(3):145-151.
[21]Kuo HW,Wu SJ,Ma TC,et al.Posttraumatic symptoms were worst among quake victims with injuries following the Chi-Chi quake in Taiwan[J].J Psychosom Res,2007,62(4):495-500.
[22]汪向东,张华彪,新富尚隆,等.地震后创伤后应激障碍的发生率及影响因素[J].中国心理卫生杂志,1999,13(1):28-30.
[2]Jordan NN,Hoge CW,Tobler SK,et al.Mental Health impact of9/11Pentagon attack:Validation of a rapid as-sessment tool[J].Am J Prev Med,2004,26(4):284-293.
[3]Ehlers A,Clark DM,Hackmann A,et al.A randomized controlled trial of cognitive therapy,a self-help booklet,and repeated assessments as early interventions for posttrau-matic stress disorder[J].Arch Gen Psychiaryt,2003,60(10):1024-1032.
[4]陈树林,高雪屏,李凌江,等.PTSD症状自评量表的信效度初步分析[J].中国心理卫生杂志,2005,19(6):373-376.
[5]American Psychiatric Association.Diagnosis and statistic manual of mental disorders[M].4th ed.Washington DC:American Psychiatric Association,1994:424-429.
[6]姜乾金.领悟社会支持量表[J].中国心理卫生杂志,1999,(增刊):131-133.
[7]American Psychiatric Association.Diagnosis and statistic manual of mental disorders(DSM-Ⅳ)[M].4th e-d.Washington DC:American Psychiatric Association,1994.
[8]Tural U,Coskun B,Onder E,et al.Psychological conse-quences of the1999earthquake in Turkey[J].J Trauma Stress,2004,17(6):451-459.
[9]Armen G.A mental health relief programme in Armenia af-ter the1988earthquake:implementation and clinical obser-vations[J].Br J Psychiatry,1993,163:230-239.
[10]John PB,Russell S,Russell PS.The prevalence of postt-raumatic stress disorder among children and adolescents af-fected by tsunami disaster in Tamil Nadu[J].J Disaster Manage Response,2007,5(1):3-7.
[11]North CS,Kawasaki A,Spitznagel EL,et al.The course of PTSD,major depression,substance abuse,and soma-tization after a natural disaster[J].J Nerv Ment Dis,2004,192:823-829.
[12]Goto T,Wilson J.A review of the history of traumatic stress studies in Japan:From traumatic neurosis to PTSD[J].Trauma Violence Abuse,2003,4:195-209.
[13]Kokai M,Fuji S,Shinfuku N,et al.Natural disaster and mental health in Asia[J].Psychiatry clin Neurosci,2004,58:110-116.
[14]Tang Catherine.So-kum TC.Trajectory of Traumatic Stress Symptoms in the Aftermath of Extreme Natural Disaster[J].J Nerv Ment Disease,2007,195(1):54-59.
[15]Chou FH,Chou P,Su TT,et al.Survey of quality of life and related risk factors for a Taiwanese village population21months after an earthquake[J].Aust NZ J Psychiatry,2004a,38:358-364.
[16]Chou FH,Chou P,Lin C,et al.The relationship between quality of life and psychiatric impairment for a Taiwanese community post earthquake[J].Qual Life Res,2004b,13:1089-1097.
[17]Wang XD,Gao L,Shinfuku N,et al.Longitudinal Study of Earthquake-Related PTSD in a Randomly Selected Com-munity Sample in North China[J].Am J Psychiatry,2000b,57(8):1260-1266.
[18]Galea S,Vlahov D,Resnic H,et al.Trends of probable posttraumatic stress disorder in New York City after the September11terrorist attacks[J].Am J Epidemiol,,2003,158:514-524.
[19]Foa FB.Street GP.Women and traumatic events[J].J Clin Psychiatry,2001,62(suppl17):29-34.
[20]赵承智,李俊福,王明山,等.地震后17个月受灾青少年PTSD及其相关因素[J].中国心理卫生杂志,2001,15(3):145-151.
[21]Kuo HW,Wu SJ,Ma TC,et al.Posttraumatic symptoms were worst among quake victims with injuries following the Chi-Chi quake in Taiwan[J].J Psychosom Res,2007,62(4):495-500.
[22]汪向东,张华彪,新富尚隆,等.地震后创伤后应激障碍的发生率及影响因素[J].中国心理卫生杂志,1999,13(1):28-30.
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