震后9个月部分受灾群众精神痛苦现况调查
摘要
目的:探讨汶川地震后9个月受灾群众的精神痛苦状况及相关因素,寻找快速评估抑郁发作、自杀倾向和创伤后应激障碍(post-traumatic stress disorder,PTSD)的方法。方法:利用方便取样,对绵阳永兴板房区和秀水镇农村的受灾群众(n=321)进行三步梯度评估。(1)使用心理健康自评问卷(Self-Re-porting Questionnaire-20,SRQ20)及PTSD筛查表(7-items Screening Scale for PTSD,PTSD7)对所有受试进行初步筛查;(2)对SRQ20≥10分或PTSD7≥4分者进行抑郁(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS),及简明国际神经精神访谈(Mini-International Neuropsychiat-ric Interview,MINI)中文版"自杀倾向"评定,对PTSD7≥4者还进行MINI"PTSD"诊断评估;(3)对SDS评分≥50者进行MINI"抑郁发作"和"PTSD"诊断评估。结果:(1)315人完成评估,其中SRQ20评分≥10或PTSD7评分≥4者占53.0%;SDS评分≥50者占37.1%,其中存在自杀倾向者18.4%;符合MINI目前抑郁发作及PTSD者分别占25.7%和27.3%,两者共病18.1%。(2)永兴板房区受试PTSD7评分及MINI"PTSD"检出率均高于秀水镇受试[(3.6±1.8)vs.(2.9±1.7),33.0%vs.16.0%;均P<0.001]。(3)Logistic回归分析显示,震时躯体受伤是目前抑郁发作(OR=2.579)和PTSD(OR=1.917)的危险因素;震后搬迁次数是PTSD的危险因素(OR=1.189)。结论:(1)震后9个月受灾群众仍存在明显的抑郁发作、PTSD及自杀倾向。震时躯体受伤对抑郁发作和PTSD有长期影响,震后多次搬迁可能促进PTSD发生及症状加重。(2)SRQ20及PTSD7与MINI结合使用可作为灾后精神痛苦的快速评估方法。
Objective:To explore the mental distress and the related factors of people who suffered 5.12 Earthquake in Sichuan at 9 months after the earthquake.And try to find the methods to quickly detect the individuals with depression,posttraumatic stress disorder(PTSD)and suicide risk.Methods:A total of 321 subjects in Yongxing temporal board houses of Mianyang and in the rural areas of Xiushui were enrolled and assessed by a three-step evaluation.First,all subjects were screened with the Self-Report questionnaire(SRQ20)and 7-items Screening Scale for PTSD(PTSD7).Second,the subjects with SRQ20 score ≥10 or PTSD7 score ≥4 were assessed with the Self-rating Depression Scale(SDS),Self-rating Anxiety Scale(SAS)and the suicide module of Mini-International Neuropsychiatric Interview(MINI).And the subjects with PTSD7 score ≥4 were also assessed the MINI PTSD module.Finally,the subjects with SDS score ≥50 were evaluated using MINI depression and PTSD modules.Results:(1)Totally 315 subjects finished the evaluations,in which 53.0% had scores of SRQ20≥10 or PTSD7≥4,37.1% had scores of SDS≥50,and 18.4% had a suicide risk.25.7% and 27.3% of them met the diagnoses of MINI current depression and PTSD respectively,and 18.1% were diagnosed as both PTSD and depression.(2)The PTSD7 score and MINI PTSD rate(3.6±1.8,33.0%)of the subjects in Yongxing board houses were higher than those in Xiushui(2.9±1.7,16.0%),Ps<0.001.(3)Logistic regression analysis showed that the physical injury was a risk factor for current depression(OR=2.579)and PTSD(OR=1.917)and frequent residence change after the earthquake was a risk factor for PTSD(OR=1.189).Conclusions:(1)People in the earthquake-hit area still have obvious depression,PTSD and suicide risk at 9 months after the earthquake.The physical injury happened during the earthquake has a long-term influence for people to get depression and PTSD,and frequent residence change after the earthquake maybe promote PTSD episode and more serious.(2)The combination of SRQ20,PTSD7 and MINI should be used to assess mental distress quickly after disasters.
Objective:To explore the mental distress and the related factors of people who suffered 5.12 Earthquake in Sichuan at 9 months after the earthquake.And try to find the methods to quickly detect the individuals with depression,posttraumatic stress disorder(PTSD)and suicide risk.Methods:A total of 321 subjects in Yongxing temporal board houses of Mianyang and in the rural areas of Xiushui were enrolled and assessed by a three-step evaluation.First,all subjects were screened with the Self-Report questionnaire(SRQ20)and 7-items Screening Scale for PTSD(PTSD7).Second,the subjects with SRQ20 score ≥10 or PTSD7 score ≥4 were assessed with the Self-rating Depression Scale(SDS),Self-rating Anxiety Scale(SAS)and the suicide module of Mini-International Neuropsychiatric Interview(MINI).And the subjects with PTSD7 score ≥4 were also assessed the MINI PTSD module.Finally,the subjects with SDS score ≥50 were evaluated using MINI depression and PTSD modules.Results:(1)Totally 315 subjects finished the evaluations,in which 53.0% had scores of SRQ20≥10 or PTSD7≥4,37.1% had scores of SDS≥50,and 18.4% had a suicide risk.25.7% and 27.3% of them met the diagnoses of MINI current depression and PTSD respectively,and 18.1% were diagnosed as both PTSD and depression.(2)The PTSD7 score and MINI PTSD rate(3.6±1.8,33.0%)of the subjects in Yongxing board houses were higher than those in Xiushui(2.9±1.7,16.0%),Ps<0.001.(3)Logistic regression analysis showed that the physical injury was a risk factor for current depression(OR=2.579)and PTSD(OR=1.917)and frequent residence change after the earthquake was a risk factor for PTSD(OR=1.189).Conclusions:(1)People in the earthquake-hit area still have obvious depression,PTSD and suicide risk at 9 months after the earthquake.The physical injury happened during the earthquake has a long-term influence for people to get depression and PTSD,and frequent residence change after the earthquake maybe promote PTSD episode and more serious.(2)The combination of SRQ20,PTSD7 and MINI should be used to assess mental distress quickly after disasters.
引文
[1]赵高峰,杨彦春,张树森,等.汶川地震极重灾区780名受灾群众心理状况调查[J].中国循证医学杂志,2008,8(10):815-819.
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[4]傅璟,赵铀,宋豪,等.汶川大地震妇女创伤后应激障碍的抽样调查研究[J].实用妇产科杂志,2008,24(12):744-746.
[5]Chou FH,Wu HC,Chou P,et al.Epidemiologic psychi-atric studies on post-disaster impact among Chi-Chi earth-quake survivors in Yu-Chi,Taiwan[J].Psychiatry ClinNeurosci,2007,61(4):370-378.
[6]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.
[7]卫生部疾病预防控制局.灾难心理危机干预培训手册[M].北京:人民卫生出版社,2008.
[8]Mari JJ,Williams P.A validity study of a psychiatricscreening questionnaire(SRQ-20)in primary care in thecity of Sao Paulo[J].Br J Psychiatry,1986,148:23-26.
[9]胡健波,黄满丽览,胡少华,等.心理健康自评问卷在汶川地震受灾人群中应用的信效度分析[J].中华预防医学杂志,2008,42(11):810-813.
[10]Araya R,Wynn R,Lewis G.Comparison of two self ad-ministered psychiatric questionnaires(GHQ-12and SRQ-20)in primary care in Chile[J].Soc Psychiatry Psychi-atr Epidemiol,1992,27(4):168-173.
[11]Naomi Breslau,Edward L.Peterson,Ronald C.Kessler,et al.Short screening scale for DSM-IV Posttraumatic StressDisorder[J].Am J Psychiatry,1999,156(6):908-911.
[12]Liu Aizhong,Tan Hongzhuan,Zhou Jia,et al.A shortDSM-IV screening scale to detect posttraumatic stress disor-der after a natural disaster in a Chinese population[J].Psychiatry Res,2008,159(3):376-381.
[13]舒良.抑郁自评量表[J].中国心理卫生杂志,1999,(增刊):194-197.
[14]吴文源.焦虑自评量表[J].中国心理卫生杂志,1999,(增刊):235-238.
[15]Sheehan DV,Lecrubier Y,Sheehan H,et al.The Validi-ty of the Mini International Neuropsychiatric Interview(MINI)according to the SCID-P and its reliability[J].Eur Psychiatry,1997,5:232-241.
[16]司天梅,舒良,党卫民,等.简明国际神经精神访谈中文版的临床信效度[J].中国心理卫生杂志,2009,23(7):493-497.
[17]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.
[18]Eksi A and Braun KL.Over-time changes in PTSD and de-pression among children surviving the1999Istanbul earth-quake[J].Eur Child Adolesc Psychiatry,2009,18(6):384-391.
[19]Chou FH,Wu HC,Chou P,et al.Epidemiologic psychi-atric studies on post-disaster impact among Chi-Chi earth-quake survivors in Yu-Chi,Taiwan[J].Psychiatry ClinNeurosci,2007,61(4):370-378.
[20]Vehid HE,Alyanak B,Eksi A.Suicide ideation after the1999earthquake in Marmara,Turkey[J].Tohoku J ExpMed,2006,208(1):19-24.
[21]赵丞智,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):145-147.
[22]汪向东,赵丞智,新福尚隆,等.地震后创伤性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.
[23]Durieux-Paillard S,Whitaker-Clinch B,Bovier PA,etal.Screening for major depression and posttraumatic stressdisorder among asylum seekers:adapting a standardizedinstrument to the social and cultural context[J].Can JPsychiatry,2006,51(9):587-597.
[2]陶炯,温盛霖,王相兰,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.
[3]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(10):868-871.
[4]傅璟,赵铀,宋豪,等.汶川大地震妇女创伤后应激障碍的抽样调查研究[J].实用妇产科杂志,2008,24(12):744-746.
[5]Chou FH,Wu HC,Chou P,et al.Epidemiologic psychi-atric studies on post-disaster impact among Chi-Chi earth-quake survivors in Yu-Chi,Taiwan[J].Psychiatry ClinNeurosci,2007,61(4):370-378.
[6]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.
[7]卫生部疾病预防控制局.灾难心理危机干预培训手册[M].北京:人民卫生出版社,2008.
[8]Mari JJ,Williams P.A validity study of a psychiatricscreening questionnaire(SRQ-20)in primary care in thecity of Sao Paulo[J].Br J Psychiatry,1986,148:23-26.
[9]胡健波,黄满丽览,胡少华,等.心理健康自评问卷在汶川地震受灾人群中应用的信效度分析[J].中华预防医学杂志,2008,42(11):810-813.
[10]Araya R,Wynn R,Lewis G.Comparison of two self ad-ministered psychiatric questionnaires(GHQ-12and SRQ-20)in primary care in Chile[J].Soc Psychiatry Psychi-atr Epidemiol,1992,27(4):168-173.
[11]Naomi Breslau,Edward L.Peterson,Ronald C.Kessler,et al.Short screening scale for DSM-IV Posttraumatic StressDisorder[J].Am J Psychiatry,1999,156(6):908-911.
[12]Liu Aizhong,Tan Hongzhuan,Zhou Jia,et al.A shortDSM-IV screening scale to detect posttraumatic stress disor-der after a natural disaster in a Chinese population[J].Psychiatry Res,2008,159(3):376-381.
[13]舒良.抑郁自评量表[J].中国心理卫生杂志,1999,(增刊):194-197.
[14]吴文源.焦虑自评量表[J].中国心理卫生杂志,1999,(增刊):235-238.
[15]Sheehan DV,Lecrubier Y,Sheehan H,et al.The Validi-ty of the Mini International Neuropsychiatric Interview(MINI)according to the SCID-P and its reliability[J].Eur Psychiatry,1997,5:232-241.
[16]司天梅,舒良,党卫民,等.简明国际神经精神访谈中文版的临床信效度[J].中国心理卫生杂志,2009,23(7):493-497.
[17]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.
[18]Eksi A and Braun KL.Over-time changes in PTSD and de-pression among children surviving the1999Istanbul earth-quake[J].Eur Child Adolesc Psychiatry,2009,18(6):384-391.
[19]Chou FH,Wu HC,Chou P,et al.Epidemiologic psychi-atric studies on post-disaster impact among Chi-Chi earth-quake survivors in Yu-Chi,Taiwan[J].Psychiatry ClinNeurosci,2007,61(4):370-378.
[20]Vehid HE,Alyanak B,Eksi A.Suicide ideation after the1999earthquake in Marmara,Turkey[J].Tohoku J ExpMed,2006,208(1):19-24.
[21]赵丞智,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):145-147.
[22]汪向东,赵丞智,新福尚隆,等.地震后创伤性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.
[23]Durieux-Paillard S,Whitaker-Clinch B,Bovier PA,etal.Screening for major depression and posttraumatic stressdisorder among asylum seekers:adapting a standardizedinstrument to the social and cultural context[J].Can JPsychiatry,2006,51(9):587-597.
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