创伤后应激障碍的相关因素分析
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摘要
目的探索"5·12"汶川地震发生后,灾区成年人发生创伤后应激障碍(post-traumatic stress disorder,PTSD)的危险因素,并进行认知模式、社会支持与PTSD的相关性分析。方法对来自地震极重灾区的10046名成年人进行人口学背景、地震经历调查,并使用PTSD症状检查量表(PTSD symptom checklist,PCL-17)对其进行评估,评估结果PCL-17≥50为可能PTSD患者。采用创伤后认知量表(posttraumatic cognition inventory,PTCl)评定个体的认知模式,社会支持量表(social support rating scale,SSRS)评定个体的全面社会支持状况。结果共有9342名个体的调查资料填写完整,最终纳入统计分析。年龄19～75岁,平均为(43.68±13.54)岁;男女比例为4216(45.1%):5126(54.9%)。已婚8243人(88.2%),未婚729人(7.8%),离异171人(1.8%),丧偶199人(2.1%)。受教育程度分别为初中以下5668人(60.7%),高中以上3389人(36.3%),不详285人(3.1%)。职业为警察350人(3.7%),工人823人(8.8%),农民1469人(15.7%),公务员616人(6.6%),教师244人(2.6%),其它5840人(54.6%)。入组个体中有137人(1.5%)被掩埋,512人(5.5%)受伤,22人(0.2%)被截肢。地震中有家人受伤或死亡者为1521人(16.3%)。PCL-17评分>50分者424人(4.5%)。不同婚姻状况之间的PCL-17评分有差异(F=8.669,P<0.05),离异及丧偶者PCL-17评分较高;警察与其他职业相比,PTSD患病率差异有统计学意义(χ2=223.490,P<0.05);文化程度不同,PCL-17评分也不同(F=7.425,P<0.05)。通过Logistic回归分析发现:离异及丧偶者、警察、地震中被掩埋者、亲人严重受伤、房屋损害严重、看到其他人被埋/受伤甚或死亡者、社会支持较少等因素均是PCL-17评分较高的高危因素。相关分析显示创伤后应激症状与个人认知模式和社会支持有相关性,认知模式与创伤后应激症状呈正相关(总分r=0.607,P<0.001),社会支持与其呈负相关(总分r=-0.068,P<0.001)。结论离异及丧偶者、警察、被掩埋者、截肢者及亲眼看见他人受伤或死亡是个体患PTSD的高危因素。个人认知模式和社会支持与PTSD的患病具有相关性。
Objective To explore the risk factors of PTSD for adults after the Wenchuan earthquake in Sichuan,and to analyze the correlations between PTSD and cognitive model and social support.Methods A total of 10046 adults were selected from the serious earthquake region.The demographic data and earthquake experiences were recorded and the PTSD checklist(PCL-17) was evaluated.Subjects with a PCL-17 score greater than 50 were considered as possible PTSD cases,and subsequently underwent a correlate analysis with PTCl and SSRS.Results Among the 10046 retrieved questionnaires,9342 were valid.In the 9342 subjects,the age was from 19 to 75 years old,and the mean age was(43.68±13.54) years;male to female ratio was 45.1:54.9.Marital status:married 88.2%,unmarried 7.8%,divorced 1.8%,widowed 2.1%.Educational level:Junior middle school and the following 60.7%,high school and above 36.3%,unknown 3.1%.Occupation:police 3.7%,workers 8.8%,farmers 1.57%,civil servants 6.6%,teachers 2.6%,and the others 54.6%.There were 137(1.5%)subjects buried,512(5.5%) wounded and 22(0.2%) amputated during the earthquake.1521(16.3%)subjects have a family wounded or death during the earthquake.There were 424(4.5%) individuals among 9342 subjects got a PCL-17 score greater than 50.Our results show there were significant different of PCL-17 score among different marriage status(F=8.669,P<0.05).The divorce and widower/widow rates were higher in possible PTSD group.Police group got the highest PCL-17 score in all careers,the result show significant difference between police and other careers groups(χ2=223.490,P<0.05).Our results also show there were different of PCL-17 score among different educational level(F=7.425,P<0.05).Logistic regression analysis showed the factors,divorced and widowed,police,buried,whose parents severely injured,whose house being destroyed,witnessed someone buried/wounded or dying during the earthquake,lower social support,were significant correlated with the higher scores of the PCL-17.There was a correlation between PTSD and personal cognitive model and social support,correlation coefficient was respectively:cognitive model(r=0.607,P<0.001);social support(r=-0.068,P<0.001).Conclusion Divorced and widowed,police,buried,the amputees and witnessed someone wounded or dying during the earthquake are high risk factors for PTSD.Personal cognitive model and social support are associated with PTSD.
Objective To explore the risk factors of PTSD for adults after the Wenchuan earthquake in Sichuan,and to analyze the correlations between PTSD and cognitive model and social support.Methods A total of 10046 adults were selected from the serious earthquake region.The demographic data and earthquake experiences were recorded and the PTSD checklist(PCL-17) was evaluated.Subjects with a PCL-17 score greater than 50 were considered as possible PTSD cases,and subsequently underwent a correlate analysis with PTCl and SSRS.Results Among the 10046 retrieved questionnaires,9342 were valid.In the 9342 subjects,the age was from 19 to 75 years old,and the mean age was(43.68±13.54) years;male to female ratio was 45.1:54.9.Marital status:married 88.2%,unmarried 7.8%,divorced 1.8%,widowed 2.1%.Educational level:Junior middle school and the following 60.7%,high school and above 36.3%,unknown 3.1%.Occupation:police 3.7%,workers 8.8%,farmers 1.57%,civil servants 6.6%,teachers 2.6%,and the others 54.6%.There were 137(1.5%)subjects buried,512(5.5%) wounded and 22(0.2%) amputated during the earthquake.1521(16.3%)subjects have a family wounded or death during the earthquake.There were 424(4.5%) individuals among 9342 subjects got a PCL-17 score greater than 50.Our results show there were significant different of PCL-17 score among different marriage status(F=8.669,P<0.05).The divorce and widower/widow rates were higher in possible PTSD group.Police group got the highest PCL-17 score in all careers,the result show significant difference between police and other careers groups(χ2=223.490,P<0.05).Our results also show there were different of PCL-17 score among different educational level(F=7.425,P<0.05).Logistic regression analysis showed the factors,divorced and widowed,police,buried,whose parents severely injured,whose house being destroyed,witnessed someone buried/wounded or dying during the earthquake,lower social support,were significant correlated with the higher scores of the PCL-17.There was a correlation between PTSD and personal cognitive model and social support,correlation coefficient was respectively:cognitive model(r=0.607,P<0.001);social support(r=-0.068,P<0.001).Conclusion Divorced and widowed,police,buried,the amputees and witnessed someone wounded or dying during the earthquake are high risk factors for PTSD.Personal cognitive model and social support are associated with PTSD.
引文
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2肖水源.社会支持评定量表[J].中国心理卫生杂志,1999,13(增刊):127～131.
3Wang XD,Gao L,Naotaka Shinfuku,et al.Long itudinal study of earthquake.related PTSD in a randomly selected community sample in north China[J].Am J Psychiatry.2000,157(12):1260～1266.
4John PB,Russell S,Russell PS.The prevalence of posttraumatic stress disorder among children and adolescents affected by tsunami disaster in Tamil Nadu[J].J Disaster Manage Response,2007,5(1):3～7.
5Green BL,Lindy JD,Grace MC,et al.Chronic post traumatic stress disorder and diagnostic CO morbidity in a disaster sample[J].Jounal of Nervous and Mental Disease,1992,180(6):760.
6杨婵娟,刘玉平,王旭萍.159名精神科医生的心理健康状况调查[J].中国健康心理学杂志,2008,5(1):40～41.
7杨琴,吴新玲,唐晋,等.护士工作压力与心理健康的调查分析[J].临床护理杂志,2008,2(1):12～14.
8Vassiliki Holeva,Nicholas Tarrier.Personality and peritraumatic disso-ciation in the prediction of PTSD in victims of road traffic accidents[J].Journal of Psychosomatic Research,2000,11(5):687～692.
9Anja JE,Dirkzwager I,Bramsen,et al.Social support,coping,life events,and posttraumatic stress symptoms among former peacekeep-ers:a prospective study[M].Personality and Individual Differences.2003:1545～1559.
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