震后6个月都江堰地区青少年创伤后应激症状及相关因素
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摘要
目的:了解汶川地震6个月后都江堰地区青少年创伤后应激症状(Posttramatic Stress Symptoms,PTSS)的检出率及人群特征,并分析其相关因素。方法:采用便利取样,选取都江堰市区内学校规模较大、学生生源来自城镇和农村的一所初中和一所高中,抽取学生2004人,其中初中7～9年级777人(年龄11～14岁),高中10年级1227人(年龄15～17岁),用心理创伤后应激障碍自评量表(Post-Trau-matic Stress Disorder Self-rating Scale,PTSD-SS)、青少年自评生活事件量表(Adolescent Self-rating Life E-vent Checklist,ASLEC)、儿童简易应付方式问卷(Children Simple Coping Style Questionnaire,CSCSQ)、自编一般人口学及地震暴露情况调查表评估创伤后应激症状及其相关因素。结果:(1)PTSS的检出率为15.9%,女生检出率高于男生(19.0%vs.12.2%,P<0.05),15～17岁年龄组检出率高于11～14岁年龄组(19.4%vs.10.4%,P<0.05);(2)使用协方差分析后,女生PTSD-SS总分仍高于男生,15～17岁组仍高于11～14岁组,农村学生仍高于城镇学生[(39.0±14.0)vs.(35.6±13.6),(39.2±15.1)vs.(34.8±11.4),(40.0±15.7)vs.(36.7±13.3),Ps<0.05],但非独生子女与独生子女间PTSS-SS总分差异无统计学意义(P=0.260);(3)较多的震后负性生活事件(β=0.387)、消极应对方式(β=0.258)、有家人伤亡(β=0.184)、其他财产损失(β=0.059)和目睹经历(β=0.136)是PTSS的危险因素(Ps<0.05),而积极应对对PTSS有保护作用(β=-0.178,P<0.001)。结论:震后6个月都江堰地区青少年创伤后应激症状的检出率依然较高;减少灾后负性生活事件的发生并引导学生采用积极的应对方式,对促进其心理康复有重要作用。
Objective:To explore the rates and related factors of posttraumatic stress symptoms(PTSS)among adolescents in Dujiangyan area 6 months after Wenchuan earthquake.Methods:One middle school and one high school located in Dujiangyan urban district with large number of enrollments and the students in which were from both rural and urban areas were selected.From these two schools,2004 students [777 from middle school(grade7-9),1227 from high senior school(grade 10)]were sampled to fill out the Self-Rating Scale for Posttraumatic Stress Disorder(PTSD-SS),Adolescent Self-rating Life Event Checklist(ASLEC),Children Simple Coping Style Questionnaire(CSCSQ),and a self-made general demographic and earthquake exposure questionnaire.Results:The rate of PTSS was 15.9%,higher in girls than in boys(19.0% vs.12.2%,P<0.05),and higher in age 15～17 group than in age 11～14 group(19.4% vs.10.4%,P<0.05).After using analysis of covariance,the total scores of PTSD-SS in girls,15～17 age group,and students from rural areas were remain higher than that in boys,11～14 age group,and students from urban areas respectively [(39.0±14.0)vs.(35.6±13.6),(39.2±15.1)vs.(34.8±11.4),(40.0±15.7)vs.(36.7±13.3),Ps <0.05],while no significant differences were showed between only-child and non only-child(P=0.260).More post-earthquake negative events(β=0.387),negative coping(β=0.258),death of family members(β=0.184),other property' s damage(β=0.059)and earthquake witness experience(β=0.136)were risk factors for PTSS(Ps <0.05),while positive coping served as a protective factor for PTSS(β=-0.178,P<0.001).Conclusion:The rate of PTSS among adolescents in Dujiangyan district is relative higher 6 months after the earthquake.It is important to decrease the incidence of post-earthquake negative events and courage students to use positive coping style.
Objective:To explore the rates and related factors of posttraumatic stress symptoms(PTSS)among adolescents in Dujiangyan area 6 months after Wenchuan earthquake.Methods:One middle school and one high school located in Dujiangyan urban district with large number of enrollments and the students in which were from both rural and urban areas were selected.From these two schools,2004 students [777 from middle school(grade7-9),1227 from high senior school(grade 10)]were sampled to fill out the Self-Rating Scale for Posttraumatic Stress Disorder(PTSD-SS),Adolescent Self-rating Life Event Checklist(ASLEC),Children Simple Coping Style Questionnaire(CSCSQ),and a self-made general demographic and earthquake exposure questionnaire.Results:The rate of PTSS was 15.9%,higher in girls than in boys(19.0% vs.12.2%,P<0.05),and higher in age 15～17 group than in age 11～14 group(19.4% vs.10.4%,P<0.05).After using analysis of covariance,the total scores of PTSD-SS in girls,15～17 age group,and students from rural areas were remain higher than that in boys,11～14 age group,and students from urban areas respectively [(39.0±14.0)vs.(35.6±13.6),(39.2±15.1)vs.(34.8±11.4),(40.0±15.7)vs.(36.7±13.3),Ps <0.05],while no significant differences were showed between only-child and non only-child(P=0.260).More post-earthquake negative events(β=0.387),negative coping(β=0.258),death of family members(β=0.184),other property' s damage(β=0.059)and earthquake witness experience(β=0.136)were risk factors for PTSS(Ps <0.05),while positive coping served as a protective factor for PTSS(β=-0.178,P<0.001).Conclusion:The rate of PTSS among adolescents in Dujiangyan district is relative higher 6 months after the earthquake.It is important to decrease the incidence of post-earthquake negative events and courage students to use positive coping style.
引文
[1]范一鸣,孙源泉,官瑞莹,等.异地复学震区中小学生PTSD及心理健康状况的调查[J].心理科学进展,2009,17(3):393-397.
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[3]Lee CS,Chang JC,Liu CY,et al.Acculturation,Psy-chiatric comobidity and Posttraumatic stress disorder in aTaiwanese aboriginal population[J].Soc Psychiatry Psy-chiatr Epidemiol,2009,44:55-62.
[4]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):146-147.
[5]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[J].中国心理卫生杂志,2005,19(8):517-520.
[6]Qouta S,Punamaki RL,El Sarraj E.Prevalence and de-terminants of PTSD among Palestinian children exposed tomilitary violence[J].Eur Child Adolesc Psychiatry,2003,12(6):265-272.
[7]Richard SE,Carol SF,Robert JU.Posttraumatic stress di-sorder following an air disaster:A prospective study[J].Am J Psychiatry,1998,155(7):934.
[8]Goenjian AK,Molina L,Steinberg AM,et al.Posttrau-matic stress and depressive reactions among Nicaraguan ad-olescents after hurricane Mitch[J].Am J Psychiatry,2001,158(5):788-794.
[9]Thienkrua W,Cardozo BL,Chakkraband ML,et al.Sy-mptoms of posttraumatic stress disorder and depression a-mong children in tsunami-affected areas in southern Thai-land[J].J Am Med Associat,2006,296(5):549-559.
[10]Sharan P,Chaudhary G,Kavathekar SA,et al.Prelimin-ary report of psychiatric disorders in survivors of a severeearthquake[J].Am J Psychiatry,1996,153(4):556-558.
[11]Richard AB,Jeno EM,Jenelle C,et al.Interaction ofposttraumatic stress disorder and chronic pain followingtraumatic brain injury[J].J Head Trauma Rehabil,1999,14:588.
[12]Joff PE,Bast BA.Coping and fefense in relation to accom-adation among a sample of blindman[J].J Never MentDis,1978,166:537-552.
[13]赵玉芳,赵守良.震前生活事件,创伤程度对中学生震后心理健康状况的影响[J].心理科学进展,2009,17(3):511-515.
[14]刘贤臣,马登岱,刘连启.心理创伤后应激障碍自评量表的编制和信度效度研究[J].中国行为医学科学,1998,7(2):93-96.
[15]刘贤臣,刘连启.青少年生活事件量表的编制与信效度测试[J].山东精神医学,1998,10(1):15-19.
[16]解亚宁.简易应对方式量表信度和效度的初步研究[J].中国临床心理学杂志,1998,6(2):114-116.
[17]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.
[18]Caldera T,Palma L,Penayo U,et al.Psychological im-pact of the hurricane mitch in nicaragua in a one-year per-spective[J].Soc Psychiatry Psychiatr Epidemiol,2001,36:108-114.
[2]Priebe S,Grappasonni I,Mari M,et al.Posttraumaticstress disorder six months after an earthquake:Findingsfrom a community sample in a rural region in Italy[J].Soc Psychiatry Psychiatr Epidemiol,2009,44:393-397.
[3]Lee CS,Chang JC,Liu CY,et al.Acculturation,Psy-chiatric comobidity and Posttraumatic stress disorder in aTaiwanese aboriginal population[J].Soc Psychiatry Psy-chiatr Epidemiol,2009,44:55-62.
[4]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):146-147.
[5]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[J].中国心理卫生杂志,2005,19(8):517-520.
[6]Qouta S,Punamaki RL,El Sarraj E.Prevalence and de-terminants of PTSD among Palestinian children exposed tomilitary violence[J].Eur Child Adolesc Psychiatry,2003,12(6):265-272.
[7]Richard SE,Carol SF,Robert JU.Posttraumatic stress di-sorder following an air disaster:A prospective study[J].Am J Psychiatry,1998,155(7):934.
[8]Goenjian AK,Molina L,Steinberg AM,et al.Posttrau-matic stress and depressive reactions among Nicaraguan ad-olescents after hurricane Mitch[J].Am J Psychiatry,2001,158(5):788-794.
[9]Thienkrua W,Cardozo BL,Chakkraband ML,et al.Sy-mptoms of posttraumatic stress disorder and depression a-mong children in tsunami-affected areas in southern Thai-land[J].J Am Med Associat,2006,296(5):549-559.
[10]Sharan P,Chaudhary G,Kavathekar SA,et al.Prelimin-ary report of psychiatric disorders in survivors of a severeearthquake[J].Am J Psychiatry,1996,153(4):556-558.
[11]Richard AB,Jeno EM,Jenelle C,et al.Interaction ofposttraumatic stress disorder and chronic pain followingtraumatic brain injury[J].J Head Trauma Rehabil,1999,14:588.
[12]Joff PE,Bast BA.Coping and fefense in relation to accom-adation among a sample of blindman[J].J Never MentDis,1978,166:537-552.
[13]赵玉芳,赵守良.震前生活事件,创伤程度对中学生震后心理健康状况的影响[J].心理科学进展,2009,17(3):511-515.
[14]刘贤臣,马登岱,刘连启.心理创伤后应激障碍自评量表的编制和信度效度研究[J].中国行为医学科学,1998,7(2):93-96.
[15]刘贤臣,刘连启.青少年生活事件量表的编制与信效度测试[J].山东精神医学,1998,10(1):15-19.
[16]解亚宁.简易应对方式量表信度和效度的初步研究[J].中国临床心理学杂志,1998,6(2):114-116.
[17]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.
[18]Caldera T,Palma L,Penayo U,et al.Psychological im-pact of the hurricane mitch in nicaragua in a one-year per-spective[J].Soc Psychiatry Psychiatr Epidemiol,2001,36:108-114.
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