5·12汶川大地震灾民创伤后应激障碍的特点分析
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摘要
目的了解5.12汶川大地震3月后北川灾民的心理健康状况以及创伤后应激障碍的特点。方法对义诊接待的140名灾民利用90项症状清单(SCL-90)和创伤后应激障碍(PTSD)简易筛查量表(SPAN)进行评分。结果86例(61.4%)发生PTSD,SCL-90总分PTSD组为(225.37±41.32)分,非PTSD组为(198.78±43.12)分,均显著高于全国常模(P<0.01);两组躯体化、抑郁、焦虑、惊恐因子分也显著高于全国常模;PTSD组躯体化、强迫、抑郁、焦虑、恐怖、偏执、精神病性因子得分与全国常模差异有显著性意义(P<0.01),躯体化、抑郁、偏执、精神病性因子得分与非PTSD组差异有显著性意义(P<0.05)。结论在PTSD灾民中,抑郁和躯体化是两个突出的表现,抑郁存在自杀的风险,应给予足够的重视;躯体症状常掩盖了情绪障碍,临床医生在对灾民的诊治过程中,应注意到躯体症状背后可能隐藏着的情绪问题。
Objective To investigate the mental health status and the characteristic of posttraumatic stress disorder(PTSD)in victims of Wenchuan earthquake in Beichuan county.Methods 140 victims were surveyed using the Symptom Checklist 90(SCL-90) and PTSD screening scale(SPAN scale) in our hospital.Results 86(61.4 %) cases were diagnosed as PTSD.Total scores of SCL-90 in PTSD group and non-PTSD group were 225.37±41.32 and 198.78±43.12 respectively.They were significantly higher than the national norm(P < 0.01).The scores of somatization,obsession,depression,anxiety,fear,paranoid,psychosis in PTSD group were significantly different as compared with the national norm(P < 0.01).The scores of somatization,depression,paranoid,psychosis in PTSD group were significantly different as compared with non-PTSD group(P < 0.05 or 0.01).Conclusion In the victims with PTSD,depression and somzatization are outstanding performance.Depression should be given enough care due to the risk of suicide.Clinicians should be sensitive to note that the emotional problem hidden behind the body symptoms during the diagnosis and treatment of victims.
Objective To investigate the mental health status and the characteristic of posttraumatic stress disorder(PTSD)in victims of Wenchuan earthquake in Beichuan county.Methods 140 victims were surveyed using the Symptom Checklist 90(SCL-90) and PTSD screening scale(SPAN scale) in our hospital.Results 86(61.4 %) cases were diagnosed as PTSD.Total scores of SCL-90 in PTSD group and non-PTSD group were 225.37±41.32 and 198.78±43.12 respectively.They were significantly higher than the national norm(P < 0.01).The scores of somatization,obsession,depression,anxiety,fear,paranoid,psychosis in PTSD group were significantly different as compared with the national norm(P < 0.01).The scores of somatization,depression,paranoid,psychosis in PTSD group were significantly different as compared with non-PTSD group(P < 0.05 or 0.01).Conclusion In the victims with PTSD,depression and somzatization are outstanding performance.Depression should be given enough care due to the risk of suicide.Clinicians should be sensitive to note that the emotional problem hidden behind the body symptoms during the diagnosis and treatment of victims.
引文
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[13]樊毫军,侯世科,彭碧波,等.印尼海啸后难民心理状况调查[J].中国行为医学科学,2006,15(1):74.
[14]Yehuda R,McFarlane AC.Conflict between current Knowledge aboutposttraumatic stress disorder and its original conceptual basis[J].Am JPsychiatry,1995,152(5):1705-1713.
[15]杨德森.基础精神医学[M].长沙:湖南科学技术出版社,1994.
[2]Ehlers A,Clark DM,Hackmann A,et al.A randomized controlled trialof cognitive therapy,a self-help booklet,and repeated assessments asearly interventions for posttraumatic stress disorder[J].Arch Gen Psy-chiat,2003,60(10):1024-1032.
[3]Breslau N,Davis CG,Peterson EL,et al.A second look at comorbibityin victims of trauma.The posttraumatic stress disorder major depressionconnection[J].Biol Psychiatry,2000,48(2):902-909.
[4]金华,吴文源,张明园.中国正常人SCL-90评定结果的初步分析[J].中国神经精神疾病杂志,1986,12(1):260-262.
[5]Yehuda R.McFarlane AC1 Conflict between current knowledge aboutposttraumatic stress disorder and its original concep tual basis1[J].AmJ p sychiatry,1995,152(4):1705-17131.
[6]伍志刚,刘爱忠,谭红专,等.洪灾区成人PTSD及其危险因素的研究[J].中国临床心理学杂志,2003,11(3):173-175.
[7]汪向东,张华彪,新福尚隆,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.
[8]张本,王学义,孙贺祥.唐山大地震所致孤儿心理创伤后应激障碍的调查[J].中华精神科杂志,2000,3(2):111-114.
[9]侯彩兰,李凌江,张燕,等.矿难后2个月和10个月创伤后应激障碍的发生率及相关因素[J].中南大学学报.医学版,2008,33(4):279-283.
[10]Yilmaz V,Cangur S,Clik HE.Sex difference and earthquake experi-ence effects on earthquake victims[J].Pers Individ Dif,2005,39(2):341-348.
[11]王相兰,陶炯,温盛霖,等.汶川地震灾民的心理健康状况及影响因素[J].中山大学学报.医学科学版,2008,29(4):367-371.
[12]Chen CC,Yeh TL,YangYK,et al.Psychiatric morbidity and post-trau-matic symptoms among survivors in the early stage following the 1999earthquake in Taiwan[J].Psychiatry Res,2001,105(12):13-22.
[13]樊毫军,侯世科,彭碧波,等.印尼海啸后难民心理状况调查[J].中国行为医学科学,2006,15(1):74.
[14]Yehuda R,McFarlane AC.Conflict between current Knowledge aboutposttraumatic stress disorder and its original conceptual basis[J].Am JPsychiatry,1995,152(5):1705-1713.
[15]杨德森.基础精神医学[M].长沙:湖南科学技术出版社,1994.
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