创伤暴露后吸烟行为变化与创伤后应激障碍的相关性研究
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摘要
目的了解创伤暴露后吸烟情况的变化与创伤暴露、创伤后应激障碍(PTSD)之间的关系。方法在汶川地震6个月后,采用目前美国PTSD流行病学调查和诊断工具,按整群分层抽样原则对1 125名参加汶川抗震救灾现场救援军人在抗震救灾前后吸烟情况的变化及PTSD的患病情况进行调查。PTSD诊断分别采用Davidson创伤量表(DTS)和DSM-Ⅳ标准确定。结果实查1 056人,共检出PTSD患者69例,患病率为6.53%。本调查发现:(1)创伤暴露未对吸烟产生不利影响。创伤暴露后总的吸烟人数仅增加5例,吸烟量由创伤暴露前的(9.43±6.13)支/天减少到创伤暴露后的(8.04±6.05)支/天(t=6.595,P=0.000)。(2)PTSD对吸烟有显著影响。PTSD与非PTSD相比会增加创伤暴露后初始吸烟的危险性(31.3%vs12.9%,χ2=4.394,P=0.036)。虽然PTSD组创伤暴露前、后总的吸烟量无明显改变(t=1.802,P=0.077),但创伤暴露后自诉吸烟量增多者PTSD组显著高于非PTSD组(χ2=17.127,P=0.000)。(3)多元Logistic回归分析表明,服役满意度低(OR=2.574,P=0.000)、创伤暴露后患PTSD(OR=2.529,P=0.001)、创伤暴露前为烟草依赖者(OR=1.334,P=0.002)、军龄长(OR=1.334,P=0.002)是地震现场救援军人创伤暴露后吸烟行为增加的显著危险因素。结论创伤暴露对吸烟无明显影响,而患PTSD会增加吸烟的危险。
Objective To investigate the association between trauma event exposure,post traumatic stress disorder(PTSD) and changes of smoking behavior.MethodsA total of 1 125 rescuing soilders experiencing Wen Chuan earthquake were enrolled stratifiedly in the study 6 months after the earthquake.They were assessed with social-demographic characteristics,the Davidson trauma scale(DTS),earthquake experience questionnaire and self-made nicotine dependence screening scale.The PTSD diagnosis was based on both DTS≥40 and DSM-IV criteria.ResultsThe final analysis was carried out on 1056 rescuing soilders.The prevalence of PTSD was 6.53%(69 cases) according to DTS criteria and DSM-IV criteria.(1)Amount of smokers increased only 5 cases after the trauma exposure,while the amount of smoking per day increased from 9.43±6.13 before the trauma exposure to 8.04±6.05 after the trauma exposure (t=6.595,P=0.000).(2)PTSD augmented the risk of smoking after the trauma exposure when compared with non-PTSD group(31.3% vs 12.9%,χ2=4.394,P=0.036).There was no significant change in amount of smoking after the trauma exposure in PTSD group,however,cases with complain of increased smoking in PTSD group were significantly more than those in non-PTSD group(χ2=17.127,P=0.000).(3)Multiple logistic regression analysis showed that low satisfaction in military service(OR=2.574,P=0.000),PTSD after trauma exposure(OR=2.529,P=0.001),nicotine dependence before trauma exposure(OR=1.334,P=0.002) and long length of military serive(OR=1.334,P=0.002)were significant predictors of increasing smoking behavior.ConclusionThis study showed that trauma exposure did not contribute to nicotine use,but PTSD was significantly associated with risk of smoking onset.
Objective To investigate the association between trauma event exposure,post traumatic stress disorder(PTSD) and changes of smoking behavior.MethodsA total of 1 125 rescuing soilders experiencing Wen Chuan earthquake were enrolled stratifiedly in the study 6 months after the earthquake.They were assessed with social-demographic characteristics,the Davidson trauma scale(DTS),earthquake experience questionnaire and self-made nicotine dependence screening scale.The PTSD diagnosis was based on both DTS≥40 and DSM-IV criteria.ResultsThe final analysis was carried out on 1056 rescuing soilders.The prevalence of PTSD was 6.53%(69 cases) according to DTS criteria and DSM-IV criteria.(1)Amount of smokers increased only 5 cases after the trauma exposure,while the amount of smoking per day increased from 9.43±6.13 before the trauma exposure to 8.04±6.05 after the trauma exposure (t=6.595,P=0.000).(2)PTSD augmented the risk of smoking after the trauma exposure when compared with non-PTSD group(31.3% vs 12.9%,χ2=4.394,P=0.036).There was no significant change in amount of smoking after the trauma exposure in PTSD group,however,cases with complain of increased smoking in PTSD group were significantly more than those in non-PTSD group(χ2=17.127,P=0.000).(3)Multiple logistic regression analysis showed that low satisfaction in military service(OR=2.574,P=0.000),PTSD after trauma exposure(OR=2.529,P=0.001),nicotine dependence before trauma exposure(OR=1.334,P=0.002) and long length of military serive(OR=1.334,P=0.002)were significant predictors of increasing smoking behavior.ConclusionThis study showed that trauma exposure did not contribute to nicotine use,but PTSD was significantly associated with risk of smoking onset.
引文
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2 Nandi A,Galea S,Ahern J,et al.Probable cigarette dependence,PTSD,and depression after an urban disaster:results from apopulation survey of New York City residents 4 months afterSeptember 11,2001[J].Psychiatry,2005,68(4):311
3 Hapke U,Schumann A,Rumpf HJ,et al.Association of smokingand nicotine dependence with trauma and posttraumatic stressdisorder in a general population sample[J].J Nerv Ment Dis,2005,193(12):843
4 Amstadter AB,Nuqent NR,Koenen KC.Association betweenCOMT,PTSD,and increased smoking following hurricaneexposure in an epidemiologic sample[J].Psychiatry,2009,72(4):360
5 Parslow RA,Jorm AF.Tobacco use after experiencing a majornatural disaster:analysis of a longitudinal study of 2063 youngadults[J].Addiction,2006,101(7):1044
6 Cook J,Jakupcak M,Rosenheck R,et al.Influence of PTSDsymptom cluster on smoking status among help-seeking Iraqand Afghanistan veterans[J].Nicotine Tob Res,2009,11(10):1189
7 American Psychiatric Association.Diagnostic and StatisticalManual of Mental Disorders 4th ed[M].DSM-Ⅳ.Washington:APA,1994:424
8 WHO.Guidelines for the conduct of tobacco smoking surveys ofthe general population[J].Genev:WHO/SMO,1983:14
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