Koren D, Arnon I, Klein E
Department of Psychiatry of the Rambam Medical Center and the B. Rappaport Faculty of Medicine, Technion, I.I.T., Haifa, Israel.
Am J Psychiatry. 1999 Mar;156(3):367-73. doi: 10.1176/ajp.156.3.367.
This study was designed to assess the natural course of posttraumatic symptoms formation, as well as the degree to which acute stress reactions predict later posttraumatic stress disorder (PTSD) in injured traffic accident victims.
A prospective, 1-year follow-up study was carried out on 74 injured traffic accident victims and a comparison group of 19 patients who were hospitalized for elective orthopedic surgery. Participants were interviewed within the first week following the accident, and follow-up interviews were performed 1, 3, 6, and 12 months after the accident. At 12 months, a structured clinical interview was administered to determine a formal DSM-III-R diagnosis of PTSD.
Twenty-four (32%) of the 74 traffic accident victims, but none of the 19 comparison subjects, met DSM-III-R criteria for PTSD at 1 year. Traffic accident victims who developed PTSD had higher levels of premorbid and comorbid psychopathology. Levels of posttraumatic symptoms were significantly higher from the outset in the subjects who developed PTSD and worsened progressively over the first 3 months, in contrast to subjects without PTSD, who manifested gradual amelioration of symptoms during this time. Existence of posttraumatic symptoms immediately after the accident was a better predictor of later PTSD than was accident or injury severity.
In this study, a significant portion of injured traffic accident victims manifested PTSD 1 year after the event. The development of PTSD at 1 year can be predicted as early as 1 week after the accident on the basis of the existence and severity of early PTSD-related symptoms. However, the first 3 months following the accident appear to be the critical period for the development of PTSD.
本研究旨在评估创伤后症状形成的自然病程，以及急性应激反应对受伤交通事故受害者后期创伤后应激障碍（PTSD）的预测程度。
对74名受伤的交通事故受害者以及19名因择期骨科手术住院的患者组成的对照组进行了为期1年的前瞻性随访研究。在事故发生后的第一周内对参与者进行访谈，并在事故发生后的1、3、6和12个月进行随访访谈。在12个月时，进行结构化临床访谈以确定PTSD的正式DSM-III-R诊断。
74名交通事故受害者中有24名（32%）在1年时符合PTSD的DSM-III-R标准，但19名对照受试者中无人符合该标准。患PTSD的交通事故受害者病前和共病精神病理学水平较高。与未患PTSD的受试者相比，患PTSD的受试者从一开始创伤后症状水平就显著更高，并在最初3个月内逐渐恶化，而未患PTSD的受试者在此期间症状逐渐改善。事故后立即出现的创伤后症状比事故或损伤严重程度更能预测后期的PTSD。
在本研究中，相当一部分受伤的交通事故受害者在事件发生1年后出现了PTSD。根据早期与PTSD相关症状的存在和严重程度，早在事故发生1周后就能预测1年后PTSD的发生。然而，事故后的前3个月似乎是PTSD发生的关键时期。
