Udwin O, Boyle S, Yule W, Bolton D, O'Ryan D
South London and Maudsley NHS Trust, Mary Sheridan Centre for Child Health, UK.
J Child Psychol Psychiatry. 2000 Nov;41(8):969-79.
This paper examines risk factors for the development of Post Traumatic Stress Disorder (PTSD), and its severity and chronicity, in a group of 217 young adults who survived a shipping disaster in adolescence. The survivors were followed up 5 to 8 years after the disaster. Risk factors examined fell into three main categories: pre-disaster child and family vulnerability factors, including childhood psychopathology; objective and subjective disaster-related experiences; and post-disaster factors, including results from screening questionnaires administered 5 months post-disaster, coping mechanisms adopted subsequently, life events, and availability of social supports. Developing PTSD following the disaster was significantly associated with being female, with pre-disaster factors of learning and psychological difficulties in the child and violence in the home, with severity of exposure to the disaster, survivors' subjective appraisal of the experience, adjustment in the early post-disaster period, and life events and social supports subsequently. When all these factors were considered together, measures of the degree of exposure to the disaster and of subjective appraisal of life threat, and ratings of anxiety obtained 5 months post-disaster, best predicted whether survivors developed PTSD. For those survivors who developed PTSD, its duration and severity were best predicted not by objective and subjective disaster-related factors, but by pre-disaster vulnerability factors of social, physical, and psychological difficulties in childhood together with ratings of depression obtained 5 months post-disaster, and whether survivors received post-disaster support at school. The implications of these findings are considered for targeting assessment and intervention efforts at survivors most at risk of developing difficulties in adjustment following similar traumatic experiences.
本文调查了217名在青少年时期经历过海难并幸存下来的年轻人中创伤后应激障碍（PTSD）的发病风险因素、严重程度及慢性化情况。在灾难发生5至8年后对幸存者进行了随访。所调查的风险因素主要分为三大类：灾前儿童及家庭脆弱性因素，包括儿童期精神病理学；客观及主观的与灾难相关的经历；以及灾后因素，包括灾难发生5个月后进行的筛查问卷结果、随后采取的应对机制、生活事件及社会支持的可获得性。灾难后发生PTSD与女性性别、儿童期学习及心理困难和家庭暴力等灾前因素、灾难暴露的严重程度、幸存者对经历的主观评估、灾后早期的适应情况以及随后的生活事件和社会支持显著相关。当综合考虑所有这些因素时，灾难暴露程度和生命威胁主观评估的指标，以及灾难发生5个月后获得的焦虑评分，最能预测幸存者是否会发生PTSD。对于那些发生PTSD的幸存者，其病程和严重程度并非由与灾难相关的客观和主观因素最佳预测，而是由儿童期社会、身体和心理困难的灾前脆弱性因素、灾难发生5个月后获得的抑郁评分，以及幸存者在学校是否获得灾后支持最佳预测。针对在类似创伤经历后最有可能出现适应困难的幸存者进行评估和干预，本文对这些研究结果的意义进行了探讨。
