Goenjian A K, Molina L, Steinberg A M, Fairbanks L A, Alvarez M L, Goenjian H A, Pynoos R S
Trauma Psychiatry Program, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, CA, USA.
Am J Psychiatry. 2001 May;158(5):788-94. doi: 10.1176/appi.ajp.158.5.788.
This study determined the severity of posttraumatic stress and depressive reactions among Nicaraguan adolescents after Hurricane Mitch and the relationship of these reactions to objective and subjective features of hurricane exposure, death of a family member, forced relocation, and thoughts of revenge.
Six months after the hurricane, 158 adolescents from three differentially exposed cities were evaluated by using a hurricane exposure questionnaire, the Child Posttraumatic Stress Disorder Reaction Index, and the Depression Self-Rating SCALE:
Severe levels of posttraumatic stress and depressive reactions were found among adolescents in the two most heavily affected cities. Severity of posttraumatic stress and depressive reactions and features of objective hurricane-related experiences followed a "dose-of-exposure" pattern that was congruent with the rates of death and destruction across cities. Level of impact (city), objective and subjective features, and thoughts of revenge accounted for 68% of the variance in severity of posttraumatic stress reaction. Severity of posttraumatic stress reaction, death of a family member, and sex accounted for 59% of the variance in severity of depression.
After a category 5 hurricane, adolescents in heavily affected areas with extreme objective and subjective hurricane-related traumatic features of exposure experience severe and chronic posttraumatic stress and comorbid depressive reactions. The recovery of the severely affected Nicaraguan adolescents is vital to the social and economic recovery of a country ravaged by years of political violence and poverty. These findings strongly indicate the need to incorporate public mental health approaches, including systematic screening and trauma/grief-focused interventions, within a comprehensive disaster recovery program.
本研究确定了米奇飓风过后尼加拉瓜青少年创伤后应激和抑郁反应的严重程度，以及这些反应与飓风暴露的客观和主观特征、家庭成员死亡、被迫搬迁和复仇念头之间的关系。
飓风过后六个月，使用飓风暴露问卷、儿童创伤后应激障碍反应指数和抑郁自评量表对来自三个受灾程度不同城市的158名青少年进行了评估。
在受灾最严重的两个城市的青少年中发现了严重的创伤后应激和抑郁反应。创伤后应激和抑郁反应的严重程度以及与飓风相关的客观经历特征呈现出一种“暴露剂量”模式，这与各城市的死亡和破坏率相符。影响程度（城市）、客观和主观特征以及复仇念头占创伤后应激反应严重程度差异的68%。创伤后应激反应的严重程度、家庭成员死亡和性别占抑郁严重程度差异的59%。
在五级飓风过后，遭受与飓风相关的极端客观和主观创伤性暴露特征影响的重灾区青少年会经历严重且长期的创伤后应激以及共病性抑郁反应。对于这个多年遭受政治暴力和贫困蹂躏的国家而言，严重受灾的尼加拉瓜青少年的康复对于其社会和经济复苏至关重要。这些发现强烈表明，有必要在全面的灾难恢复计划中纳入公共心理健康方法，包括系统筛查和以创伤/悲伤为重点的干预措施。
