[恐怖袭击受害者创伤后应激的前瞻性研究]
[Prospective study of post-traumatic stress in victims of terrorist attacks].
作者信息
Jehel L, Duchet C, Paterniti S, Consoli S M, Guelfi J D
机构信息
Service de Psychologie Clinique et de Psychiatrie de Liaison, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75908 Paris.
出版信息
Encephale. 2001 Sep-Oct;27(5):393-400.
In 1995-96 several terrorist attacks struck Paris. After that, the French government decided to optimize the service claimed to treat psychological repercussions of attacks victims. For this reason we need to better understand the psychopathology developing after these traumatic events in order to adjust the various steps of the treatment. In December 1996, a terrorist attack occurred in a Paris subway. Medical and medico-psychological teams intervened immediately on the site to help victims. Among 115 victims, 4 persons died and 35 were seriously injured. The aim of our study was to evaluate the psychological impact among a population of terrorist attacks victims by a prospective study and to identify predictive factors of posttraumatic stress disorder (PTSD). We evaluated PTSD rates at 6 and 18 months, the relationship between coping style and PTSD, and whether PTSD increased health care utilization. Two follow up evaluations were performed in the 6th and 7th month respectively, by means of self-questionnaires sent by mail. Among 115 victims of the bombing attack occurred in December 1996, the 111 survivors were asked to participate to the study. The subjects who accepted and could use French questionnaires were considered eligible for the inclusion: the main criteria of the Watson's PTSD Inventory for the specific post-traumatic symptoms were used; the Goldberg's General Health Questionnaire was used to measure the general psychopathology; to identify coping styles we used the questionnaire "Ways of Coping Check List" of Vitaliano at 6 months and the "Coping Inventory for Stressful Situations (CISS)" by Endler at 18 months; a small questionnaire was proposed to evaluate injuries, hospitalization and specific treatment immediately or after the event. Among 70 subjects who accepted to participate, 56 (33 females) could be evaluated at 6 months and 32 (14 females) subjects at 18th months. The mean age at 6 months was 38.4 years: 41% of participants met PTSD criteria at 6 months, 34.4% still had PTSD at 18 months; at 18th months, 50% subjects presented GHQ scores higher than 3, corresponding to the cut-off revealing mental suffering; people hospitalized more than two days immediately after the event presented significantly lower PTSD scores at 6 months. General characteristics of risks factors for PTSD were: at 6 and 18 months, women and younger people presented significantly higher PTSD scores; for the CISS at 18 months Emotion-oriented coping correlated significantly with PTSD (r = 0.49, p = 0.007), while task-oriented coping and PTSD correlated negatively (r = -0.39; p = 0.04). Avoidance coping's styles were not correlated with PTSD. About predictive factors: the GHQ-12 and PTSD-I scores at 6 months were significantly correlated with PTSD-I scores at 18 months (respectively r = 0.73, p = 0.018 and r = 0.75, p = 0.0029); by a multiple regression we observed that PTSD-I score at 6 months predicted the PTSD-I score at 18 months, adjusted on sex and age. The others characteristics at 18 months were: medication use increased significantly at 18 months; people who lived another traumatic event since December 1996 presented a 18 month PTSD score higher than the other victims. In spite of the small size of this sample, the principal interest of this study is the prospective data in a population exposed by the same traumatic event. We note the high score of PTSD at 18 months. Terrorism exposure resulted in persisting PTSD in a significant proportion of victims; this was related to coping style. Moreover PTSD increased health care utilization. We discuss these results comparing with other similar populations in France, Israel and USA. We discuss overall the role of coping styles during the time after an attack; we insist on considering this aspect in the therapeutic strategies. These data contribute to inform that people with a high PTSD score at 6 months presented a high risk to suffer PTSD at 18 months. These results underline the importance of early diagnosis to propose early medical and psychological help to the victims.
1995 - 1996年期间,巴黎遭受了数次恐怖袭击。此后,法国政府决定优化旨在治疗袭击受害者心理创伤的服务。因此,我们需要更好地了解这些创伤事件后出现的精神病理学情况,以便调整治疗的各个环节。1996年12月,巴黎地铁发生了一起恐怖袭击事件。医疗和医学心理团队立即在现场进行干预,以帮助受害者。在115名受害者中,4人死亡,35人受重伤。我们研究的目的是通过前瞻性研究评估恐怖袭击受害者群体的心理影响,并确定创伤后应激障碍(PTSD)的预测因素。我们评估了6个月和18个月时的PTSD发生率、应对方式与PTSD之间的关系,以及PTSD是否增加了医疗保健的利用率。分别在第6个月和第7个月通过邮寄自我问卷的方式进行了两次随访评估。在1996年12月发生的爆炸袭击事件的115名受害者中,111名幸存者被邀请参与研究。接受并能使用法语问卷的受试者被认为符合纳入标准:采用了沃森PTSD量表中针对特定创伤后症状的主要标准;使用戈德堡一般健康问卷来测量一般精神病理学情况;为了确定应对方式,我们在6个月时使用了维塔利阿诺的“应对方式检查表”问卷,在18个月时使用了恩德勒的“应激情境应对量表(CISS)”;还提出了一份小问卷来评估受伤情况、住院情况以及事件发生后立即或之后的具体治疗情况。在70名接受参与的受试者中,56名(33名女性)在6个月时可进行评估,32名(14名女性)受试者在18个月时可进行评估。6个月时的平均年龄为38.4岁:41%的参与者在6个月时符合PTSD标准,34.4%的人在18个月时仍患有PTSD;在18个月时,50%的受试者的GHQ得分高于3,这一分数对应着表明精神痛苦的临界值;事件发生后立即住院超过两天的人在6个月时的PTSD得分显著更低。PTSD风险因素的一般特征如下:在6个月和18个月时,女性和年轻人的PTSD得分显著更高;在18个月时,对于CISS,以情绪为导向的应对方式与PTSD显著相关(r = 0.49,p = 0.007),而以任务为导向的应对方式与PTSD呈负相关(r = -0.39;p = 0.04)。回避应对方式与PTSD无关。关于预测因素:6个月时的GHQ - 12得分和PTSD - I得分与18个月时的PTSD - I得分显著相关(分别为r = 0.73,p = 0.018和r = 0.75,p = 0.0029);通过多元回归分析,我们观察到6个月时的PTSD - I得分可预测18个月时的PTSD - I得分,并根据性别和年龄进行了调整。18个月时的其他特征如下:18个月时药物使用显著增加;自1996年12月以来经历过另一次创伤事件的人在18个月时的PTSD得分高于其他受害者。尽管该样本规模较小,但本研究的主要价值在于同一创伤事件暴露人群中的前瞻性数据。我们注意到18个月时PTSD得分较高。恐怖袭击导致相当一部分受害者持续患有PTSD;这与应对方式有关。此外,PTSD增加了医疗保健的利用率。我们将这些结果与法国、以色列和美国的其他类似人群进行了比较讨论。我们全面讨论了袭击后应对方式的作用;我们强调在治疗策略中应考虑这一方面。这些数据有助于说明6个月时PTSD得分高的人在18个月时患PTSD的风险也高。这些结果强调了早期诊断的重要性,以便为受害者提供早期的医疗和心理帮助。