McMillen Curtis, North Carol, Mosley Muriel, Smith Elizabeth
Department of Psychiatry, School of Medicine, Washington University, St Louis, MO 63130, USA.
Compr Psychiatry. 2002 Nov-Dec;43(6):478-85. doi: 10.1053/comp.2002.34632.
This report empirically examines multiple explanations for the high rates of psychiatric comorbidity seen with posttraumatic stress disorder (PTSD). One hundred sixty-two St. Louis area survivors of the 1993 Great Midwest Floods were interviewed a few months after the flood subsided using the Diagnostic Interview Schedule (DIS) and its Disaster Supplement to assess psychiatric history relative to PTSD and five other psychiatric disorders. Thirty-five subjects (23%) met criteria for PTSD related to the flood. PTSD was frequently comorbid with other disorders. Seventeen subjects (10%) developed a new, non-PTSD psychiatric disorder after the flood. New non-PTSD disorders were rare in the absence of PTSD symptoms. Though prior psychiatric history was predictive of developing PTSD, no support was found that prior psychiatric history contributed to PTSD through social vulnerability. Thus, support was found for a model in which PTSD contributes to the development of other disorders following trauma, whereas no evidence was found to suggest that comorbid disorders develop independently of PTSD following trauma, or that comorbidity was due to symptom overlap among disorders. The lack of support for models in which psychosocial resources mediate the effect of psychiatric history on the development of PTSD indirectly confirms models of physiological vulnerability to PTSD development.
本报告通过实证研究，对创伤后应激障碍（PTSD）患者中高比例的精神疾病共病现象进行了多种解释。1993年中西部大洪水的162名圣路易斯地区幸存者在洪水退去几个月后接受了访谈，使用诊断访谈表（DIS）及其灾难补充表来评估与PTSD及其他五种精神疾病相关的精神病史。35名受试者（23%）符合与洪水相关的PTSD标准。PTSD常与其他疾病共病。17名受试者（10%）在洪水后患上了一种新的、非PTSD的精神疾病。在没有PTSD症状的情况下，新的非PTSD疾病很少见。虽然既往精神病史可预测PTSD的发生，但未发现支持既往精神病史通过社会易感性导致PTSD的证据。因此，研究支持了一种模型，即PTSD会导致创伤后其他疾病的发生，而没有证据表明共病疾病在创伤后独立于PTSD发生，或者共病是由于疾病之间的症状重叠。对社会心理资源介导精神病史对PTSD发生影响的模型缺乏支持，这间接证实了PTSD发生的生理易感性模型。
