Malt U F, Olafsen O M
Department of Psychosomatic and Behavioral Medicine, National Hospital, University of Oslo, Norway.
Psychiatr Med. 1992;10(3):117-34.
We studied the cognitive, emotional and behavioral responses at four points of time in a random sample of 109 accidentally injured adults via audio taped semistructured interviews and self-assessment rating scales. Neither the subjects appraisal of death or disability, nor the emotional responses corresponded strongly to the severity of the physical injury sustained or the "objective" threat to life but, instead, reflected, to a large extent, the personal meaning of the injury or the accident. Dissociative responses reported by 17 persons were of short duration and associated with young age and immaturity, and did not predict or a poor longterm post-traumatic psychiatric course. Ratings of intrusion, avoidance and anxiety were more strongly associated with psychopathology than "objective" danger or injury severity. This study indicates that following civilian trauma, the cognitive, emotional and behavioral responses are strongly related to preaccident and accident-independent life circumstances. The findings question the validity of the DSM-IIIR criterion of stressors of PTSD in civilian accidents, and suggest that post-traumatic mental disorders should be evaluated in much the same way as psychiatric disorders after physical illness.
我们通过录音半结构化访谈和自我评估量表，对109名意外受伤成年人的随机样本在四个时间点的认知、情绪和行为反应进行了研究。受试者对死亡或残疾的评估以及情绪反应，均与所遭受身体损伤的严重程度或对生命的“客观”威胁没有强烈关联，相反，在很大程度上反映了损伤或事故的个人意义。17人报告的分离反应持续时间较短，且与年轻和不成熟有关，并未预示创伤后精神疾病的不良长期病程。闯入、回避和焦虑评分与精神病理学的关联，比与“客观”危险或损伤严重程度的关联更为紧密。这项研究表明，在平民创伤后，认知、情绪和行为反应与事故前及与事故无关的生活状况密切相关。这些发现质疑了《精神疾病诊断与统计手册》第三版修订本（DSM-IIIR）中创伤后应激障碍（PTSD）应激源标准在平民事故中的有效性，并表明创伤后精神障碍的评估方式应与身体疾病后的精神障碍评估方式大致相同。
