Melhem Nadine M, Day Nancy, Shear M Katherine, Day Richard, Reynolds Charles F, Brent David
Department of Child and Adolescent Psychiatry, Centers for Mid-Life and Late-Life Mood and Anxiety Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Am J Psychiatry. 2004 Aug;161(8):1411-6. doi: 10.1176/appi.ajp.161.8.1411.
The phenomenology of grief among children and adolescents is not well studied. A syndrome of traumatic grief, distinct from depression and anxiety, has been described among bereaved adults. The purpose of this study was to describe the symptoms and course of traumatic grief among adolescents exposed to a peer's suicide and to examine the relationship between traumatic grief and depression and posttraumatic stress disorder (PTSD) in this population.
A total of 146 friends and acquaintances of 26 suicide victims were included in this study. Subjects were interviewed at 6, 12-18, and 36 months after the peer's suicide. A subgroup was also interviewed 6 years afterward. The Texas Revised Inventory of Grief was administered at 6, 12-18, and 36 months; the Inventory of Complicated Grief was administered at the 6-year assessment.
Principal component analysis of the Texas Revised Inventory of Grief resulted in two factors: one assessing a traumatic grief reaction and another assessing a milder or even normal grief reaction. The occurrence of traumatic grief was found to be independent from that of depression and PTSD. Traumatic grief at 6 months predicted the onset or course of depression and PTSD at subsequent assessments.
Similar to adults, adolescents experience a traumatic grief reaction after exposure to a peer's suicide. Clinicians should be alerted to the occurrence of traumatic grief reactions among adolescents and the need to assess these reactions and address them in their treatment approaches.
儿童和青少年悲伤的现象学尚未得到充分研究。在经历丧亲之痛的成年人中,已经描述了一种与抑郁和焦虑不同的创伤性悲伤综合征。本研究的目的是描述遭受同伴自杀的青少年创伤性悲伤的症状和病程,并探讨该人群中创伤性悲伤与抑郁及创伤后应激障碍(PTSD)之间的关系。
本研究共纳入了26名自杀受害者的146名朋友和熟人。在同伴自杀后的6个月、12 - 18个月和36个月对受试者进行访谈。还在6年后对一个亚组进行了访谈。在6个月、12 - 18个月和36个月时使用德克萨斯修订悲伤量表;在6年评估时使用复杂悲伤量表。
对德克萨斯修订悲伤量表进行主成分分析得出两个因素:一个评估创伤性悲伤反应,另一个评估较轻微甚至正常的悲伤反应。发现创伤性悲伤的发生与抑郁和PTSD的发生无关。6个月时的创伤性悲伤可预测后续评估中抑郁和PTSD的发作或病程。
与成年人相似,青少年在遭受同伴自杀后会经历创伤性悲伤反应。临床医生应警惕青少年中创伤性悲伤反应的发生,以及在治疗方法中评估和处理这些反应的必要性。