Schreiber Shaul, Soskolne Varda, Kozohovitch Haim, Deviri Ehud
Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.
Gen Hosp Psychiatry. 2004 Nov-Dec;26(6):443-52. doi: 10.1016/j.genhosppsych.2004.06.005.
History of prolonged traumatization has been associated with reduced quality of life (QoL) and difficulties in coping with major life-threatening conditions. We assessed the association between the impact of Holocaust experience (posttraumatic symptoms) and QoL of patients before and after an open heart surgery.
Sixty-three Holocaust survivors were interviewed before open heart surgery (at admission), 52 at follow-up at 1 week, and 58 at follow-up at 6 months. The interview included background data, Impact of Event Scale (IES), Mastery scale, and QoL measured by the Nottingham Health Profile. Medical data were retrieved from the patients' charts.
The total IES score indicate a high level of posttraumatic symptoms at all the time points (close to a mean of 18), but there was a clear trend of changes in the avoidance subscale: At admission, the patients manifested lower avoidance compared with the levels after the surgery and at the follow-up. No significant differences in IES were found by Holocaust experiences. Significant improvements in most components of QoL were found at the follow-up. In multivariate analyses at each time point, the findings show that those with higher levels of posttraumatic symptoms are more at risk for problems in pain and mobility domains of QoL at admission, for emotional reaction after the surgery, and at the follow-up, these associations are only at trend level, while lower sense of mastery became significant.
The improvement in QoL despite persistence of the impact of the Holocaust may indicate that past severe prolonged traumatization does not necessarily reduce the survivors' ability to cope with and regain physical and psychosocial functioning after a severe life-threatening medical condition. This may be further generalized to other significant crisis situations in life, such as prolonged periods of stress, suffered by many populations throughout the world.
长期遭受创伤的经历与生活质量（QoL）下降以及应对重大危及生命状况的困难有关。我们评估了大屠杀经历的影响（创伤后症状）与心脏直视手术前后患者生活质量之间的关联。
对63名大屠杀幸存者在心脏直视手术前（入院时）进行访谈，1周随访时有52人，6个月随访时有58人。访谈内容包括背景数据、事件影响量表（IES）、掌控感量表以及通过诺丁汉健康概况测量的生活质量。从患者病历中获取医疗数据。
IES总分表明在所有时间点创伤后症状水平都很高（接近平均18分），但回避分量表有明显的变化趋势：入院时，患者表现出的回避程度低于手术后及随访时的水平。按大屠杀经历未发现IES有显著差异。在随访时发现生活质量的大多数组成部分有显著改善。在每个时间点的多变量分析中，结果表明创伤后症状水平较高的人在入院时生活质量的疼痛和活动领域出现问题的风险更高，在手术后及随访时有情绪反应，这些关联仅处于趋势水平，而较低的掌控感变得显著。
尽管大屠杀的影响持续存在，但生活质量仍有改善，这可能表明过去严重且长期的创伤不一定会降低幸存者在严重危及生命的医疗状况后应对并恢复身体和心理社会功能的能力。这可能进一步推广到生活中的其他重大危机情况，例如全世界许多人群遭受的长期压力。
