Simeon Daphne, Greenberg Jennifer, Nelson Dorothy, Schmeidler James, Hollander Eric
Mount Sinai School of Medicine, Department of Psychiatry, New York, NY 10029, USA.
J Clin Psychiatry. 2005 Feb;66(2):231-7. doi: 10.4088/jcp.v66n0212.
We conducted a 1-year follow-up of an original mail survey of early reactions to the World Trade Center disaster.
Of the 75 subjects originally surveyed, 58 (77%) responded. The survey included measures of dissociation (Dissociative Experiences Scale, Cambridge Depersonalization Scale, Clinician-Administered Dissociative States Scale), post-traumatic stress (Impact of Event Scale-Revised), social support (Interpersonal Support Evaluation List-short form), and a life quality measure (Quality of Life Enjoyment and Satisfaction Questionnaire-short form). We hypothesized that dissociative versus posttraumatic symptoms at follow-up could be dissected on the basis of early reactions.
Responders and nonresponders did not differ in baseline characteristics. Exposure was not associated with dissociation or posttraumatic stress at follow-up. Of distress, dissociation, and posttraumatic stress at baseline, baseline dissociation was the strongest predictor of outcome dissociation while baseline posttraumatic stress was the strongest predictor of outcome posttraumatic stress. Of 4 peritraumatic distress factors generated in the original survey, "loss of control" and "guilt/shame" were significantly related to dissociation and posttraumatic stress at outcome, while "helplessness/anger" was only associated with posttraumatic stress at outcome. Lesser improvement in posttraumatic stress over the first year was significantly related to less social support and greater comorbid dissociation. Interim social support was associated with better life quality and fewer symptoms at outcome.
There was evidence for partly independent pathways toward dissociation versus posttraumatic stress 1 year after the disaster. Feelings of guilt and shame, and persistent dissociation, were poor prognostic factors, while social support had a powerful ameliorating influence.
我们对一项关于世贸中心灾难早期反应的原始邮件调查进行了为期1年的随访。
在最初调查的75名受试者中，58名（77%）进行了回复。该调查包括解离测量（解离体验量表、剑桥人格解体量表、临床医生施测的解离状态量表）、创伤后应激测量（事件影响量表修订版）、社会支持测量（人际支持评估清单简表）以及生活质量测量（生活质量享受与满意度问卷简表）。我们假设随访时的解离症状与创伤后应激症状可根据早期反应进行区分。
回复者与未回复者在基线特征方面无差异。随访时暴露与解离或创伤后应激无关。在基线时的痛苦、解离和创伤后应激中，基线解离是结局解离的最强预测因素，而基线创伤后应激是结局创伤后应激的最强预测因素。在原始调查中产生的4个创伤周围痛苦因素中，“失去控制”和“内疚/羞耻”与结局时的解离和创伤后应激显著相关，而“无助/愤怒”仅与结局时的创伤后应激相关。创伤后应激在第一年的改善较少与社会支持较少及共病解离较多显著相关。中期社会支持与更好的生活质量及结局时较少的症状相关。
有证据表明灾难发生1年后，解离和创伤后应激存在部分独立的发展路径。内疚和羞耻感以及持续的解离是不良预后因素，而社会支持具有强大的改善作用。
