Grieger Thomas A, Cozza Stephen J, Ursano Robert J, Hoge Charles, Martinez Patricia E, Engel Charles C, Wain Harold J
Department of Psychiatry, B-3074, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA.
Am J Psychiatry. 2006 Oct;163(10):1777-83; quiz 1860. doi: 10.1176/ajp.2006.163.10.1777.
This study examined rates, predictors, and course of probable posttraumatic stress disorder (PTSD) and depression among seriously injured soldiers during and following hospitalization.
The patients were 613 U.S. soldiers hospitalized following serious combat injury. Standardized screening instruments were administered 1, 4, and 7 months following injury; 243 soldiers completed all three assessments. Cross-sectional and longitudinal analyses of risk factors were performed. PTSD was assessed with the PTSD Checklist; depression was assessed with the Patient Health Questionnaire. Combat exposure, deployment length, and severity of physical problems were also assessed.
At 1 month, 4.2% of the soldiers had probable PTSD and 4.4% had depression; at 4 months, 12.2% had PTSD and 8.9% had depression; at 7 months, 12.0% had PTSD and 9.3% had depression. In the longitudinal cohort, 78.8% of those positive for PTSD or depression at 7 months screened negative for both conditions at 1 month. High levels of physical problems at 1 month were significantly predictive of PTSD (odds ratio=9.1) and depression at 7 months (odds ratio=5.7) when the analysis controlled for demographic variables, combat exposure, and duration of deployment. Physical problem severity at 1 month was also associated with PTSD and depression severity at 7 months after control for 1-month PTSD and depression severity, demographic variables, combat exposure, and deployment length.
Early severity of physical problems was strongly associated with later PTSD or depression. The majority of soldiers with PTSD or depression at 7 months did not meet criteria for either condition at 1 month.
本研究调查了重伤士兵在住院期间及出院后可能患创伤后应激障碍（PTSD）和抑郁症的发生率、预测因素及病程。
研究对象为613名因严重战斗受伤而住院的美国士兵。在受伤后1个月、4个月和7个月使用标准化筛查工具进行评估；243名士兵完成了全部三次评估。对危险因素进行了横断面和纵向分析。使用PTSD检查表评估PTSD；使用患者健康问卷评估抑郁症。还评估了战斗暴露情况、部署时长和身体问题的严重程度。
在1个月时，4.2%的士兵可能患有PTSD，4.4%的士兵患有抑郁症；在4个月时，12.2%的士兵患有PTSD，8.9%的士兵患有抑郁症；在7个月时，12.0%的士兵患有PTSD，9.3%的士兵患有抑郁症。在纵向队列中，7个月时PTSD或抑郁症呈阳性的士兵中，78.8%在1个月时这两种情况的筛查均为阴性。在分析中控制了人口统计学变量、战斗暴露情况和部署时长后，1个月时严重的身体问题显著预测了7个月时的PTSD（优势比=9.1）和抑郁症（优势比=5.7）。在控制了1个月时的PTSD和抑郁症严重程度、人口统计学变量、战斗暴露情况和部署时长后，1个月时身体问题的严重程度也与7个月时PTSD和抑郁症的严重程度相关。
早期身体问题的严重程度与后期的PTSD或抑郁症密切相关。7个月时患有PTSD或抑郁症的大多数士兵在1个月时不符合任何一种情况的标准。
