Galea Sandro, Ahern Jennifer, Tracy Melissa, Hubbard Alan, Cerda Magdalena, Goldmann Emily, Vlahov David
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan 48104-2548, USA.
Epidemiology. 2008 Jan;19(1):47-54. doi: 10.1097/EDE.0b013e31815c1dbf.
Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited.
We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models.
Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR] = 1.91 per 1 unit increase in number of stressors, [95% confidence interval = 1.55-2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71-2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09-2.52]; OR = 1.57 for low [1.08-2.35]), low income (OR = 0.87 per $10,000 increase [0.81-0.92]), female sex (1.60 [1.11-2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05-2.97]).
These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.
创伤后应激障碍是一种常见且致残的心理病理学疾病。关于创伤后应激症状预测因素的纵向研究有限。
2002年，我们通过对纽约市大都市区成年居民进行电话调查，招募了2752名参与者参与一项基于人群的前瞻性队列研究；参与者在30个月内完成了3次随访访谈。估计了删失权重以考虑潜在偏差。我们使用带有自抽样置信区间的广义估计方程逻辑回归模型，在多变量模型中评估创伤后应激随时间变化的预测因素。
创伤后应激随时间变化的预测因素包括持续存在的压力源（压力源数量每增加1个单位，优势比[OR]=1.91，[95%置信区间=1.55-2.36]）和创伤事件（创伤事件数量每增加1个单位，OR=1.92[CI=1.71-2.22]）、社会支持（与高水平相比，中等水平的OR=1.71[1.09-2.52]；低水平的OR=1.57[1.08-2.35]）、低收入（每增加10,000美元，OR=0.87[0.8¬1-0.92]）、女性（1.60[1.11-2.23]）以及拉丁裔种族（与白人相比，OR=1.74[1.05-2.97]）。
这些发现表明，持续存在的压力源在解释创伤后应激随时间变化的轨迹方面起着核心作用，并且压力源和创伤经历之外的因素可能解释了创伤后应激风险中的性别和种族差异。专注于减少持续逆境的干预措施可能有助于减轻创伤事件的后果。
