Nishi Daisuke, Matsuoka Yutaka, Nakajima Satomi, Noguchi Hiroko, Kim Yoshiharu, Kanba Shigenobu, Schnyder Ulrich
Department of Psychiatry, National Disaster Medical Center, Tokyo 190-0014, Japan.
Compr Psychiatry. 2008 Jul-Aug;49(4):393-8. doi: 10.1016/j.comppsych.2008.02.003. Epub 2008 Apr 1.
In longitudinal studies of traumatic stress, it is particularly important to examine the data for any differences between those who drop out and those who continue to participate, because reluctance to participate might reflect symptoms of avoidance frequently seen in posttraumatic stress disorder (PTSD). However, whether those who drop out are at high risk of PTSD remains unclear. Over a 25-month period, 188 consecutive patients with motor vehicle accident (MVA)-related injuries admitted emergently were enrolled and followed for 4 to 6 weeks. Baseline characteristics were compared between subjects who did and did not participate in the follow-up study. At 4 to 6 weeks, 66 (35.1%) of the participants had dropped out. Bivariate analyses revealed that those who dropped out were likely to be men, alcohol drinkers, smokers, and unconscious just after MVA and to have fewer years of education, less severe injuries, less posttraumatic symptoms, and lower cooperativeness as assessed by the Temperament and Character Inventory. Logistic regression analysis revealed that male sex, unconsciousness during MVA, low cooperativeness, and less severe injuries were significant predictors of dropout. The literature says that male sex and unconsciousness just after MVA might be protective factors against MVA-related PTSD, whereas low cooperativeness is a risk factor for general mental problems. To summarize, it is expected that those who drop from the follow-up are unlikely to have MVA-related PTSD, but might have mental problems independent of injury.
在创伤应激的纵向研究中,特别重要的是检查退出研究的人和继续参与研究的人之间的数据差异,因为不愿参与可能反映了创伤后应激障碍(PTSD)中常见的回避症状。然而,退出研究的人是否有患PTSD的高风险仍不清楚。在25个月的时间里,连续纳入了188例因机动车事故(MVA)相关损伤而紧急入院的患者,并随访4至6周。对参与和未参与随访研究的受试者的基线特征进行了比较。在4至6周时,66名(35.1%)参与者退出。双变量分析显示,退出者可能为男性、饮酒者、吸烟者,在MVA后即刻昏迷,且受教育年限较少、损伤较轻、创伤后症状较少,以及根据气质和性格量表评估的合作性较低。逻辑回归分析显示,男性、MVA期间昏迷、合作性低和损伤较轻是退出的显著预测因素。文献表明,男性和MVA后即刻昏迷可能是预防MVA相关PTSD的保护因素,而合作性低是一般精神问题的风险因素。总之,预计退出随访的人不太可能患有MVA相关PTSD,但可能有与损伤无关的精神问题。