Lima B R, Pai S, Santacruz H, Lozano J
Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
J Nerv Ment Dis. 1991 Jul;179(7):420-7. doi: 10.1097/00005053-199107000-00006.
We evaluated 102 adult victims of low socioeconomic status living in tent camps 8 months following the Armero disaster in Colombia to ascertain the level of psychiatric morbidity. Ninety-one percent of the subjects identified by the screening instrument as being emotionally distressed met DSM-III criteria for a psychiatric disorder. The most frequent diagnoses were posttraumatic stress disorder and major depression. These findings indicate that a simple screening instrument can be reliably used for the detection of significant emotional problems among disaster victims. They also show that these victims are not merely distressed; rather, they present clear and treatable psychiatric disorders that center on anxiety and depression. Interventions for their adequate management need to be designed, implemented, and evaluated. In a developing country, however, the high prevalence of mental disorders among disaster victims far exceeds the specialized mental health resources. The general health sector, particularly the primary level of care, must participate actively in the delivery of mental health services to meet this need, particularly for a socioeconomically disadvantaged population. The narrow range of psychiatric disorders detected among the disaster victims makes it possible to circumscribe the training of the primary care worker in disaster mental health to these priority conditions.
我们对哥伦比亚阿尔梅罗灾难发生8个月后居住在帐篷营地的102名社会经济地位低下的成年受害者进行了评估,以确定其精神疾病的发病水平。筛查工具认定为情绪困扰的受试者中,91%符合精神疾病的《精神疾病诊断与统计手册》第三版(DSM-III)标准。最常见的诊断是创伤后应激障碍和重度抑郁症。这些发现表明,一种简单的筛查工具可可靠地用于检测灾难受害者中的重大情绪问题。它们还表明,这些受害者不仅仅是痛苦;相反,他们存在以焦虑和抑郁为核心的明确且可治疗的精神疾病。需要设计、实施和评估对其进行适当管理的干预措施。然而,在一个发展中国家,灾难受害者中精神障碍的高患病率远远超过了专门的心理健康资源。一般卫生部门,尤其是初级保健层面,必须积极参与提供心理健康服务以满足这一需求,特别是针对社会经济弱势群体。在灾难受害者中检测到的精神疾病范围较窄,使得可以将初级保健工作者在灾难心理健康方面的培训限定于这些优先情况。