Santos Monica R, Russo Joan, Aisenberg Gino, Uehara Edwina, Ghesquiere Angela, Zatzick Douglas F
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington 98104, USA.
Psychiatry. 2008 Fall;71(3):234-45. doi: 10.1521/psyc.2008.71.3.234.
Recent commentary has advocated for epidemiological investigation as a foundational science for understanding disparities in the delivery of mental health care and for the development of early trauma-focused interventions. Few acute care investigations have examined the diversity of ethnic/racial heritages or compared variations in early posttraumatic distress in representative samples of injured trauma survivors. Hospitalized injury survivors at two United States level I trauma centers were randomly approached in order to document linguistic and ethnic/racial diversity. Approximately 12% of patients approached were non-English speaking with 16 languages represented. English speaking, inpatients were screened for posttraumatic stress disorder, peritraumatic dissociative, and depressive symptoms. For 269 English speaking study participants, ethnic/racial group status was clearly categorized into one group for 72%, two groups for 25%, and three groups for 3% of participants. Regression analyses that adjusted for relevant clinical and demographic characteristics revealed that relative to whites, patients from American Indian, African American, Hispanic, and Asian heritages demonstrated significant elevations in one or more posttraumatic symptom clusters. A remarkable diversity of heritages was identified, and posttraumatic distress was elevated in ethnic/racial minority patients. Policy-relevant clinical investigations that combine evidence-based treatments, bilingual/bicultural care-management strategies, and support for trauma center organizational capacity building may be required in order to enhance the quality of mental health care for diverse injured trauma survivors.
最近的评论主张将流行病学调查作为一门基础科学，用于理解精神卫生保健服务中的差异以及开展早期以创伤为重点的干预措施。很少有急性护理研究考察过种族/民族传承的多样性，或比较过受伤创伤幸存者代表性样本中创伤后早期痛苦的差异。研究人员在美国两家一级创伤中心对住院的受伤幸存者进行了随机走访，以记录语言和种族/民族的多样性。被走访的患者中约12%不讲英语，共使用16种语言。对讲英语的住院患者进行了创伤后应激障碍、创伤期间解离及抑郁症状的筛查。对于269名讲英语的研究参与者，72%的参与者种族/民族群体身份被明确归为一类，25%归为两类，3%归为三类。在对相关临床和人口统计学特征进行调整的回归分析中发现，与白人相比，具有美洲印第安人、非裔美国人、西班牙裔和亚裔传承的患者在一个或多个创伤后症状群中表现出显著升高。研究发现了显著的传承多样性，且创伤后痛苦在少数族裔患者中有所增加。可能需要开展与政策相关的临床研究，将循证治疗、双语/双文化护理管理策略以及对创伤中心组织能力建设的支持结合起来，以提高为不同受伤创伤幸存者提供的精神卫生保健质量。
