Integrated Post-SARS Clinic, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong.
Gen Hosp Psychiatry. 2010 Nov-Dec;32(6):590-8. doi: 10.1016/j.genhosppsych.2010.07.007. Epub 2010 Sep 15.
Post-traumatic stress disorder (PTSD) is one of the most prevalent long-term psychiatric diagnoses among survivors of severe acute respiratory syndrome (SARS).
The objective of this study was to identify the predictors of chronic PTSD in SARS survivors.
PTSD at 30 months after the SARS outbreak was assessed by the Structured Clinical Interview for the DSM-IV. Survivors' demographic data, medical information and psychosocial variables were collected for risk factor analysis.
Multivariate logistic regression analysis showed that female gender as well as the presence of chronic medical illnesses diagnosed before the onset of SARS and avascular necrosis were independent predictors of PTSD at 30 months post-SARS. Associated factors included higher-chance external locus of control, higher functional disability and higher average pain intensity.
The study of PTSD at 30 months post-SARS showed that the predictive value of acute medical variables may fade out. Our findings do not support some prior hypotheses that the use of high dose corticosteroids is protective against the development of PTSD. On the contrary, the adversity both before and after the SARS outbreak may be more important in hindering recovery from PTSD. The risk factor analysis can not only improve the detection of hidden psychiatric complications but also provide insight for the possible model of care delivery for the SARS survivors. With the complex interaction of the biopsychosocial challenges of SARS, an integrated multidisciplinary clinic setting may be a superior approach in the long-term management of complicated PTSD cases.
创伤后应激障碍（PTSD）是严重急性呼吸综合征（SARS）幸存者中最常见的长期精神诊断之一。
本研究旨在确定 SARS 幸存者慢性 PTSD 的预测因素。
采用 DSM-IV 结构临床访谈评估 SARS 爆发后 30 个月的 PTSD。收集幸存者的人口统计学数据、医疗信息和社会心理变量，进行危险因素分析。
多变量逻辑回归分析显示，女性性别以及 SARS 发病前存在慢性疾病和无菌性坏死是 SARS 后 30 个月 PTSD 的独立预测因素。相关因素包括更高的外部控制机会、更高的功能障碍和更高的平均疼痛强度。
对 SARS 后 30 个月 PTSD 的研究表明，急性医疗变量的预测价值可能会消失。我们的研究结果不支持一些先前的假设，即使用大剂量皮质类固醇可预防 PTSD 的发生。相反，SARS 前后的逆境可能更重要，会阻碍 PTSD 的康复。危险因素分析不仅可以提高对潜在精神并发症的检测，还可以为 SARS 幸存者的可能护理模式提供见解。由于 SARS 带来的生物心理社会挑战的复杂相互作用，综合多学科诊所可能是长期管理复杂 PTSD 病例的一种优越方法。
