Department of Psychiatry and Behavioral Sciences, University of Washington Harborview Medical Center, 325 9th Ave., Seattle, WA 98104-2499, USA.
Psychiatr Serv. 2011 Mar;62(3):264-71. doi: 10.1176/ps.62.3.pss6203_0264.
Few clinical epidemiologic investigations have assessed whether youths exposed to a traumatic injury demonstrate elevations in the full spectrum of provider-recognized psychiatric disorders compared with unexposed, noninjured youths.
In a population-based prospective cohort study, data for children and adolescents aged ten to 19 who were enrolled in the Group Health Cooperative health plan were screened for injury visits in the index year of 2001 (N=20,507). Psychiatric diagnoses, including anxiety and acute stress, depressive, substance use, and disruptive behavior disorders, given to these youths over the next three years (2002-2004) were documented, as were psychotropic medication prescriptions. Regression analyses assessed for an independent association between injury and psychiatric disorders and prescription of psychotropic medication.
In adjusted regression analyses, injury in the index year was independently associated with significantly increased odds of receiving a diagnosis of anxiety or acute stress (odds ratio [OR]=1.21, 95% confidence interval [CI]=1.02-1.44), depression (OR=1.30, CI=1.10-1.53), and a substance use disorder (OR=1.56, CI=1.21-2.00) and of receiving a psychotropic medication prescription (OR=1.37, CI=1.20-1.57). Youths with traumatic brain injuries also were significantly more likely to receive psychotropic medication prescriptions.
Traumatic injury was independently associated with an increased risk of receiving a full spectrum of anxiety, depressive, and substance use diagnoses among youths aged ten to 19. Population-based surveillance procedures that incorporate screening and stepped-care interventions targeting the spectrum of postinjury emotional disturbances have the potential to improve the quality of mental health care for youths treated in general medical settings.
很少有临床流行病学研究评估过创伤后暴露的青少年与未暴露、未受伤的同龄人相比，是否会出现更广泛的被医生认可的精神障碍。
在一项基于人群的前瞻性队列研究中，对参加 Group Health Cooperative 健康计划的 10 至 19 岁儿童和青少年进行了筛查，以确定其在 2001 年（N=20,507）的索引年度是否有受伤就诊记录。记录了这些青少年在接下来的三年（2002-2004 年）中被诊断出的精神疾病，包括焦虑和急性应激、抑郁、物质使用和破坏性行为障碍，以及精神药物处方。回归分析评估了受伤与精神障碍和精神药物处方之间的独立关联。
在调整后的回归分析中，索引年度的受伤与接受焦虑或急性应激（比值比[OR]=1.21，95%置信区间[CI]=1.02-1.44）、抑郁（OR=1.30，CI=1.10-1.53）和物质使用障碍（OR=1.56，CI=1.21-2.00）诊断以及接受精神药物处方（OR=1.37，CI=1.20-1.57）的几率显著增加相关。创伤性脑损伤的青少年也更有可能接受精神药物处方。
创伤与 10 至 19 岁青少年接受全面焦虑、抑郁和物质使用诊断的风险增加独立相关。基于人群的监测程序，结合针对创伤后情绪障碍的筛查和阶梯式护理干预，有可能改善一般医疗环境中治疗的青少年的精神卫生保健质量。
