Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea.
J Clin Psychiatry. 2012 May;73(5):e594-600. doi: 10.4088/JCP.11m07348.
We explored the course of trauma-related psychological symptoms and psychiatric diagnoses in 167 children who, as fourth graders, witnessed death at school and assessed the long-term effects of their symptoms on quality of life and their parents' rearing stress.
167 children were evaluated using diverse self-rating symptom scales at 2 days (T1: May 19, 2007), 2 months (T2: July 16, 2007), 6 months (T3: November 12-17, 2007), and 30 months (T4: November 16-21, 2009) after the accident. All children were interviewed with the Diagnostic Interview Schedule for Children-Version IV (DISC-IV) at T1. High-risk children were assessed with the DISC-IV at T3 and T4. Children's quality of life and parental stress were assessed in all children and parents using the Parenting Stress Index and the Child Health and Illness Profile at T4.
The mean scores and prevalence of severe posttraumatic stress disorder (PTSD) and anxiety symptoms decreased significantly over time (P < .001), but depressive symptoms did not. Although the prevalence of DISC-IV-based diverse anxiety disorders decreased significantly over time, 45% of high-risk subjects evaluated with the DISC-IV met criteria for an anxiety or depressive disorder at T4. Linear and logistic regression analyses showed that depressive symptoms at 6 months predicted more severe parental stress (β = 0.51; odds ratio [OR] = 2.88), less satisfaction (β = -0.25; OR = 2.66), and lower achievement (β = -0.41; OR = 1.50) at 30 months. PTSD symptoms were not associated with parental stress or quality of life at T4.
This study provides new evidence regarding the long-term course of trauma-related symptoms and diagnostic changes in children exposed to a single trauma. Children's depressive symptoms predicted lower children's quality of life and higher parental rearing stress after 2 years. Careful assessment and management of depressive symptoms can potentially reduce parental stress and improve quality of life of children.
我们探究了 167 名在四年级目睹学校死亡事件的儿童创伤相关心理症状和精神诊断的发展过程，并评估了其症状对生活质量以及其父母养育压力的长期影响。
167 名儿童在事故发生后第 2 天（T1：2007 年 5 月 19 日）、第 2 个月（T2：2007 年 7 月 16 日）、第 6 个月（T3：2007 年 11 月 12-17 日）和第 30 个月（T4：2009 年 11 月 16-21 日）使用多种自评症状量表进行评估。所有儿童在 T1 时均接受儿童诊断访谈量表第四版（DISC-IV）访谈。高风险儿童在 T3 和 T4 时接受 DISC-IV 评估。在 T4 时，所有儿童及其父母使用养育压力指数和儿童健康和疾病简表评估儿童生活质量和父母养育压力。
严重创伤后应激障碍（PTSD）和焦虑症状的平均评分和发生率随时间显著下降（P<.001），但抑郁症状没有。尽管基于 DISC-IV 的各种焦虑障碍的发生率随时间显著下降，但 45%的接受 DISC-IV 评估的高风险受试者在 T4 时符合焦虑或抑郁障碍标准。线性和逻辑回归分析显示，6 个月时的抑郁症状预测 30 个月时更严重的父母养育压力（β=0.51；比值比[OR]=2.88）、更低的满意度（β=-0.25；OR=2.66）和更低的成就（β=-0.41；OR=1.50）。T4 时 PTSD 症状与父母压力或生活质量无关。
本研究提供了关于儿童暴露于单一创伤后与创伤相关症状和诊断变化的长期过程的新证据。儿童的抑郁症状预测 2 年后儿童生活质量降低和父母养育压力增加。仔细评估和管理抑郁症状可能会降低父母压力并改善儿童的生活质量。
