Department of Health Sciences, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
Psychopathology. 2013;46(2):120-30. doi: 10.1159/000339459. Epub 2012 Aug 21.
The assessment of acute stress reactions and psychiatric symptomatology shortly after the occurrence of a traumatic catastrophic event, like an earthquake, is essential for implementing relief activities and for the identification of the long-term aftermath. The aim of our study was to assess the psychological distress and the occurrence of acute stress disorder (ASD) among individuals seeking help at the General Hospital Psychiatric Unit at San Salvatore Hospital following the earthquake at L'Aquila. Factors (sociodemographic, coping strategies, event-related and postevent variables) associated with the acute stress reactions were also assessed.
For the first 4 weeks following the earthquake, 122 help-seekers were assessed with a checklist of traumatic-event-related variables. Measurement instruments included the Stanford Acute Stress Reaction Questionnaire (SASRQ) for the detection of ASD according to DSM-IV criteria, the 12-item General Health Questionnaire (GHQ-12) for assessing psychological distress, and the Brief Cope questionnaire for assessing coping strategies.
Despite the high level of psychological distress (GHQ-12 ≥20, cut-off value) found in 65.6% of the subjects, only 6 subjects (4.9%) could be considered affected by 'full' ASD, whereas 48 subjects (39.3%) could be considered affected by 'partial' ASD, which is defined as showing at least one symptom on each DSM-IV criterion as evidenced by scoring higher than 3 on each SASRQ scale. The strongest predictor of traumatic stress reactions among all the predictor variables included in our study was having been trapped/injured under rubble during the earthquake, and among earthquake stressors (explaining 20% of variance in our model), a weaker predictor was the loss of personal privacy because of home displacement. In our model, more variance (39%) was explained when individual psychopathological variables and coping styles were also included as predictors. Showing coping strategies as exhibiting 'behavioural disengagement' or 'requesting emotional support from others' were found to increase the likelihood of a positive estimate of being an 'ASD case', while the adoption of an 'acceptance' coping style seemed to reduce the likelihood of the positive estimate of being an 'ASD case'.
This study underlines the importance of identifying ASD subsyndromal cases and taking appropriate intervention/prevention measures that focus on giving psychological support to individuals trapped/injured under rubble, showing a low acceptance of reality. A relevant underestimated source of distress was the dislocation in large accommodation settings (such as large tent camps) in which individuals lack privacy.
在创伤性灾难性事件（如地震）发生后，对急性应激反应和精神症状进行评估，对于实施救援活动和识别长期后果至关重要。我们的研究目的是评估在拉奎拉地震后，前往圣萨尔瓦托雷医院综合医院精神科就诊的个体的心理困扰和急性应激障碍（ASD）的发生情况。还评估了与急性应激反应相关的因素（社会人口学、应对策略、事件相关和事件后变量）。
在地震发生后的头 4 周内，使用创伤事件相关变量检查表评估了 122 名寻求帮助的人。测量工具包括斯坦福急性应激反应问卷（SASRQ），用于根据 DSM-IV 标准检测 ASD；12 项一般健康问卷（GHQ-12），用于评估心理困扰；以及简要应对量表，用于评估应对策略。
尽管 65.6%的受试者存在较高水平的心理困扰（GHQ-12≥20，截断值），但只有 6 名受试者（4.9%）被认为患有“完全”ASD，而 48 名受试者（39.3%）被认为患有“部分”ASD，这是指在每个 SASRQ 量表上的评分高于 3，表现出至少一个 DSM-IV 标准上的症状。在我们研究中纳入的所有预测变量中，预测创伤性应激反应的最强因素是在地震中被困/受伤，而在地震应激源中（解释我们模型中 20%的差异），较弱的预测因素是因房屋搬迁而失去个人隐私。在我们的模型中，当将个体心理病理变量和应对方式也作为预测因素纳入时，解释了更多的方差（39%）。表现出“行为脱离”或“向他人寻求情感支持”的应对策略被发现增加了被认为是“ASD 病例”的可能性，而采用“接受”应对方式似乎降低了被认为是“ASD 病例”的可能性。
本研究强调了识别 ASD 亚综合征病例并采取适当干预/预防措施的重要性，这些措施侧重于为被困/受伤的个体提供心理支持，表现出对现实的低接受度。一个被低估的重要困扰源是在缺乏隐私的大型住宿环境（如大型帐篷营地）中重新安置。
