Regioplan Policy Research, Nieuwezijds Voorburgwal 35, Amsterdam, RD, 1012, the Netherlands.
BMC Psychiatry. 2012 Sep 18;12:147. doi: 10.1186/1471-244X-12-147.
Disaster experiences have been associated with higher prevalence rates of (mental) health problems. The objective of this study was to examine the independent relation between a series of single disaster experiences versus the independent predictive value of a accumulation of disaster experiences, i.e. a sum score of experiences and symptoms of distress and post-traumatic stress disorder (PTSD).
Survivors of a fireworks disaster participated in a longitudinal study and completed a questionnaire three weeks (wave 1), eighteen months (wave 2) and four years post-disaster (wave 3). Ten years post-disaster (wave 4) the respondents consisted of native Dutch survivors only. Main outcome measures were general distress and symptoms of PTSD.
Degree of disaster exposure (sum score) and some disaster-related experiences (such as house destroyed, injured, confusion) were related to distress at waves 2 and 3. This relation was mediated by distress at an earlier point in time. None of the individual disaster-related experiences was independently related to symptoms of distress. The association between the degree of disaster exposure and symptoms of PTSD at waves 2 and 3 was still statistically significant after controlling for symptoms of distress and PTSD at earlier point in time. The variable 'house destroyed' was the only factor that was independently related to symptoms of PTSD at wave 2. Ten years after the disaster, disaster exposure was mediated by symptoms of PTSD at waves 2 and 3. Disaster exposure was not independently related to symptoms of PTSD ten years post-disaster.
Until 4 years after the disaster, degree of exposure (a sum score) was a risk factor for PTSD symptoms while none of the individual disaster experiences could be identified as an independent risk factor. Ten years post-disaster, disaster exposure was no longer an independent risk factor for symptoms of PTSD. Since symptoms of PTSD and distress at earlier waves perpetuate the symptoms at later waves, health care workers should aim their resources at those who still have symptoms after one and a half year post-disaster, to prevent health problems at medium and long-term.
灾难经历与更高的（心理）健康问题发生率有关。本研究的目的是检验一系列单一灾难经历与灾难经历的积累（即经历和痛苦及创伤后应激障碍（PTSD）症状的总和得分）的独立预测价值之间的独立关系。
烟花灾难的幸存者参加了一项纵向研究，并在灾难后三星期（第 1 波）、十八个月（第 2 波）和四年（第 3 波）时完成了一份问卷。十年后（第 4 波），只包括原籍荷兰的幸存者。主要结局指标是一般痛苦和 PTSD 症状。
灾难暴露程度（总和得分）和一些与灾难有关的经历（如房屋被毁、受伤、困惑）与第 2 波和第 3 波的痛苦有关。这种关系是通过更早时候的痛苦来介导的。没有一个单独的与灾难有关的经历与痛苦症状有关。在控制更早时间点的痛苦和 PTSD 症状后，灾难暴露程度与第 2 波和第 3 波的 PTSD 症状之间的关联仍然具有统计学意义。“房屋被毁”是唯一与第 2 波 PTSD 症状独立相关的因素。灾难发生十年后，灾难暴露程度由第 2 波和第 3 波的 PTSD 症状介导。灾难暴露程度与十年后 PTSD 症状无关。
在灾难发生后的 4 年内，暴露程度（总和得分）是 PTSD 症状的危险因素，而没有一个单独的灾难经历可以被确定为独立的危险因素。灾难发生十年后，灾难暴露程度不再是 PTSD 症状的独立危险因素。由于 PTSD 症状和更早时期的痛苦在后期持续存在，卫生保健工作者应将资源集中在灾难发生后一年半仍有症状的人身上，以预防中长期的健康问题。
