Nadew Gelaye T
CUCRH, University of Western Australia, Port Hedland, Australia.
Rural Remote Health. 2012 Oct;12(4):1667. Epub 2012 Oct 12.
Generations of Aboriginal people have been exposed to strings of traumatic events with devastating psychosocial health consequences, including psychiatric morbidities and mortalities, and medical complications. Posttraumatic Stress Disorder (PTSD) is a psychiatric morbidity directly linked to traumatic events. Despite research findings indicating traumatic exposure and resultant PTSD in Indigenous communities, little attention has been given to this condition in mental healthcare delivery. Consequently, clinical and psychosocial interventions are misguided and failed to deliver positive outcomes. The objective of this study is to explore the relationship between exposure to traumatic events, prevalence of PTSD and alcohol abuse in remote Aboriginal communities in Western Australia.
A combination of structured clinical interview and multiple survey questionnaires - Composite International Diagnostic Interview (CIDI), and Impact of Events Scale (IES), Alcohol Use Disorder Identification Test (AUDIT) and Indigenous Trauma Profile (ITP) - were administered to 221 Indigenous participants aged 18 to 65 years.
The overwhelming majority, 97.3% (n=215) of participants were exposed to traumatic events. Analysis of CIDI results using DSM-IV diagnostic criteria shows a life time prevalence of 55.2% (n=122) for PTSD, 20% (n=44) for major depression (recurrent) and 2.3% (n=5) for a single episode. A total of 96% (n=212) participants reported consuming a drink containing alcohol and 73.8% (n=163) met diagnostic criteria for alcohol use related disorders, abuse and dependence. Of participants who met the PTSD diagnostic criteria, 91% (n=111) met diagnostic criteria for alcohol use related disorders. Other impacts of trauma such as other anxiety disorders, dysthymic disorder and substances abuses were also identified.
The rate of exposure to traumatic events and prevalence of PTSD are disproportionately higher in the communities studied than the national average and one of the highest recorded in survivors of specific traumatic events in the world. A very high rate of alcohol abuse and dependence in participants who met diagnostic criteria for PTSD demonstrates correlation between alcohol abuse and PTSD. It also suggests that alcohol is used as self-medication.
几代原住民都经历了一连串创伤性事件，这些事件对他们的心理社会健康造成了毁灭性影响，包括精神疾病、死亡以及医疗并发症。创伤后应激障碍（PTSD）是一种与创伤性事件直接相关的精神疾病。尽管研究结果表明原住民社区存在创伤暴露及由此导致的创伤后应激障碍，但在精神卫生保健服务中，这种情况很少受到关注。因此，临床和心理社会干预受到误导，未能取得积极效果。本研究的目的是探讨西澳大利亚偏远原住民社区中创伤性事件暴露、创伤后应激障碍患病率与酒精滥用之间的关系。
对221名年龄在18至65岁的原住民参与者进行了结构化临床访谈，并结合多种调查问卷——复合国际诊断访谈（CIDI）、事件影响量表（IES）、酒精使用障碍识别测试（AUDIT）和原住民创伤概况（ITP）。
绝大多数参与者，即97.3%（n = 215）经历过创伤性事件。使用《精神疾病诊断与统计手册》第四版（DSM-IV）诊断标准对CIDI结果进行分析显示，创伤后应激障碍的终生患病率为55.2%（n = 122），复发性重度抑郁症的患病率为20%（n = 44），单次发作的患病率为2.3%（n = 5）。共有96%（n = 212）的参与者报告饮用过含酒精饮料，73.8%（n = 163）符合酒精使用相关障碍、滥用和依赖的诊断标准。在符合创伤后应激障碍诊断标准的参与者中，91%（n = 111）符合酒精使用相关障碍的诊断标准。还发现了创伤的其他影响，如其他焦虑障碍心境恶劣障碍和物质滥用。
在所研究的社区中，创伤性事件的暴露率和创伤后应激障碍的患病率远高于全国平均水平，是世界上特定创伤事件幸存者中记录到的最高患病率之一。在符合创伤后应激障碍诊断标准的参与者中，酒精滥用和依赖的比例非常高，这表明酒精滥用与创伤后应激障碍之间存在关联。这也表明酒精被用作自我治疗手段。
