1Mater Child and Youth Mental Health Service, Brisbane, Australia.
Aust N Z J Psychiatry. 2014 Jan;48(1):80-6. doi: 10.1177/0004867413500349. Epub 2013 Aug 23.
To describe PTSD symptom persistence and resolution, including the potential phenomenon of late-onset PTSD, in children and adolescents 18 months after a cyclone disaster; and to investigate factors that predict longer-term symptom outcome.
71 children and 191 adolescents who were screened three months after a Category 5 Cyclone were re-screened 18 months post-disaster. Child-report measures included the PTSD Reaction Index, measures of event exposure and social connectedness.
Approximately 1-in-5 children and 1-in-12 adolescents endorsed cyclone-related PTSD symptoms at the moderate to severe level 18 months post-disaster. Of these approximately one-half (44.8%) of children were in the 'high-persister' group at 18-month follow-up. Persistence of low symptoms was very common (97.6%) and late-onset PTSD was a rare phenomenon. This pattern was similar in adolescents: 25.0% were in the 'high-persister' group and few students experienced late-onset PTSD. In multivariate analysis, only initial severe to very severe PTSD category made a significant independent contribution to explaining persisting moderate to severe PTSD symptoms in primary school students (ORadj=8.33, 95% CI=1.45-47.84). There was a trend for a similar result in secondary students.
A child or adolescent with few PTSD symptoms three months post-disaster is likely to remain so unless a further traumatic event occurs. However, if symptomatic at three months, there is approximately a 30-45% chance that the child or adolescent will still be symptomatic 18 months after the disaster. Given the high rate of students in the 'resolver' group, initial posttraumatic symptoms are a necessary but not sufficient condition for predicting chronic symptomatology. Other targets for predictive modelling include initial threat perception and high and low social connectedness.
描述创伤后应激障碍（PTSD）症状的持续性和缓解情况，包括儿童和青少年在气旋灾难后 18 个月时出现迟发性 PTSD 的潜在现象；并探讨预测长期症状结果的因素。
在 5 级气旋发生三个月后，对 71 名儿童和 191 名青少年进行筛查，在灾难发生 18 个月后再次进行筛查。儿童报告的测量方法包括 PTSD 反应指数、事件暴露和社会联系的测量。
大约五分之一的儿童和十二分之一的青少年在气旋灾难后 18 个月时出现了与气旋相关的 PTSD 症状，这些症状达到中度至重度水平。其中大约一半（44.8%）的儿童在 18 个月的随访中属于“高持续组”。低症状的持续性非常常见（97.6%），迟发性 PTSD 是一种罕见现象。这种模式在青少年中也相似：25.0%的青少年属于“高持续组”，很少有学生经历迟发性 PTSD。在多变量分析中，只有初始严重到非常严重的 PTSD 类别对解释小学生持续中度到重度 PTSD 症状具有显著的独立贡献（ORadj=8.33，95%CI=1.45-47.84）。在中学生中也存在类似的趋势。
如果一个儿童或青少年在气旋灾难后三个月时仅有少量 PTSD 症状，那么他们很可能会一直保持这种状态，除非再次发生创伤性事件。然而，如果在三个月时就有症状，那么大约有 30-45%的可能性，他们在灾难发生后 18 个月仍会有症状。鉴于大多数学生属于“解决者”组，初始创伤后症状是预测慢性症状的必要但非充分条件。预测模型的其他目标包括初始威胁感知和高低社会联系。
