Department of Psychiatry, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
Am J Geriatr Psychiatry. 2014 Jan;22(1):86-97. doi: 10.1016/j.jagp.2013.01.064. Epub 2013 Feb 6.
Examine the longitudinal course of posttraumatic stress disorder (PTSD) in older adults and its influence on mental health quality of life (MHQoL).
Evaluation performed at baseline, and 3 and 6 months postrandomization as part of a longitudinal trial.
A total of 1,185 participants, with a mean (±SD) age of 73.53 (±5.98) years, at seven primary care sites (including five Veterans Affairs clinics), were divided into four groups, namely, no trauma (n = 661), trauma only (n = 319), partial PTSD (n = 114), and PTSD (n = 81), based on reports of trauma and associated PTSD symptoms.
The prevalence of comorbid depression, anxiety, and alcohol use disorders, assessed using the Diagnostic and Statistical Manual, Fourth Edition, criteria and changes in MHQoL, as assessed by the Short Form-36 mental component score.
At baseline, the PTSD group had higher frequencies of comorbid depression and anxiety disorders and worse MHQoL than the other groups. Both chronic (participants diagnosed with PTSD at all three assessments) and fluctuating (participants moving to or from one of the other groups) trajectories of course were observed during the follow-up period, which appeared to be separate from that of the comorbid disorders. Even after accounting for those comorbid disorders, PTSD had an independent association with poorer MHQoL at multiple time points, especially in men, whereas trauma without PTSD symptoms (trauma only) had better MHQoL.
PTSD had chronic and fluctuating courses, with negative effects on MHQoL, while partial PTSD might represent a transitional state, underscoring the need to better identify and treat PTSD at any phase in later life.
研究老年人创伤后应激障碍（PTSD）的纵向病程及其对心理健康生活质量（MHQoL）的影响。
作为一项纵向试验的一部分，在基线、随机分组后 3 个月和 6 个月进行评估。
共有 1185 名参与者，平均（±SD）年龄为 73.53（±5.98）岁，来自七个初级保健点（包括五个退伍军人事务诊所），根据创伤和相关 PTSD 症状的报告，分为四组：无创伤（n=661）、仅有创伤（n=319）、部分 PTSD（n=114）和 PTSD（n=81）。
使用《精神障碍诊断与统计手册》第四版标准评估共病抑郁、焦虑和酒精使用障碍的患病率，并使用 SF-36 心理成分评分评估 MHQoL 的变化。
基线时，PTSD 组的共病抑郁和焦虑障碍发生率较高，MHQoL 较差。在随访期间观察到慢性（所有三次评估均诊断为 PTSD 的参与者）和波动（从其他组转移或进入其他组的参与者）病程轨迹，这似乎与共病障碍的轨迹不同。即使考虑到这些共病障碍，PTSD 在多个时间点与较差的 MHQoL 仍存在独立关联，尤其是在男性中，而无 PTSD 症状的创伤（仅有创伤）则具有更好的 MHQoL。
PTSD 具有慢性和波动的病程，对 MHQoL 产生负面影响，而部分 PTSD 可能代表一种过渡状态，这强调了在晚年任何阶段都需要更好地识别和治疗 PTSD。
