创伤后 6 个月创伤后应激障碍：与酒精使用和抑郁的关系。
Posttraumatic stress disorder following traumatic injury at 6 months: associations with alcohol use and depression.
机构信息
From the Division of Trauma, Critical Care and Acute Care, Baylor University Medical Center (A.M.W., M.L.F., L.B.P.); Baylor Research Institute (M.R., K.R.-F., S.P.), Dallas, Texas; Baylor Scott and White Health (M.M.B.), Dallas, Texas; and University of Texas Southwestern Medical Center (K.R.F.), Dallas, Texas.
出版信息
J Trauma Acute Care Surg. 2014 Feb;76(2):517-22. doi: 10.1097/TA.0000000000000110.
BACKGROUND
Posttraumatic stress disorder (PTSD) is progressively recognized as a psychological morbidity in injured patients. Participants in a longitudinal study were identified as PTSD positive or PTSD negative at 6 months following injury. Risky alcohol use, depression, demographic, and injury-related variables were explored.
METHODS
This prospective cohort included patients 18 years or older, admitted to our Level I trauma center. Outcome measures included PTSD Checklist-Civilian Version (PCL-C), Alcohol Use Disorders Identification Test (AUDIT-C), and Patient Health Questionnaire (PHQ-8). Demographic and injury variables were collected.
RESULTS
A total of 211 participants enrolled in the study, and 118 participants completed measures at both baseline and 6 months. Of the participants, 25.4% (n = 30) screened positive for PTSD at 6 months. The entire sample showed a decline in risky alcohol use at 6 months (p = 0.0043). All PTSD-positive participants at 6 months were also positive for depression (p < 0.0001). For the entire sample, there was a 10% increase in depression from baseline to 6 months (p = 0.03). However, for those participants who were PTSD positive at 6 months, there was a 53% increase in depression from baseline (p = 0.0002) as compared with the group at 6 months without PTSD. Statistically significant differences were found between PTSD-positive and PTSD-negative participants regarding age (40.1 [15.9] vs. 50.9 [18.2], p = 0.0047), male (77% vs. 50%, p = 0.0109), penetrating injury (30% vs. 4%, p < 0.0001), PTSD history (17% vs. 4%, p = 0.0246), or other psychiatric condition (63% vs. 19%, p ≤ 0.001).
CONCLUSION
PTSD was not associated with risky alcohol use at 6 months. Surprisingly, risky alcohol use declined in both groups. Incidence of PTSD (25.4%, n = 30) and risky alcohol use (25%, n = 29) were equal at 6 months. Although the American College of Surgeons' Committee on Trauma requires brief screening and intervention for risky alcohol use owing to societal impact, reinjury rates, and cost effectiveness, our study suggests that screening for psychological conditions may be equally important.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
创伤后应激障碍（PTSD）逐渐被认为是受伤患者的一种心理障碍。在受伤后 6 个月，参与者被确定为 PTSD 阳性或 PTSD 阴性。探讨了危险饮酒、抑郁、人口统计学和损伤相关变量。
方法
本前瞻性队列研究纳入 18 岁及以上、我院 1 级创伤中心收治的患者。结局测量包括平民版创伤后应激障碍检查表（PCL-C）、酒精使用障碍识别测试（AUDIT-C）和患者健康问卷（PHQ-8）。收集人口统计学和损伤变量。
结果
共有 211 名参与者入组，118 名参与者在基线和 6 个月时完成了测量。在参与者中，25.4%（n=30）在 6 个月时 PTSD 筛查阳性。整个样本在 6 个月时危险饮酒量下降（p=0.0043）。所有在 6 个月时 PTSD 阳性的参与者也有抑郁（p<0.0001）。对于整个样本，从基线到 6 个月抑郁增加了 10%（p=0.03）。然而，对于那些在 6 个月时 PTSD 阳性的参与者，与 6 个月时无 PTSD 的组相比，抑郁增加了 53%（p=0.0002）。在 PTSD 阳性和 PTSD 阴性参与者之间，年龄（40.1[15.9] vs. 50.9[18.2]，p=0.0047）、男性（77% vs. 50%，p=0.0109）、穿透性损伤（30% vs. 4%，p<0.0001）、PTSD 病史（17% vs. 4%，p=0.0246）或其他精神疾病（63% vs. 19%，p≤0.001）有统计学显著差异。
结论
6 个月时 PTSD 与危险饮酒无关。令人惊讶的是，两组的危险饮酒量都有所下降。6 个月时 PTSD 的发生率（25.4%，n=30）和危险饮酒量（25%，n=29）相等。尽管美国外科医师学院创伤委员会因社会影响、再损伤率和成本效益而要求对危险饮酒进行简短筛查和干预，但我们的研究表明，筛查心理状况可能同样重要。
证据水平
预后研究，III 级。
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