Lunney Carole A, Schnurr Paula P, Cook Joan M
National Center for PTSD, White River Junction, Vermont, USA.
J Trauma Stress. 2014 Apr;27(2):144-51. doi: 10.1002/jts.21908. Epub 2014 Apr 2.
Assessment of posttraumatic stress disorder (PTSD) in older adults has received limited investigation. The purpose of this study was to compare the severity of PTSD symptoms in treatment-seeking older and younger U.S. veterans with PTSD. Participants were 360 male and 284 female veterans enrolled in 2 separate clinical trials of psychotherapy for PTSD. About 4% of the participants were age 60 years or older. Symptoms were assessed before treatment using clinician-rated and self-report measures. For men, only numbing symptoms were lower in older veterans; this was so in clinician ratings, d = 0.76, and self-reports, d = 0.65. For women, clinician-rated hyperarousal symptoms were lower in older veterans, d = 0.57. Clinician-rated and self-reported symptoms were strongly related, Bs = 0.95 and 0.80 in the male and female samples, respectively. Among men, clinician-rated and self-reported reexperiencing and hyperarousal symptoms were associated only in younger veterans. Accurate assessment of PTSD symptoms in older adults is essential to identifying and implementing effective treatment. Our findings suggest that some symptoms may be lower in older men, and that some symptoms of PTSD may be underdetected in older women. Future research should assess the combined effect of gender and age on PTSD symptom presentation.
对老年人创伤后应激障碍（PTSD）的评估研究有限。本研究旨在比较寻求治疗的美国老年和年轻PTSD退伍军人的PTSD症状严重程度。参与者为360名男性和284名女性退伍军人，他们参与了两项针对PTSD的心理治疗独立临床试验。约4%的参与者年龄在60岁及以上。在治疗前使用临床医生评定和自我报告测量方法对症状进行评估。对于男性，只有麻木症状在老年退伍军人中较低；临床医生评定中d = 0.76，自我报告中d = 0.65时均如此。对于女性，临床医生评定的过度警觉症状在老年退伍军人中较低，d = 0.57。临床医生评定和自我报告的症状密切相关，男性样本中B = 0.95，女性样本中B = 0.80。在男性中，临床医生评定和自我报告的再体验和过度警觉症状仅在年轻退伍军人中相关。准确评估老年人的PTSD症状对于识别和实施有效治疗至关重要。我们的研究结果表明，老年男性的某些症状可能较低，而老年女性的某些PTSD症状可能未被充分检测到。未来的研究应评估性别和年龄对PTSD症状表现的综合影响。
