Pietrzak Robert H, el-Gabalawy Renée, Tsai Jack, Sareen Jitender, Neumeister Alexander, Southwick Steven M
United States Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.
J Affect Disord. 2014 Jun;162:102-6. doi: 10.1016/j.jad.2014.03.024. Epub 2014 Mar 27.
Posttraumatic stress disorder (PTSD) is characterized by heterogeneous clusters of re-experiencing, avoidance, numbing, and hyperarousal symptoms. However, data are lacking regarding the predominant, population-based typologies of this disorder, and how they are linked to trauma-related characteristics, psychiatric comorbidities, and health-related quality of life.
We used latent class analyses (LCAs) to evaluate predominant typologies of PTSD in a nationally representative sample of 2463 U.S. adults with PTSD. Multinomial logistic regression analyses were then conducted to evaluate trauma-related characteristics, psychiatric comorbidities, and health-related quality of life variables associated with these typologies.
LCAs revealed three predominant typologies of PTSD-Anxious-Re-experiencing (weighted prevalence=32.2%), Dysphoric (32.8%), and High Symptom (35.0%). Compared to the Dysphoric class, the Anxious-Re-experiencing and High Symptom classes were more likely to report sexual assault, physical assault, and military combat as their worst traumatic events; had an earlier age of onset and longer duration of PTSD; and were more likely to be diagnosed with nicotine dependence and borderline personality disorder, to have attempted suicide, and had poorer physical health-related quality of life (HRQoL). The High Symptom class had increased odds of all disorders, suicide attempts, and the poorest HRQoL.
Diagnoses were based on DSM-IV criteria and cross-sectional analyses preclude examination of how PTSD typologies are temporally related to other variables.
PTSD in the general U.S. adult population is characterized by three predominant typologies, which are differentially linked to trauma and clinical characteristics. These findings underscore the importance of personalized approaches to the assessment, monitoring, and treatment of PTSD that take into consideration the heterogeneous manifestations of this disorder.
创伤后应激障碍（PTSD）的特征是反复体验、回避、麻木和过度警觉等症状的异质性集群。然而，关于这种障碍在人群中的主要类型，以及它们如何与创伤相关特征、精神共病和健康相关生活质量相关的数据尚缺乏。
我们使用潜在类别分析（LCA）来评估2463名患有PTSD的美国成年人全国代表性样本中PTSD的主要类型。然后进行多项逻辑回归分析，以评估与这些类型相关的创伤相关特征、精神共病和健康相关生活质量变量。
LCA揭示了PTSD的三种主要类型——焦虑-反复体验型（加权患病率=32.2%）、烦躁型（32.8%）和高症状型（35.0%）。与烦躁型相比，焦虑-反复体验型和高症状型更有可能报告性侵犯、身体攻击和军事战斗是他们最严重的创伤事件；PTSD发病年龄更早、病程更长；更有可能被诊断为尼古丁依赖和边缘性人格障碍，有自杀企图，身体健康相关生活质量（HRQoL）较差。高症状型在所有疾病、自杀企图和最差的HRQoL方面的几率增加。
诊断基于DSM-IV标准，横断面分析无法检查PTSD类型与其他变量在时间上的关系。
美国成年普通人群中的PTSD以三种主要类型为特征，这些类型与创伤和临床特征存在不同的关联。这些发现强调了在评估、监测和治疗PTSD时采用个性化方法的重要性，该方法应考虑到这种障碍的异质性表现。
