Pagotto Luiz Felipe, Mendlowicz Mauro Vitor, Coutinho Evandro Silva Freire, Figueira Ivan, Luz Mariana Pires, Araujo Alexandre Xavier, Berger William
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil.
Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-UFRJ), Rio de Janeiro, RJ, Brazil; Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niterói, RJ, Brazil.
Compr Psychiatry. 2015 Apr;58:68-73. doi: 10.1016/j.comppsych.2015.01.002. Epub 2015 Jan 14.
There is a dearth of literature dealing with the impact of the severity of posttraumatic symptoms and of comorbid mental disorders on the health-related quality of life (HRQOL) of victims of civilian violence with a primary diagnosis of PTSD.
To investigate the influence of the severity of posttraumatic symptoms and of presence of comorbid mental disorders on the HRQOL of treatment-seeking outpatients with PTSD.
A sample of 65 PTSD patients was recruited in a specialized outpatient clinic. The volunteers had the diagnoses of PTSD and of comorbid mental disorders established with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The severity of posttraumatic, depression and anxiety symptoms was measured with the PCL-C, BDI and BAI, respectively. HRQOL was assessed by means of the SF-36, a 36-item self-administered scale that measures eight domains of quality of life: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. Multiple linear regression models were fitted to investigate the relationship between the severity of posttraumatic, mood, and anxiety symptoms; the presence of specific current comorbid disorders and of psychotic symptoms, and the number of current comorbid conditions for each of the eight domains of HRQOL, after adjusting for the effect of sociodemographic characteristics.
The severity of PTSD symptoms predicted worse HRQOL in all eight domains of SF-36, even after controlling for the severity of depression and anxiety symptoms, the presence of panic disorder, OCD, specific and social phobia, psychotic symptoms, and the number of comorbid disorders. The strongest negative association between PTSD symptoms severity and HRQOL was found in the Social Functioning domain. Although the inclusion of the depressive symptoms in the models led to a reduction of the magnitude of the negative association between the severity of PTSD symptoms and the HRQOL domain scores, the former still accounted for most of the explained variance of the latter.
We found that even in the presence of comorbid mental disorders, the severity of posttraumatic symptoms remained the strongest predictor for impaired HRQOL in PTSD outpatients. Our results suggest that improvement of HRQOL should be considered a therapeutic objective and an essential outcome measure in the treatment of PTSD.
关于创伤后症状严重程度及共病精神障碍对以创伤后应激障碍（PTSD）为主要诊断的平民暴力受害者健康相关生活质量（HRQOL）的影响，相关文献匮乏。
探讨创伤后症状严重程度及共病精神障碍的存在对寻求治疗的PTSD门诊患者HRQOL的影响。
在一家专门的门诊诊所招募了65名PTSD患者。通过《精神疾病诊断与统计手册第四版》轴I障碍结构化临床访谈（SCID-I）确定志愿者患有PTSD及共病精神障碍。分别用创伤后应激障碍检查表平民版（PCL-C）、贝克抑郁量表（BDI）和贝克焦虑量表（BAI）测量创伤后、抑郁和焦虑症状的严重程度。通过SF-36评估HRQOL，这是一个包含36个条目的自评量表，测量生活质量的八个领域：活力、身体功能、身体疼痛、总体健康感知、身体角色功能、情感角色功能、社会角色功能和心理健康。在调整社会人口学特征的影响后，采用多元线性回归模型研究创伤后、情绪和焦虑症状的严重程度；特定当前共病障碍和精神病性症状的存在；以及当前共病情况的数量与HRQOL八个领域中每个领域之间的关系。
即使在控制了抑郁和焦虑症状的严重程度、惊恐障碍、强迫症、特定恐惧症和社交恐惧症、精神病性症状以及共病障碍的数量之后，PTSD症状的严重程度在SF-36的所有八个领域中都预示着更差的HRQOL。在社会功能领域发现PTSD症状严重程度与HRQOL之间的负相关最强。尽管将抑郁症状纳入模型导致PTSD症状严重程度与HRQOL领域得分之间负相关的幅度减小，但前者仍占后者可解释变异的大部分。
我们发现，即使存在共病精神障碍，创伤后症状的严重程度仍然是PTSD门诊患者HRQOL受损的最强预测因素。我们的结果表明，改善HRQOL应被视为PTSD治疗的一个治疗目标和一项重要的结局指标。
