创伤后应激障碍的轨迹：创伤后 6 年的随访。
Trajectory of post-traumatic stress following traumatic injury: 6-year follow-up.
机构信息
Richard A. Bryant, PhD, School of Psychology, University of New South Wales and Brain Dynamics Centre, University of Sydney and Westmead Millennium Institute, Sydney, Australia; Angela Nickerson, PhD, School of Psychology, University of New South Wales, New South Wales, Australia; Mark Creamer, PhD, Meaghan O'Donnell, PhD, David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne; Isaac Galatzer-Levy, PhD, Department of Psychiatry, New York University, New York, USA; Alexander C. McFarlane, MD, Centre for Military and Veteran Health, University of Adelaide, Adelaide, Australia; Derrick Silove, MD, School of Psychiatry, University of New South Wales, New South Wales, Australia.
出版信息
Br J Psychiatry. 2015 May;206(5):417-23. doi: 10.1192/bjp.bp.114.145516. Epub 2015 Feb 5.
BACKGROUND
Traumatic injuries affect millions of patients each year, and resulting post-traumatic stress disorder (PTSD) significantly contributes to subsequent impairment.
AIMS
To map the distinctive long-term trajectories of PTSD responses over 6 years by using latent growth mixture modelling.
METHOD
Randomly selected injury patients (n = 1084) admitted to four hospitals around Australia were assessed in hospital, and at 3, 12, 24 and 72 months. Lifetime psychiatric history and current PTSD severity and funxctioning were assessed.
RESULTS
Five trajectories of PTSD response were noted across the 6 years: (a) chronic (4%), (b) recovery (6%), (c) worsening/recovery (8%), (d) worsening (10%) and (e) resilient (73%). A poorer trajectory was predicted by female gender, recent life stressors, presence of mild traumatic brain injury and admission to intensive care unit.
CONCLUSIONS
These findings demonstrate the long-term PTSD effects that can occur following traumatic injury. The different trajectories highlight that monitoring a subset of patients over time is probably a more accurate means of identifying PTSD rather than relying on factors that can be assessed during hospital admission.
背景
创伤性损伤每年影响数以百万计的患者，由此导致的创伤后应激障碍（PTSD）显著加剧了后续损伤。
目的
使用潜在增长混合模型来绘制 PTSD 反应的独特长期轨迹。
方法
随机选择了澳大利亚四家医院收治的创伤患者（n=1084），分别在住院期间、3、12、24 和 72 个月进行评估。评估了终生精神病史以及当前 PTSD 的严重程度和功能。
结果
在 6 年中观察到了 PTSD 反应的 5 种轨迹：（a）慢性（4%）、（b）恢复（6%）、（c）恶化/恢复（8%）、（d）恶化（10%）和（e）弹性（73%）。女性性别、近期生活压力源、轻度创伤性脑损伤和入住重症监护病房的存在预测了更差的轨迹。
结论
这些发现表明，创伤性损伤后可能会出现长期的 PTSD 效应。不同的轨迹表明，随着时间的推移监测部分患者可能是识别 PTSD 的更准确方法，而不是依赖于在住院期间可以评估的因素。
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