Forbes David, Nickerson Angela, Alkemade Nathan, Bryant Richard A, Creamer Mark, Silove Derrick, McFarlane Alexander C, Van Hooff Miranda, Fletcher Susan L, O'Donnell Meaghan
Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton VIC 3053, Australia
J Clin Psychiatry. 2015 Sep;76(9):1193-9. doi: 10.4088/JCP.14m09075.
Little research to date has explored the typologies of psychopathology following trauma, beyond development of particular diagnoses such as posttraumatic stress disorder (PTSD). The objective of this study was to determine the longitudinal patterns of these typologies, especially the movement of persons across clusters of psychopathology.
In this 6-year longitudinal study, 1,167 hospitalized severe injury patients who were recruited between April 2004-February 2006 were analyzed, with repeated measures at baseline, 3 months, 12 months, and 72 months after injury. All patients met the DSM-IV criterion A1 for PTSD. Structured clinical interviews were used to assess psychiatric disorders at each follow-up point. Latent class analysis and latent transition analysis were applied to assess clusters of individuals determined by psychopathology. The Mini International Neuropsychiatric Interview (MINI) and Clinician-Administered PTSD Scale (CAPS) were employed to complete diagnoses.
Four latent classes were identified at each time point: (1) Alcohol/Depression class (3 months, 2.1%; 12 months, 1.3%; and 72 months, 1.1%), (2) Alcohol class (3 months, 3.3%; 12 months, 3.7%; and 72 months, 5.4%), (3) PTSD/Depression class (3 months, 10.3%; 12 months, 11.5%; and 72 months, 6.4%), and (4) No Disorder class (3 months, 84.2%; 12 months, 83.5%; and 72 months, 87.1%). Latent transition analyses conducted across the 2 transition points (12 months and 72 months) found consistently high levels of stability in the No Disorder class (90.9%, 93.0%, respectively) but lower and reducing levels of consistency in the PTSD/Depression class (81.3%, 46.6%), the Alcohol/Depression class (59.7%, 21.5%), and the Alcohol class (61.0%, 36.5%), demonstrating high levels of between-class migration.
Despite the array of psychiatric disorders that may develop following severe injury, a 4-class model best described the data with excellent classification certainty. The high levels of migration across classes indicate a complex pattern of psychopathology expression over time. The findings have considerable implications for tailoring multifocused interventions to class type, as well as flexible stepped care models, and for the potential development and delivery of transdiagnostic interventions targeting underlying mechanisms.
迄今为止，除了诸如创伤后应激障碍（PTSD）等特定诊断的发展之外，很少有研究探讨创伤后精神病理学的类型。本研究的目的是确定这些类型的纵向模式，尤其是个体在精神病理学集群之间的转移情况。
在这项为期6年的纵向研究中，分析了2004年4月至2006年2月期间招募的1167名住院重伤患者，在受伤后的基线、3个月、12个月和72个月进行重复测量。所有患者均符合PTSD的DSM-IV标准A1。在每个随访点使用结构化临床访谈来评估精神障碍。应用潜在类别分析和潜在转变分析来评估由精神病理学确定的个体集群。采用迷你国际神经精神病学访谈（MINI）和临床医生管理的PTSD量表（CAPS）来完成诊断。
在每个时间点确定了四个潜在类别：（1）酒精/抑郁类别（3个月时为2.1%；12个月时为1.3%；72个月时为1.1%），（2）酒精类别（3个月时为3.3%；12个月时为3.7%；72个月时为5.4%），（3）PTSD/抑郁类别（3个月时为10.3%；12个月时为11.5%；72个月时为6.4%），以及（4）无障碍类别（3个月时为84.2%；12个月时为83.5%；72个月时为87.1%）。在两个转变点（12个月和72个月）进行的潜在转变分析发现，无障碍类别始终具有很高的稳定性（分别为90.9%和93.0%），但PTSD/抑郁类别（81.3%，46.6%）、酒精/抑郁类别（59.7%，21.5%）和酒精类别（61.0%，36.5%）的一致性水平较低且呈下降趋势，表明类别之间的迁移程度很高。
尽管重伤后可能会出现一系列精神障碍，但一个四类模型能以极高的分类确定性最好地描述数据。跨类别迁移程度高表明精神病理学表现随时间呈复杂模式。这些发现对于根据类别类型定制多焦点干预措施以及灵活的逐步护理模式，以及针对潜在机制的跨诊断干预措施的潜在开发和实施具有重要意义。
