中国洪灾后创伤后应激障碍的康复：13年随访及集体行动程度对其的预测
Recovery from post-traumatic stress disorder after a flood in China: a 13-year follow-up and its prediction by degree of collective action.
作者信息
Hu Shimin, Tan Hongzhuan, Cofie Reuben, Zhou Jia, Yang Tubao, Tang Xuemin, Liu Aizhong
机构信息
Department of Epidemiology and Health Statistics, School of Public Health of Central South University, 110 Xiangya Road, Changsha, Hunan, 410007, PR China.
出版信息
BMC Public Health. 2015 Jul 7;15:615. doi: 10.1186/s12889-015-2009-6.
BACKGROUND
Victims exposed to serious traumatic experiences may develop post-traumatic stress disorder (PTSD) and suffer this mental health problem for a long time. Different types of trauma displayed a chronicity rate of PTSD within the range of 6.3-68.9 %. As one of the most common and severe natural disasters, the natural progression of flood related PTSD has not been revealed. The aim of this study was to estimate the chronicity rate and identify the prognostic factors of PTSD in flood victims.
METHODS
Flood victims, who were over the age of 16 and diagnosed with PTSD in 2000 in Huarong, Ziyang, and Anxiang counties of Hunan province, China, were enrolled in this survey. Current probable PTSD was analyzed using the PTSD Checklist-Civilian version. Data were collected in face-to-face interviews and analyzed using univariate analysis and multiple logistic regression models.
RESULTS
The rate of current probable PTSD was 15.4 %. The current occurrences of re-experiencing, avoidance/numbing, and hyper-arousal symptom groups were 69.3 %, 17.2 %, and 50.2 %, respectively. Significant prognostic factors for current probable PTSD were flood-related stressors (e.g., life-threatening experiences, extreme physical adversity, and extreme psychological adversity) and frequency of general collective action. The relationships still existed when taking the fluctuation of frequency of general collective action into consideration. Gender and education level showed no influence on the recovery from PTSD. The impact of age in this study was inconsistent; in the 2000 model, around 2006 model, around 2013 model, and all FGCA model, older age was positive prognosis factor for PTSD; in the univariate analysis and fluctuation model, age showed no influence on the recovery from PTSD.
CONCLUSIONS
Our findings indicated that PTSD can persist 13 years after a flood. Demographic characteristics (e.g., age, gender, and education level) seem to have no influence on the recovery from PTSD. Trauma-related stressors and social participation are important predictors for remission from chronic PTSD.
背景
遭受严重创伤经历的受害者可能会患上创伤后应激障碍（PTSD），并长期受此心理健康问题困扰。不同类型的创伤显示PTSD的慢性化率在6.3%-68.9%之间。作为最常见且严重的自然灾害之一，与洪水相关的PTSD的自然发展过程尚未明确。本研究旨在估计洪水受害者中PTSD的慢性化率，并确定其预后因素。
方法
本调查纳入了2000年在中国湖南省华容县、资阳县和安乡县年龄超过16岁且被诊断为PTSD的洪水受害者。使用PTSD检查表-平民版分析当前可能存在的PTSD。通过面对面访谈收集数据，并使用单因素分析和多元逻辑回归模型进行分析。
结果
当前可能存在PTSD的比例为15.4%。当前重新体验、回避/麻木和过度警觉症状组的发生率分别为69.3%、17.2%和50.2%。当前可能存在PTSD的显著预后因素是与洪水相关的应激源（如危及生命的经历、极端身体逆境和极端心理逆境）以及一般集体行动的频率。考虑到一般集体行动频率的波动时，这种关系仍然存在。性别和教育水平对PTSD的恢复没有影响。本研究中年龄的影响不一致；在2000年模型、2006年左右模型、2013年左右模型以及所有FGCA模型中，年龄较大是PTSD的积极预后因素；在单因素分析和波动模型中，年龄对PTSD的恢复没有影响。
结论
我们的研究结果表明，洪水发生13年后PTSD仍可能持续存在。人口统计学特征（如年龄、性别和教育水平）似乎对PTSD的恢复没有影响。与创伤相关的应激源和社会参与是慢性PTSD缓解的重要预测因素。
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