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[创伤后应激障碍儿童及青少年创伤事件的频率与类型]

[Frequency and Type of Traumatic Events in Children and Adolescents with a Posttraumatic Stress Disorder].

作者信息

Loos Sabine, Wolf Saskia, Tutus Dunja, Goldbeck Lutz

机构信息

Universitatsklinikum Ulm, Klinik fur Kinderund Jugendpsychiatrie/Psychotherapie.

Universitatsklinik Ulm, Kinder- und Jugendpsychiatrie/-psychotherapie, Steinhovelstrase 1, 89073 Ulm.

出版信息

Prax Kinderpsychol Kinderpsychiatr. 2015;64(8):617-33. doi: 10.13109/prkk.2015.64.8.617.

Abstract

The risk for children and adolescents to be exposed to a potentially traumatic event (PTE) is high. The present study examines the frequency of PTEs in children and adolescents with Posttraumatic Stress Disorder (PTSD), the type of index trauma, and its relation to PTSD symptom severity and gender. A clinical sample of 159 children and adolescents between 7-16 years was assessed using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). All reported PTEs from the checklist were analyzed according to frequency. The index events were categorized according to the following categories: cause (random vs. intentional), relation to offender (intrafamilial vs. extrafamilial), patient's role (victim, witness or vicarious traumatization), and type of PTE (physical or sexual violence). Relation between categories and PTSD symptom severity and sex were analyzed with inferential statistics. On average participants reported five PTEs, most frequently physical violence without weapons (57.9%), loss of loved person through death (45.9%), and sexual abuse/assaults (44%). The most frequent index traumata were intentional (76.7%). Regarding trauma type, there was a significant difference concerning higher symptom severity in children and adolescents who experienced sexual abuse/assault compared to physical violence (t=-1.913(109), p=0.05). A significantly higher symptom severity was found for girls compared to boys for the trauma categories extrafamilial offender (z=-2,27, p=0.02), victim (z=-2,11, p=0,04), and sexual abuse/assault (z=-2,43, p=0,01). Clinical and diagnostic implications are discussed in relation to the amendments of PTSD diagnostic criteria in DSM-5.

摘要

儿童和青少年暴露于潜在创伤性事件(PTE)的风险很高。本研究调查了患有创伤后应激障碍(PTSD)的儿童和青少年中PTE的发生频率、索引创伤的类型及其与PTSD症状严重程度和性别的关系。使用儿童和青少年临床医生管理的PTSD量表(CAPS-CA)对159名7至16岁的儿童和青少年临床样本进行了评估。根据频率对清单中所有报告的PTE进行了分析。索引事件根据以下类别进行分类:原因(随机与故意)、与犯罪者的关系(家庭内与家庭外)、患者的角色(受害者、目击者或替代性创伤)以及PTE的类型(身体暴力或性暴力)。使用推断统计分析类别与PTSD症状严重程度和性别的关系。参与者平均报告了5次PTE,最常见的是无武器身体暴力(57.9%)、因死亡失去亲人(45.9%)以及性虐待/攻击(44%)。最常见的索引创伤是故意的(76.7%)。关于创伤类型,经历性虐待/攻击的儿童和青少年与身体暴力相比,在症状严重程度较高方面存在显著差异(t=-1.913(109),p=0.05)。在家庭外犯罪者(z=-2.27,p=0.02)、受害者(z=-2.11,p=0.04)和性虐待/攻击(z=-2.43,p=0.01)等创伤类别中,女孩的症状严重程度明显高于男孩。结合《精神疾病诊断与统计手册》第5版(DSM-5)中PTSD诊断标准的修订,讨论了临床和诊断意义。

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