Wild J, Smith K V, Thompson E, Béar F, Lommen M J J, Ehlers A
Department of Experimental Psychology,University of Oxford,Oxford,UK.
King's College London,London,UK.
Psychol Med. 2016 Sep;46(12):2571-82. doi: 10.1017/S0033291716000532. Epub 2016 Jun 28.
It is unclear which potentially modifiable risk factors best predict post-trauma psychiatric disorders. We aimed to identify pre-trauma risk factors for post-traumatic stress disorder (PTSD) or major depression (MD) that could be targeted with resilience interventions.
Newly recruited paramedics (n = 453) were assessed for history of mental disorders with structured clinical interviews within the first week of their paramedic training and completed self-report measures to assess hypothesized predictors. Participants were assessed every 4 months for 2 years to identify any episodes of PTSD and MD; 386 paramedics (85.2%) participated in the follow-up interviews.
In all, 32 participants (8.3%) developed an episode of PTSD and 41 (10.6%) an episode of MD during follow-up. In all but nine cases (2.3%), episodes had remitted by the next assessment 4 months later. At 2 years, those with episodes of PTSD or MD during follow-up reported more days off work, poorer sleep, poorer quality of life, greater burn-out; and greater weight-gain for those with PTSD. In line with theories of PTSD and depression, analyses controlling for psychiatric and trauma history identified several pre-trauma predictors (cognitive styles, coping styles and psychological traits). Logistic regressions showed that rumination about memories of stressful events at the start of training uniquely predicted an episode of PTSD. Perceived resilience uniquely predicted an episode of MD.
Participants at risk of developing episodes of PTSD or depression could be identified within the first week of paramedic training. Cognitive predictors of episodes of PTSD and MD are promising targets for resilience interventions.
尚不清楚哪些潜在的可改变风险因素能最好地预测创伤后精神障碍。我们旨在确定创伤后应激障碍（PTSD）或重度抑郁症（MD）的创伤前风险因素，以便通过恢复力干预措施加以应对。
新招募的护理人员（n = 453）在护理人员培训的第一周内通过结构化临床访谈评估精神障碍病史，并完成自我报告测量以评估假设的预测因素。在2年时间里，每4个月对参与者进行一次评估，以确定是否出现PTSD和MD发作；386名护理人员（85.2%）参与了随访访谈。
在随访期间，共有32名参与者（8.3%）出现PTSD发作，41名（10.6%）出现MD发作。除9例（2.3%）外，在4个月后的下一次评估时，发作均已缓解。到2年时，随访期间出现PTSD或MD发作的人报告的缺勤天数更多、睡眠更差、生活质量更差、倦怠感更强；PTSD患者体重增加更多。与PTSD和抑郁症的理论一致，在控制了精神病史和创伤史的分析中确定了几个创伤前预测因素（认知风格、应对方式和心理特质）。逻辑回归显示，培训开始时对压力事件记忆的反复思考是PTSD发作的独特预测因素。感知到的恢复力是MD发作的独特预测因素。
在护理人员培训的第一周内就可以识别出有发生PTSD或抑郁症发作风险的参与者。PTSD和MD发作的认知预测因素是恢复力干预措施的有前景的目标。
