Fornells-Ambrojo Miriam, Gracie Alison, Brewin Chris R, Hardy Amy
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK;
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Eur J Psychotraumatol. 2016 Sep 27;7:32095. doi: 10.3402/ejpt.v7.32095. eCollection 2016.
Posttraumatic stress disorder (PTSD) in response to psychosis and associated experiences (psychosis-related PTSD, or PR-PTSD) is the subject of a growing field of research. However, a wide range of PR-PTSD prevalence rates has been reported. This may be due to definitional and methodological inconsistencies in the assessment of PR-PTSD.
The focus of the review is two-fold. (1) To identify factors that enhance, or detract from, the robustness of PR-PTSD assessment and (2) to critically evaluate the evidence in relation to these identified criteria, including the impact on PR-PTSD prevalence rates.
Four quality criteria, whose development was informed by mainstream PTSD research, were selected to evaluate findings on PR-PTSD prevalence. Two criteria related to assessment of psychosis-related stressors (participant identification of worst moments of discrete threat events; psychometrically robust trauma measure) and two focussed on PR-PTSD symptom measurement (adequate time elapsed since trauma; use of validated PTSD interview) in the context of psychosis.
Twenty-one studies of PR-PTSD, with prevalence rates ranging from 11 to 51%, were evaluated. Fourteen studies (67%) used robust PTSD measures but PR-trauma was not specifically defined or assessed with validated measures. Eleven studies (52%) assessed PTSD before sufficient time had elapsed since the trauma. Due to significant methodological limitations, it was not possible to review PR-PTSD rates and provide a revised estimate of prevalence.
Methodological limitations are common in existing studies of PR-PTSD prevalence. Specific recommendations for improving assessment of psychosis-related trauma are made to guide the development of this new and emerging field. The review concludes with a proposed conceptualisation of PR-PTSD in the context of current diagnostic systems. The utility of the PR-PTSD term and its theoretical underpinnings are discussed.
创伤后应激障碍（PTSD）对精神病及相关经历的反应（与精神病相关的创伤后应激障碍，或PR-PTSD）是一个研究领域不断扩大的主题。然而，已报告的PR-PTSD患病率范围很广。这可能是由于PR-PTSD评估中定义和方法的不一致。
本综述的重点有两个方面。（1）确定增强或削弱PR-PTSD评估稳健性的因素，以及（2）批判性地评估与这些确定标准相关的证据，包括对PR-PTSD患病率的影响。
选择了四个质量标准（其制定参考了主流PTSD研究）来评估PR-PTSD患病率的研究结果。两个标准与精神病相关应激源的评估有关（参与者对离散威胁事件最糟糕时刻的识别；心理测量学上稳健的创伤测量），另外两个标准侧重于在精神病背景下PR-PTSD症状的测量（创伤后经过足够的时间；使用经过验证的PTSD访谈）。
对21项PR-PTSD研究进行了评估，患病率从11%到51%不等。14项研究（67%）使用了稳健的PTSD测量方法，但PR-创伤未被具体定义或用经过验证的测量方法进行评估。11项研究（52%）在创伤后经过足够时间之前就评估了PTSD。由于存在重大的方法学局限性，无法回顾PR-PTSD发病率并提供患病率的修订估计值。
方法学局限性在现有PR-PTSD患病率研究中很常见。针对改善精神病相关创伤评估提出了具体建议，以指导这一新兴领域的发展。综述最后提出了在当前诊断系统背景下PR-PTSD的概念化。讨论了PR-PTSD术语的实用性及其理论基础。
