Carolina Population Center,The University of North Carolina at Chapel Hill,Chapel Hill,USA.
Department of Human Ecology,Graduate School of Medicine,The University of Tokyo,Tokyo,Japan.
Epidemiol Psychiatr Sci. 2019 Feb;28(1):45-53. doi: 10.1017/S2045796017000233. Epub 2017 May 15.
To investigate whether adverse childhood experiences (ACEs) modify the impact of exposure to a natural disaster (the 2011 Great East Japan earthquake and tsunami) on the occurrence of posttraumatic stress disorder (PTSD) among older people.
Data were collected as part of the Japan Gerontological Evaluation Study (JAGES), which is an on-going epidemiological survey investigating social determinants of health among older people across Japan. Information on PTSD symptoms based on the Screening Questionnaire for Disaster Mental Health, traumatic exposure to the earthquake (i.e., house damage and loss of relatives/friends during the earthquake/tsunami) and ACEs was obtained from 580 participants aged 65 or older living in Iwanuma City, Miyagi Prefecture, which suffered severe damage as a result of the earthquake and the subsequent tsunami in March 2011. Associations were examined using Poisson regression analysis with a robust variance estimator after adjusting for covariates.
The prevalence of PTSD was 9.7% in this population; compared to those with no traumatic experience, the prevalence of PTSD was approximately two times higher among those who experienced the loss of close friends/relatives (PR = 1.84, 95% CI = 1.11-3.03, p = 0.018), or whose house was damaged (PR = 2.15, 95% CI = 1.07-4.34, p = 0.032). ACE was not significantly associated with PTSD. Stratified analyses by the presence of ACE showed that damage due to the earthquake/tsunami was associated with PTSD only among those without ACEs; more specifically, among non-ACE respondents the PR of PTSD associated with house damage was 6.67 (95% CI = 1.66-26.80), while for the loss of a relative or a close friend it was 3.56 (95% CI = 1.18-10.75). In contrast, no statistically significant associations were observed among those with ACEs.
Following the Great East Japan earthquake/tsunami in 2011 a higher risk of developing PTSD symptoms was observed in 2013 especially among older individuals without ACEs. This suggests that ACEs might affect how individuals respond to subsequent traumatic events later in life.
探讨童年期不良经历（ACEs）是否会改变老年人在经历自然灾害（2011 年东日本大地震和海啸）后发生创伤后应激障碍（PTSD）的情况。
数据是作为日本老年学评估研究（JAGES）的一部分收集的，该研究是一项正在进行的流行病学调查，旨在研究日本老年人健康的社会决定因素。根据灾难心理健康筛查问卷，从 2011 年 3 月在地震和随后的海啸中遭受严重破坏的宫城县岩沼市的 580 名 65 岁或以上的参与者那里获得了 PTSD 症状、地震创伤暴露（即房屋损坏和亲人/朋友在地震/海啸中丧生）和 ACE 的信息。在调整了协变量后，使用具有稳健方差估计的泊松回归分析来检查关联。
该人群中 PTSD 的患病率为 9.7%；与没有创伤经历的人相比，失去亲密朋友/亲戚的人（PR = 1.84，95%CI = 1.11-3.03，p = 0.018）或房屋受损（PR = 2.15，95%CI = 1.07-4.34，p = 0.032）的 PTSD 患病率约高两倍。ACE 与 PTSD 无显著关联。根据 ACE 的存在进行分层分析表明，只有在没有 ACE 的情况下，地震/海啸造成的破坏才与 PTSD 有关；更具体地说，在非 ACE 受访者中，与房屋损坏相关的 PTSD 的 PR 为 6.67（95%CI = 1.66-26.80），而与失去亲属或亲密朋友相关的 PR 为 3.56（95%CI = 1.18-10.75）。相比之下，在 ACE 患者中未观察到具有统计学意义的关联。
2011 年东日本大地震/海啸后，2013 年尤其在没有 ACE 的老年人中，观察到 PTSD 症状的发生风险更高。这表明 ACE 可能会影响个体在以后的生活中对后续创伤事件的反应方式。
