Maddoux John, McFarlane Judith, Symes Lene, Fredland Nina, Feder Gene
Texas Woman's University, Center Research Design and Analysis, P.O. Box 425619, Denton, TX 76204, United States.
Texas Woman's University, College of Nursing, 6700 Fannin, Houston, TX 77030, United States.
Arch Psychiatr Nurs. 2018 Jun;32(3):475-482. doi: 10.1016/j.apnu.2018.02.001. Epub 2018 Feb 17.
Worldwide one in three women report intimate partner violence. Many of these women report long term mental health problems, especially PTSD, which is associated with negative problem solving, isolation, somatization, depression, and anxiety. Children are impacted by their exposure to domestic violence and experience internal (i.e., depression, anxiety) and external (i.e., hostility, delinquency) behavioral clinical problems. To predict which women will experience chronic PTSD symptoms, a PTSD predictor tool was developed and applied to PTSD symptom scores four years after 300 mothers with children (age 18 months to 16 years) received assistance for the violence. At four years, 266 (89%) of the 300 mother child dyads were retained. Of those, 245 met inclusion criteria for this study and 53% had scores above the clinical threshold for PTSD. The predictor tool performed well. There was a significant association, χ (4) = 11.83, p = .019, Cramer's V = 0.229, between mothers predicted at low/some risk for chronic PTSD and scoring below the cut-off score for diagnostic PTSD symptoms at four years. Mothers predicted to be at extreme risk for chronic PTSD reported PTSD symptoms at or above the diagnostic level at 48 months. Children whose mothers had PTSD were at greater risk for Borderline/Clinical range behavioral problems compared to children whose mothers did not have PTSD. Relative risk values ranged from 2.07 (Externalizing) to 2.30 (Internalizing). When appropriate interventions are available, the PTSD predictor tool can assist with triage and guided referral of women at risk for chronic PTSD.
全球范围内，三分之一的女性报告遭受过亲密伴侣暴力。这些女性中有许多人报告存在长期心理健康问题，尤其是创伤后应激障碍（PTSD），这与消极的问题解决方式、孤立、躯体化、抑郁和焦虑有关。儿童会因接触家庭暴力而受到影响，并出现内部（如抑郁、焦虑）和外部（如敌意、犯罪）行为方面的临床问题。为了预测哪些女性会出现慢性创伤后应激障碍症状，开发了一种创伤后应激障碍预测工具，并将其应用于300名有孩子（年龄在18个月至16岁之间）的母亲在遭受暴力后获得援助四年后的创伤后应激障碍症状评分。四年后，300对母婴中有266对（89%）被保留。其中，245对符合本研究的纳入标准，53%的人得分高于创伤后应激障碍的临床阈值。该预测工具表现良好。在预测为慢性创伤后应激障碍低风险/部分风险的母亲与四年后诊断创伤后应激障碍症状得分低于临界值之间存在显著关联，χ（4）=11.83，p = 0.019，克莱默V系数 = 0.229。预测为慢性创伤后应激障碍极高风险的母亲在48个月时报告的创伤后应激障碍症状达到或高于诊断水平。与母亲没有创伤后应激障碍的儿童相比，母亲患有创伤后应激障碍的儿童出现边缘/临床范围行为问题的风险更大。相对风险值范围从2.07（外化）到2.30（内化）。当有适当的干预措施时，创伤后应激障碍预测工具可以帮助对有慢性创伤后应激障碍风险的女性进行分诊和指导转诊。
