School of Psychology, South China Normal University, Guangzhou, Guangdong, People's Republic of China.
Center for Studies of Psychological Application, South China Normal University, Guangzhou, Guangdong, People's Republic of China.
J Abnorm Child Psychol. 2019 Apr;47(4):671-681. doi: 10.1007/s10802-018-0462-2.
Although posttraumatic stress disorder (PTSD) is highly comorbid with psychiatric disorders, little longitudinal research has been conducted to determine the potentially causal links. This study aimed to investigate the prevalence and comorbidity patterns of posttraumatic stress disorder symptoms and psychiatric symptoms among adolescents exposed to the 2008 Wenchuan earthquake in China and to examine the bidirectional prospective associations between PTSD symptoms and other psychiatric symptoms. A sample of 1573 adolescent survivors (45.8% male; mean age at initial survey was 15.0 years, SD = 1.3) completed a battery of standardized measures assessing symptoms of PTSD, depression, panic disorder, generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social phobia, conduct disorder, and attention deficit hyperactivity disorder at 6 and 18 months post-earthquake. Among participants with PTSD symptoms, 91.9 and 94.0% had at least one comorbid psychiatric disorder at 6 and 18 months post-earthquake, respectively; however, among those without PTSD symptoms, 54.3 and 50.4% had at least one psychiatric disorder. PTSD symptoms were more likely to co-occur with subtypes of anxiety or depression symptoms than with behavior problems. Participants who were screened as having PTSD comorbid with depression or SAD at 6 months were less likely to recover from PTSD over time. Longitudinal analyses showed that symptoms of depression, GAD and SAD predicted increases in PTSD symptoms. In turn, PTSD symptoms predicted increases in GAD and panic disorder symptoms. Overall, our results support causal hypotheses of PTSD comorbidity. Specific multi-modal assessments and treatments targeting to both PTSD and its comorbidity disorders are warranted.
尽管创伤后应激障碍（PTSD）与精神障碍高度共病，但很少有纵向研究来确定潜在的因果关系。本研究旨在调查中国汶川地震后青少年 PTSD 症状和精神症状的患病率和共病模式，并检验 PTSD 症状与其他精神症状之间的双向前瞻性关联。本研究共纳入 1573 名青少年幸存者（45.8%为男性；初始调查时的平均年龄为 15.0 岁，标准差=1.3 岁），在地震后 6 个月和 18 个月时使用标准化量表评估 PTSD 症状、抑郁、惊恐障碍、广泛性焦虑障碍（GAD）、分离焦虑障碍（SAD）、社交恐惧症、品行障碍和注意缺陷多动障碍。在 PTSD 症状患者中，分别有 91.9%和 94.0%在地震后 6 个月和 18 个月时至少存在一种共患精神障碍；然而，在没有 PTSD 症状的患者中，分别有 54.3%和 50.4%至少存在一种精神障碍。PTSD 症状更可能与焦虑或抑郁症状的亚型共现，而不是与行为问题共现。在 6 个月时被筛查为 PTSD 合并抑郁或 SAD 的患者随着时间的推移更不可能从 PTSD 中恢复。纵向分析表明，抑郁、GAD 和 SAD 症状预示着 PTSD 症状的增加。反过来，PTSD 症状预示着 GAD 和惊恐障碍症状的增加。总体而言，我们的研究结果支持 PTSD 共病的因果假设。需要针对 PTSD 及其共病障碍进行特定的多模式评估和治疗。
