创伤相关精神障碍及其在临床样本中的相关性：尼泊尔一家精神病诊所创伤患者的横断面研究。
Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal.
机构信息
Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Brain and Neuroscience Center, Kathmandu, Nepal.
出版信息
PLoS One. 2020 Jun 15;15(6):e0234203. doi: 10.1371/journal.pone.0234203. eCollection 2020.
BACKGROUND
Nepal, like many other low-income countries, has a great burden of mental health issues but few resources to meet them. In addition, Nepal has endured several traumatic events in recent decades but the impact on mental health has not been studied in clinical settings. This study explores trauma-related psychiatric disorders and their correlates.
METHODS
100 patients with a history of trauma who visited the outpatient psychiatry clinic at a University hospital in Kathmandu were assessed. The Composite International Diagnostic Interview 2.1 (CIDI) was used to evaluate lifetime and current depressive disorder, generalized anxiety disorder (GAD) and lifetime post-traumatic stress disorder (PTSD). Current PTSD was evaluated using PSTD Checklist-Civilian Version (PCL-C).
RESULTS
The median number of lifetime traumatic events was two. Natural disaster was the most common trauma type (84%) compared to other types of trauma. Rape was reported as the most traumatizing. Current PTSD was found in 15%, depression in 33% and GAD in 38% of the patients. The lifetime rates were PTSD 83%, depression 45% and GAD 40%. There was high comorbidity between the disorders. The 31 to 45 years age group, above high school education level and trauma types other than earthquake were independently associated with current PTSD. Marital status and upper socioeconomic status (SES) compared to upper-middle SES were independently associated with lifetime PTSD. Both lifetime and current depression rates were independently associated with the upper SES compared to upper-middle SES. Place of living, education above high school and lower-middle SES were significantly associated with lifetime and current GAD.
CONCLUSION
PTSD, depression and GAD were prevalent in a trauma exposed patient population visiting a psychiatric clinic in Nepal. High rates of comorbidities and several risk factors were identified. Our findings highlight the need for addressing trauma related disorders in clinical settings in developing countries.
背景
尼泊尔与许多其他低收入国家一样，面临着严重的心理健康问题，但资源却很少。此外，尼泊尔在最近几十年经历了几次创伤性事件，但这些事件对心理健康的影响尚未在临床环境中进行研究。本研究探讨了与创伤相关的精神障碍及其相关因素。
方法
在加德满都一所大学医院的门诊精神病诊所，对 100 名有创伤史的患者进行评估。使用复合国际诊断访谈 2.1 版（CIDI）评估终生和当前的抑郁障碍、广泛性焦虑症（GAD）和终生创伤后应激障碍（PTSD）。使用 PTSD 检查表-平民版（PCL-C）评估当前 PTSD。
结果
终生创伤事件中位数为 2 次。自然灾害是最常见的创伤类型（84%），而其他类型的创伤则较为少见。强奸被报告为最具创伤性的事件。当前 PTSD 在 15%、抑郁在 33%和 GAD 在 38%的患者中发现。终生 PTSD 发生率为 83%，抑郁发生率为 45%，GAD 发生率为 40%。这些障碍之间存在高度共病。31 至 45 岁年龄组、高于高中教育水平和地震以外的创伤类型与当前 PTSD 独立相关。与中上 SES 相比，婚姻状况和上 SES 与终生 PTSD 独立相关。与中上 SES 相比，上 SES 与终生和当前抑郁发生率均独立相关。居住地、高中以上教育程度和中下 SES 与终生和当前 GAD 显著相关。
结论
在尼泊尔一家精神病诊所就诊的创伤暴露患者群体中，PTSD、抑郁和 GAD 较为普遍。发现了较高的共病率和一些风险因素。我们的研究结果强调了在发展中国家的临床环境中解决与创伤相关的障碍的必要性。
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