Castro-Vale Ivone, Severo Milton, Carvalho Davide, Mota-Cardoso Rui
Medical Psychology Unit, Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
Department of Clinical Epidemiology, Predictive Medicine and Public Health, and Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal.
Healthcare (Basel). 2020 Sep 24;8(4):359. doi: 10.3390/healthcare8040359.
Vulnerability factors for posttraumatic stress disorder (PTSD) development are still controversial. Our aim was to study the vulnerability factors for the development of war-related PTSD over a period of 40 years after exposure. A cross-sectional, observational study was carried out on 61 male traumatized war veterans, taking into consideration adverse childhood experiences (ACE), attachment orientations, number of non-war-related traumatic events, and war experiences. Lifetime PTSD was assessed by using the Clinician-Administered PTSD Scale. Insecure attachment styles were significantly associated with lifetime PTSD and even after adjustment for war exposure this was still significant. Non-war-related traumatic events were not associated with lifetime PTSD, whereas ACE were associated with lifetime PTSD. War-related experiences were also associated with lifetime PTSD, except for injury or disease. The results for our sample show that, 40 years after war, the intensity of war-related experiences and ACE were significantly and independently associated with the development of lifetime PTSD. Insecure attachment was significantly associated with lifetime PTSD, which, in turn, are both positively associated with war exposure. These findings may have implications for patient care, as they constitute a strong argument that attachment-focused therapies could well be necessary 40 years after trauma.
创伤后应激障碍（PTSD）发生的脆弱性因素仍存在争议。我们的目的是研究暴露后40年内与战争相关的PTSD发生的脆弱性因素。对61名受过创伤的男性退伍军人进行了一项横断面观察性研究，考虑了童年不良经历（ACE）、依恋取向、非战争相关创伤事件的数量和战争经历。使用临床医生管理的PTSD量表评估终生PTSD。不安全的依恋方式与终生PTSD显著相关，即使在对战争暴露进行调整后，这种相关性仍然显著。非战争相关的创伤事件与终生PTSD无关，而ACE与终生PTSD有关。除受伤或患病外，与战争相关的经历也与终生PTSD有关。我们样本的结果表明，战争结束40年后，与战争相关的经历强度和ACE与终生PTSD的发生显著且独立相关。不安全依恋与终生PTSD显著相关，而终生PTSD又都与战争暴露呈正相关。这些发现可能对患者护理有影响，因为它们有力地证明了在创伤40年后以依恋为重点的治疗可能是必要的。
