Division of Preventive Medicine, 12357University of Alberta, Edmonton, Alberta, Canada.
Department of Community Health Sciences and Psychiatry, Mathison Centre for Mental Health Research and Education, University of Calgary, Alberta, Canada.
Can J Psychiatry. 2021 Aug;66(8):719-725. doi: 10.1177/0706743720974824. Epub 2020 Nov 26.
The study was designed to estimate the prevalence of mental disorders in a cohort of firefighters who had been deployed to a devastating fire in Fort McMurray, Alberta, in 2016.
A cohort of firefighters was established and followed up by online questionnaires. The contact in October 2018 to March 2019 included the PCL-5 questionnaire screening for post-traumatic stress disorder (PTSD) and the Hospital Anxiety and Depression Scale (HADS) screening for anxiety and depression. A sample was selected comprising all scoring ≥31 on the PCL-5 or ≥12 on either scale of the HADS, 30% of those scoring 8 to 11 on the HADS, and 10% of those with lower scores on all scales. This sample was assessed through a structured clinical interview to categorize disorders as defined in (). Interviews were carried out face-to-face or by telephone between August 2019 and February 2020. Diagnoses in the interview sample were reweighted to obtain prevalence estimates for the whole cohort. In an analysis of receiver operating characteristics (ROC), possible cut points for scores from each screening questionnaire were examined.
In 2018 to 2019, 1,000 of the cohort of 1,234 firefighters completed the HADS and 998 completed the PCL-5. Of these, 282 were identified for structured clinical interviews for (SCID) assessment. Interviews were carried out with 192. Among those assessed, 40.6% met the criteria for PTSD, 30.7% for an anxiety disorder, and 28.5% for a depressive disorder. When reweighted to allow for sampling and losses to assessment, cohort prevalence estimates were as follows: PTSD 21.4% (15.7% to 29.1%), anxiety disorders 15.8% (11.0% to 22.5%), and depressive disorders 14.3% (9.9% to 20.8%). Lower prevalence estimates were obtained when using the cut point with least misclassification in the ROC analysis.
Using the gold-standard SCID assessment, high rates of mental disorders were found in this cohort of firefighters who had experienced a devastating fire. Fewer cases would have been identified by screening questionnaire alone.
本研究旨在估计 2016 年艾伯塔省麦克默里堡毁灭性火灾中部署的消防员队列中精神障碍的患病率。
建立了一个消防员队列，并通过在线问卷进行了随访。2018 年 10 月至 2019 年 3 月的联系包括 PCL-5 问卷筛查创伤后应激障碍（PTSD）和医院焦虑和抑郁量表（HADS）筛查焦虑和抑郁。选择了所有 PCL-5 评分≥31 分或 HADS 任何一量表评分≥12 分、HADS 评分 8 至 11 分的样本的 30%以及所有量表评分较低的样本的 10%。通过结构化临床访谈评估该样本，根据 （）对障碍进行分类。访谈于 2019 年 8 月至 2020 年 2 月之间面对面或通过电话进行。访谈样本中的诊断被重新加权，以获得整个队列的患病率估计值。在接收器操作特性（ROC）分析中，检查了每个筛查问卷的可能得分切点。
在 2018 年至 2019 年期间，1234 名消防员队列中的 1000 名完成了 HADS，998 名完成了 PCL-5。其中，282 名被确定为进行结构化临床访谈（SCID）评估。对 192 人进行了访谈。在接受评估的人员中，40.6%符合 PTSD 标准，30.7%符合焦虑症标准，28.5%符合抑郁症标准。经重新加权以允许抽样和评估损失后，队列患病率估计值如下：PTSD 21.4%（15.7%至 29.1%），焦虑症 15.8%（11.0%至 22.5%），抑郁症 14.3%（9.9%至 20.8%）。在 ROC 分析中使用错误分类最少的切点时，得到了较低的患病率估计值。
使用金标准 SCID 评估，在经历了毁灭性火灾的消防员队列中发现了很高的精神障碍发生率。仅通过筛查问卷就会发现更少的病例。
