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新遭受创伤与再次遭受创伤的青少年创伤后成长模型。

Model of Post-traumatic Growth in Newly Traumatized vs. Retraumatized Adolescents.

作者信息

Pazderka Hannah, Brown Matthew Rg, McDonald-Harker Caroline Beth, Greenshaw Andrew James, Agyapong Vincent Io, Noble Shannon, Mankowski Monica, Lee Bonnie, Omeje Joy, Brett-MacLean Pamela, Kitching Deborah Terry, Hayduk Leslie A, Silverstone Peter H

机构信息

Department of Psychiatry, University of Alberta, Edmonton, AB, Canada.

Be Brave Ranch, Centre for Treatment of Child Sexual Abuse, Edmonton, AB, Canada.

出版信息

Front Psychiatry. 2021 Sep 30;12:682055. doi: 10.3389/fpsyt.2021.682055. eCollection 2021.

Abstract

In our analysis of adolescents affected by the 2016 Fort McMurray wildfire, we observed many negative mental health effects in individuals with a prior history of psychological trauma. Elevated rates of depression and markers of post-traumatic stress disorder (PTSD) were observed, consistent with the hypothesis that prior trauma may reduce sensitivity thresholds for later psychopathology (stress sensitization). Surprisingly, levels of anxiety did not differ based on prior trauma history, nor were retraumatized individuals at increased risk for recent (past month) suicidal ideation. These results are more suggestive of inoculation by prior trauma than stress sensitization. This led us to consider whether individuals with a prior trauma history showed evidence of Post-Traumatic Growth (PTG), a condition in which the experience of a previous trauma leads to areas of sparing or even improvement. To investigate this issue, we generated a structural equation model (SEM) exploring the role of anxiety in previously traumatized ( = 295) and wildfire trauma alone ( = 740) groups. Specifically, models were estimated to explore the relationship between hopelessness, anxiety, PTSD symptoms, self-efficacy and potential protective factors such as friend and family support in both groups. The model was tested using a cross-sectional sample of affected youth, comparing effects between the two groups. While both models produced relatively good fit, differences in the effects and chi-squared values led us to conclude that the groups are subject to different causal specifications in a number of areas, although details warrant caution pending additional investigation. We found that adolescents with a prior trauma history appear to have a more realistic appraisal of potential difficulties associated with traumatic events, and seem less reactive to potentially unsettling PTSD symptoms. They also seemed less prone to overconfidence as they got older, an effect seen in the adolescents without a history of trauma. Our findings provide preliminary evidence that the construct of anxiety may work differently in newly traumatized and retraumatized individuals, particularly in the context of mass trauma events.

摘要

在我们对受2016年麦克默里堡野火影响的青少年的分析中,我们观察到有心理创伤史的个体出现了许多负面心理健康影响。观察到抑郁率和创伤后应激障碍(PTSD)标志物升高,这与先前创伤可能降低后期精神病理学敏感性阈值(应激敏感化)的假设一致。令人惊讶的是,焦虑水平并未因先前创伤史而有所不同,再次受创伤的个体近期(过去一个月)自杀意念的风险也没有增加。这些结果更表明先前创伤起到了预防作用,而非应激敏感化。这使我们思考有先前创伤史的个体是否表现出创伤后成长(PTG)的迹象,即先前创伤经历导致某些方面未受影响甚至有所改善的一种情况。为了研究这个问题,我们构建了一个结构方程模型(SEM),探讨焦虑在先前受过创伤的群体(n = 295)和仅受过野火创伤的群体(n = 740)中的作用。具体而言,估计模型以探究两组中绝望感、焦虑、PTSD症状、自我效能感以及诸如朋友和家庭支持等潜在保护因素之间的关系。该模型使用受影响青少年的横断面样本进行测试,比较两组之间的效应。虽然两个模型的拟合度都相对较好,但效应和卡方值的差异使我们得出结论,尽管细节有待进一步调查需谨慎对待,但两组在多个方面受到不同因果规范的影响。我们发现,有先前创伤史的青少年似乎对与创伤事件相关的潜在困难有更现实的评估,并且对可能令人不安的PTSD症状反应较小。随着年龄增长,他们似乎也不太容易过度自信,而在没有创伤史的青少年中则会出现这种效应。我们的研究结果提供了初步证据,表明焦虑结构在新受创伤和再次受创伤的个体中可能有不同作用,特别是在大规模创伤事件的背景下。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f4aa/8514981/b8d9b9ffded5/fpsyt-12-682055-g0001.jpg

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