Epidemiology of Psychiatric Conditions, Substance use and Social environment (EPICSS), Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Eur Psychiatry. 2022 Sep 8;65(1):e60. doi: 10.1192/j.eurpsy.2022.2311.
Experiencing exceptionally threatening or horrifying traumas can lead to posttraumatic stress disorder (PTSD). Increasing political unrest/war/natural disasters worldwide could cause more traumatic events and change the population burden of PTSD. Most PTSD research is based on surveys, prone to selection/recall biases with inconsistent results. The aim was therefore, to use register-based data to identify the occurrence of PTSD and contributing factors in the Swedish general population.
This register-based cohort study used survival analysis. Individuals born between 1960-1995, aged ≥15 years, registered and living in Sweden, not emigrating, anytime between 1990-2015, not receiving specialized care for PTSD before 2006 were included ( = 4,673,764), and followed from their 15th/16th birth date until first PTSD diagnosis between 2006-2016 or study endpoint (31-December-2016). PTSD cases (ICD-10: F43.1) were identified from the national patient register. Mean follow-up time was 18.8 years.
Between 2006-2016, the incidence of specialized healthcare utilization for PTSD nearly doubled, and 0.7% of the study population received such care. The highest risk was observed for refugees [aHR 8.18; 95% CI:7.85-8.51] and for those with depressive disorder [aHR 4.51; 95% CI:3.95-5.14]. Higher PTSD risk was associated with female sex, older age, low education, single parenthood, low household income, urbanicity, and being born to a foreign-born parent.
PTSD is more common among refugee migrants, individuals with psychiatric disorders, and the socioeconomically disadvantaged. It is important that provision of services for PTSD are made available, particularly to these higher risk, and often hard-to-reach groups.
经历异常威胁或恐怖的创伤事件可能导致创伤后应激障碍（PTSD）。全球范围内不断增加的政治动荡/战争/自然灾害可能会导致更多创伤事件，并改变 PTSD 的人口负担。大多数 PTSD 研究基于调查，容易受到选择/回忆偏倚的影响，结果不一致。因此，本研究旨在使用基于登记的数据在瑞典普通人群中确定 PTSD 的发生和相关因素。
本基于登记的队列研究使用生存分析。纳入年龄≥15 岁，于 1990-2015 年期间在瑞典登记居住且未移民，在 2006 年前未接受 PTSD 专科治疗的 1960-1995 年出生者（=4673764 人），随访至其 15/16 岁生日至 2006-2016 年间首次 PTSD 诊断或研究截止日期（2016 年 12 月 31 日）。从国家患者登记处确定 PTSD 病例（ICD-10：F43.1）。平均随访时间为 18.8 年。
2006-2016 年，接受 PTSD 专科治疗的患者比例几乎翻了一番，有 0.7%的研究人群接受了此类治疗。难民的风险最高[aHR 8.18；95%CI：7.85-8.51]，其次是有抑郁障碍的患者[aHR 4.51；95%CI：3.95-5.14]。女性、年龄较大、受教育程度较低、单亲家庭、低家庭收入、城市地区和外国出生的父母等与 PTSD 风险较高相关。
PTSD 在难民移民、精神疾病患者和社会经济弱势群体中更为常见。重要的是，应提供 PTSD 服务，特别是针对这些高风险和往往难以接触到的群体。
