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构建一个关于创伤性和不良经历后创伤后应激障碍症状连续性与变化的发展模型。

Toward a Developmental Model of Continuity and Change in PTSD Symptoms following Exposure to Traumatic and Adverse Experiences.

作者信息

Weems Carl F, McCurdy Bethany H, Scozzafava Mikaela D

机构信息

Department of Human Development and Family Studies, Iowa State University Ames, 4380, Palmer, IA 50011 USA.

出版信息

J Child Adolesc Trauma. 2021 Nov 19;16(2):391-402. doi: 10.1007/s40653-021-00398-2. eCollection 2023 Jun.

Abstract

A developmental understanding of the expression of posttraumatic stress (PTS) symptoms following trauma in childhood requires identifying continuity and change in not just overall symptoms but in the individual symptoms as well. Such models of change also require understanding multiple dimensions of time. That is, longitudinal change-the passage of time-may have different effects on symptom expression depending on when in time an individual entered the study - such as what age they were when first assessed. This paper addresses these ideas with an overview of the developmental differences in the assessment of PTS from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), longitudinal research on posttraumatic stress disorder (PTSD) symptoms, and providing synthesis within a symptom network perspective. We then provide an illustration of how individual PTSD symptoms change over time at different ages (elementary versus middle school) with a secondary analysis of data from a previously reported study (n = 191 youth, aged 8-15, assessed at two time points six months apart). The reanalysis of the data suggests both continuity and change in symptoms over time (i.e., some symptoms were more stable than other symptoms) with differences in symptom rates and their longitudinal change as a function of age (i.e., some symptoms more common or more stable in younger versus older or older versus younger). We close with avenues for future research aimed at better understanding symptom cascades over time and at different ages and potential implications for future iterations of assessment/classification systems.

摘要

要从发展的角度理解童年创伤后创伤后应激(PTS)症状的表达,不仅需要识别总体症状随时间的连续性和变化,还需要识别个体症状的连续性和变化。这种变化模型还需要理解时间的多个维度。也就是说,纵向变化——时间的推移——可能对症状表达产生不同的影响,这取决于个体进入研究的时间,比如他们首次接受评估时的年龄。本文通过概述《精神疾病诊断与统计手册》第五版(DSM - 5)中创伤后应激(PTS)评估的发展差异、创伤后应激障碍(PTSD)症状的纵向研究,并从症状网络的角度进行综合阐述,来探讨这些观点。然后,我们通过对先前一项报告研究(n = 191名8 - 15岁青少年,在相隔六个月的两个时间点进行评估)的数据进行二次分析,举例说明不同年龄(小学与中学)的个体PTSD症状如何随时间变化。数据的重新分析表明,症状随时间既有连续性又有变化(即有些症状比其他症状更稳定),症状发生率及其纵向变化因年龄而异(即有些症状在较年轻与较年长个体中更常见或更稳定,反之亦然)。我们最后提出了未来研究的方向,旨在更好地理解不同年龄随时间变化的症状级联反应以及对评估/分类系统未来版本的潜在影响。

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