Department of Advisium, 's Heeren Loo Advisium, Amersfoort, The Netherlands.
Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
J Intellect Disabil Res. 2024 Oct;68(10):1087-1113. doi: 10.1111/jir.13178. Epub 2024 Aug 11.
Stressful life events are events that do not fulfil the A criterion of PTSD in the DSM-5(TR) but are perceived as negative by the person. There is an ongoing debate about the usefulness of the A criterion as a gate criterion for PTSD, and especially regarding which events qualify as traumatic or stressful life events. This debate is particularly important for individuals with intellectual disabilities (ID) or borderline intellectual functioning (BIF), as they seem to be more likely to experience traumatic and stressful life events than their peers without ID-BIF and appear to be more susceptible to the disruptive effects of these events. As a result, people with ID-BIF are more likely to develop mental health and behavioural problems. There is insufficient knowledge about how the relationship between stressful life events and PTSD symptoms should be interpreted, how traumatic and stressful life events are defined and distinguished in people with ID, and whether the A criterion should be broadened for individuals with ID-BIF. The aim of this scoping review was to understand stressful life events and their relationship with PTSD symptoms, other mental health and/or behavioural problems in individuals with ID-BIF.
The scoping review was conducted in accordance with the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).
Thirty-eight studies were included. Five studies focused on stressful life events and PTSD symptoms. The other studies examined associations between stressful life events and other mental health and/or behavioural problems. Most of the studies did not clearly differentiate between stressful and traumatic events according to the A criterion of PTSD in the DSM-IV (TR) or DSM-5(TR). Of the six studies in which stressful life events were specified and could be distinguished from traumatic events, one found a positive association between PTSD symptoms and stressful life events and five showed weak to strong positive associations with other mental health and/or behavioural problems.
PTSD symptoms following stressful life events in individuals with ID-BIF are underrepresented in the literature. The lack of a clear definition of stressful life events leads to a gap in the knowledge on whether and how stressful life events may lead to PTSD symptoms, other mental health and/or behavioural problems in individuals with ID-BIF. Therefore, no general conclusions or recommendations can be made regarding the appropriateness of the PTSD A criterion for individuals with ID-BIF. Further research is needed to establish the role of stressful life events in relation to PTSD symptoms and to inform the assessment and effective treatment in people with ID-BIF, as expert clinical experience studies suggest that broadening the PTSD A criterion should be considered for people with ID-BIF.
应激性生活事件是指不符合 DSM-5(TR) 中 PTSD 的 A 标准但被当事人认为是负面的事件。目前，关于 A 标准作为 PTSD 的门控标准的有用性存在持续的争论，特别是关于哪些事件属于创伤性或应激性生活事件。对于智障人士（ID）或边缘智力功能（BIF）的人来说，这场争论尤为重要，因为他们似乎比没有 ID-BIF 的同龄人更容易经历创伤性和应激性生活事件，并且似乎更容易受到这些事件的破坏性影响。因此，ID-BIF 的人更容易出现心理健康和行为问题。目前，对于如何解释应激性生活事件与 PTSD 症状之间的关系、如何在 ID 患者中定义和区分创伤性和应激性生活事件，以及 A 标准是否应该为 ID-BIF 患者放宽，人们的了解还不够。本综述的目的是了解 ID-BIF 患者的应激性生活事件及其与 PTSD 症状、其他心理健康和/或行为问题的关系。
本综述按照 JBI 系统评价方法和 PRISMA-ScR 扩展的系统评价和荟萃分析的首选报告项目进行。
纳入了 38 项研究。其中 5 项研究关注应激性生活事件与 PTSD 症状的关系，其他研究则考察了应激性生活事件与其他心理健康和/或行为问题之间的关系。大多数研究没有根据 DSM-IV(TR) 或 DSM-5(TR) 中的 PTSD 的 A 标准明确区分应激性和创伤性事件。在六项明确区分应激性生活事件和创伤性事件的研究中，一项研究发现 PTSD 症状与应激性生活事件呈正相关，五项研究显示与其他心理健康和/或行为问题呈弱到强的正相关。
智障人士（ID）或边缘智力功能（BIF）患者的应激性生活事件后出现 PTSD 症状的文献报道不足。由于缺乏对应激性生活事件的明确定义，因此，关于应激性生活事件是否以及如何可能导致 ID-BIF 患者出现 PTSD 症状、其他心理健康和/或行为问题，目前尚缺乏相关知识。因此，不能就 ID-BIF 患者的 PTSD A 标准的适当性得出一般结论或建议。需要进一步的研究来确定应激性生活事件与 PTSD 症状之间的关系，并为 ID-BIF 患者的评估和有效治疗提供信息，因为专家临床经验研究表明，应该考虑为 ID-BIF 患者放宽 PTSD A 标准。
