Fontana A, Rosenheck R
Veterans Affairs Northeast Program Evaluation Center, Evaluation Division of the National Center for PTDS, West Haven, Connecticut 06516.
J Nerv Ment Dis. 1994 Dec;182(12):677-84. doi: 10.1097/00005053-199412000-00001.
Data from the National Vietnam Veterans Readjustment Study, conducted from 1986 to 1988, were used to develop and cross-validate a model of the etiology of posttraumatic stress disorder (PTSD) among a community sample of 1198 male Vietnam theater veterans. The initial model specified causal paths among five sets of variables, ordered according to their historical occurrence: a) premilitary risk factors and traumas, b) war-related and non-war-related traumas during the military, c) homecoming reception, d) postmilitary traumas, and e) PTSD. The initial model was refined and then cross-validated, leading to the specification of a final model with highly satisfactory fit and parsimony. In terms of the magnitude of their contribution to the development of PTSD, lack of support from family and friends at the time of the homecoming and exposure to combat were the two most influential contributors. Other contributing factors, in order of importance, were Hispanic ethnicity, societal rejection at the time of homecoming, childhood abuse, participation in abusive violence, and family instability. Exposure to war-related and non-war-related traumas occurred largely independently of each other, with war-related traumas contributing substantially more than non-war-related traumas to the development of PTSD. Limitations to interpretation of the results are noted due to the retrospective nature of the data and the inevitable omission of other etiological factors.
1986年至1988年开展的越南退伍军人全国重新适应研究的数据，被用于在1198名越南战区男性退伍军人的社区样本中开发和交叉验证创伤后应激障碍（PTSD）病因模型。初始模型规定了五组变量之间的因果路径，这些变量根据其发生的先后顺序排列：a）入伍前的风险因素和创伤，b）服役期间与战争相关和与战争无关的创伤，c）回国待遇，d）退伍后的创伤，以及e）创伤后应激障碍。对初始模型进行了完善，然后进行交叉验证，从而确定了一个拟合度和简约性都非常令人满意的最终模型。就其对创伤后应激障碍发展的贡献程度而言，回国时缺乏家人和朋友的支持以及经历战斗是两个最具影响力的因素。其他影响因素按重要性排序依次为西班牙裔、回国时受到社会排斥、童年期受虐、参与虐待性暴力以及家庭不稳定。接触与战争相关和与战争无关的创伤在很大程度上相互独立，与战争无关的创伤相比，与战争相关的创伤对创伤后应激障碍发展的促成作用要大得多。由于数据的回顾性性质以及不可避免地遗漏其他病因因素，对结果的解释存在局限性。
