North C S, Smith E M, Spitznagel E L
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110.
Am J Psychiatry. 1994 Jan;151(1):82-8. doi: 10.1176/ajp.151.1.82.
Posttraumatic stress disorder (PTSD) has been best studied among combat veterans. Less is known about PTSD among civilian populations exposed to traumatic events. A recent mass murder spree by a gunman in a cafeteria in Killeen, Tex., has provided a unique opportunity to study acute-phase civilian responses to a combat type of experience.
Approximately 1 month after the disaster, 136 survivors were interviewed with the Diagnostic Interview Schedule/Disaster Supplement.
In the acute postdisaster period, 20% of the men and 36% of the women met criteria for PTSD, which was the most prevalent psychiatric disorder. Most subjects who developed PTSD had no history of psychiatric illness. Rates of preexisting PTSD were relatively high and did not predict the presence of PTSD after the disaster. A history of other predisaster psychiatric disorders predicted postdisaster PTSD in women but not in men. One-half of the women and one-fourth of the men with postdisaster PTSD also met criteria for another postdisaster psychiatric diagnosis, especially major depression. Psychopathology was infrequent in subjects without PTSD.
Disaster intervention workers may be able to most effectively use limited mental health provider resources in the acute postdisaster period by focusing on screening for acute PTSD, which will identify the majority of cases with psychiatric disorders following this kind of disaster. Survivors who have no history of psychiatric disorder should be screened along with those who do because in the present study, they represented the majority of the PTSD cases. Subjects with a history of major depression and women with preexisting psychopathology may be especially vulnerable to posttraumatic syndromes. Individuals with PTSD should be further examined for additional psychiatric diagnoses that may complicate recovery, especially major depression. PTSD among survivors of civilian combat-like experiences does not appear to present in the same way that it has been described in Vietnam veterans.
创伤后应激障碍（PTSD）在退伍军人中得到了最为深入的研究。对于经历创伤事件的平民群体中的PTSD，我们了解得较少。德克萨斯州基林市一家自助餐厅近期发生的枪手大规模杀人事件，为研究平民对战斗类经历的急性期反应提供了一个独特的机会。
灾难发生约1个月后，使用诊断访谈表/灾难补充版对136名幸存者进行了访谈。
在灾难后的急性期，20%的男性和36%的女性符合PTSD的诊断标准，这是最常见的精神障碍。大多数患上PTSD的受试者既往无精神疾病史。既往PTSD的发生率相对较高，但并不能预测灾难后PTSD的发生。其他灾难前精神障碍史可预测女性灾难后PTSD的发生，但对男性则不然。灾难后患有PTSD的女性中有一半、男性中有四分之一还符合另一种灾难后精神障碍诊断标准，尤其是重度抑郁症。无PTSD的受试者精神病理学表现并不常见。
灾难干预工作者在灾难后的急性期或许能够通过专注于筛查急性PTSD，最有效地利用有限的心理健康服务资源，这将识别出此类灾难后大多数患有精神障碍的病例。无精神疾病史的幸存者应与有精神疾病史的幸存者一同接受筛查，因为在本研究中，他们占PTSD病例的大多数。有重度抑郁症病史的受试者以及有既往精神病理学表现的女性可能尤其易患创伤后综合征。对患有PTSD的个体应进一步检查是否存在可能使康复复杂化的其他精神障碍诊断，尤其是重度抑郁症。平民经历类似战斗的事件后发生的PTSD，其表现似乎与越南退伍军人中所描述的不同。
