Delahanty D L, Dougall A L, Craig K J, Jenkins F J, Baum A
University of Pittsburgh Cancer Institute, Department of Behavioral Medicine and Oncology, PA 15213, USA.
Psychosom Med. 1997 Sep-Oct;59(5):467-76. doi: 10.1097/00006842-199709000-00002.
The present study examined the effects of working at the crash site of USAir Flight 427 on psychological, cardiovascular, and immunological sequelae of stress within 2 months of the recovery work and again 6 months after the crash.
A total of 159 workers at the crash site and 41 controls were examined within 2 months of the crash and again 6 months after the crash. Subjects were initially grouped according to whether they had contact with human remains. For a finer-grained analysis of exposure to bodies, subjects were also grouped by degree of exposure, determined by the area in which the workers were stationed. Dependent measures included intrusive thoughts, coping styles, and symptom reporting, as well as heart rate and blood pressure, and NK cell number and activity.
Workers exposed to body parts at the actual crash site, and those who were exposed to remains without expecting to be, exhibited more symptoms of stress than workers who saw bodies and body parts at the morgue and those who did not see human remains. Non-morgue workers who were exposed to bodies or body parts had the highest levels of intrusive thoughts at both time points, and the highest NK cell activity at Time 1. NK activity in this group decreased to levels comparable with other groups at Time 2.
Increased NK activity is unusual in chronic stress situations, and may be because of acute stress experienced as a result of being asked to talk and think about the crash. The finding that the more one was exposed to human remains the less distress he or she reported is discussed in terms of adaptation, expectancy, and control.
本研究调查了参与美国航空427号航班坠机事故现场救援工作的人员在救援工作结束后2个月内以及坠机事故发生6个月后的心理、心血管和免疫方面的应激后遗症。
共有159名坠机事故现场救援人员和41名对照人员在坠机事故发生后2个月内接受了检查,并在坠机事故发生6个月后再次接受检查。研究对象最初根据是否接触过遇难者遗体进行分组。为了更细致地分析接触遗体的情况,研究对象还根据接触程度进行了分组,接触程度由其工作地点决定。因变量包括侵入性思维、应对方式和症状报告,以及心率、血压、自然杀伤细胞数量和活性。
在实际坠机现场接触过遗体碎片的救援人员,以及那些意外接触到遗体的救援人员,比在停尸房看到遗体和遗体碎片的救援人员以及未看到遇难者遗体的救援人员表现出更多的应激症状。在两个时间点,非停尸房接触过遗体或遗体碎片的救援人员侵入性思维水平最高,在时间1时自然杀伤细胞活性也最高。该组在时间2时自然杀伤细胞活性降至与其他组相当的水平。
在慢性应激情况下自然杀伤细胞活性增加并不常见,这可能是由于被要求谈论和思考坠机事故所经历的急性应激所致。研究结果表明,接触遇难者遗体越多的人报告的痛苦越少,这可以从适应、预期和控制的角度进行讨论。