O'Toole B I, Marshall R P, Schureck R J, Dobson M
Department of Community Medicine, University of New South Wales, Australia.
Aust N Z J Psychiatry. 1998 Feb;32(1):21-31. doi: 10.3109/00048679809062702.
The aims of this paper are to determine the risk factors for combat-related posttraumatic stress disorder (PTSD) and to examine the relative contribution of pre-military factors, pre-trauma psychiatric diagnoses, military factors such as combat posting, and combat and casualty stress exposure.
An epidemiological cohort study using standardised psychiatric, social and health interviews was undertaken with a national random sample of male Australian Army Vietnam veterans. Multivariate logistic regression was used to examine the relative contribution of factors derived from interview and from military records in four categories: pre-enlistment circumstances including home life, education, major life stress; pre-Vietnam psychiatric diagnoses; military experiences before and during Vietnam; and combat and stress experiences.
Of the 128 data items examined, significant associations were found for 39, in addition to combat stress. Pre-enlistment items accounted for about 3% of the deviance towards PTSD diagnosis, pre-enlistment psychiatric diagnosis about 13%, military variables about 7% and combat stress about 18%; all factors together accounted for 42%.
The results confirm that pre-military and military variables make only a small but significant contribution to PTSD either alone or after controlling for combat stress; that psychiatric diagnoses of depression, dysthymia and agoraphobia make strong contributions to PTSD; but that combat stress makes the largest contribution even after controlling for the effects of other variables. Psychiatric diagnoses and combat stress appear to be independent in their effects on PTSD.
本文旨在确定与战斗相关的创伤后应激障碍（PTSD）的风险因素，并研究入伍前因素、创伤前精神疾病诊断、诸如战斗岗位等军事因素以及战斗和伤亡压力暴露的相对贡献。
采用标准化的精神、社会和健康访谈，对澳大利亚陆军越战男性退伍军人的全国随机样本进行了一项流行病学队列研究。多变量逻辑回归用于检验从访谈和军事记录中得出的四类因素的相对贡献：入伍前情况，包括家庭生活、教育、重大生活压力；越战前期精神疾病诊断；越战前后的军事经历；以及战斗和压力经历。
在检查的128个数据项中，除战斗压力外，有39项存在显著关联。入伍前项目对PTSD诊断偏差的贡献率约为3%，入伍前精神疾病诊断约为13%，军事变量约为7%，战斗压力约为18%；所有因素加起来占42%。
结果证实，入伍前和军事变量单独或在控制战斗压力后对PTSD的贡献虽小但显著；抑郁症、心境恶劣和广场恐惧症的精神疾病诊断对PTSD有很大贡献；但即使在控制其他变量的影响后，战斗压力的贡献最大。精神疾病诊断和战斗压力对PTSD的影响似乎是独立的。
