汶川地震重灾区青少年创伤后应激障碍及其相关因素

目的:了解四川绵竹地区青少年创伤后应激障碍的筛出率及其相关因素。方法:在汶川大地震后3个月,随机整群抽样调查绵竹地区587名中学生。使用自编的创伤暴露基本情况问卷和LosAngeles症状核查表青少年版筛查创伤后应激障碍的现患率。结果:绵竹地区青少年创伤后应激障碍的检出率有4.3%,而且存在明显的性别差异。分层回归分析发现,性别、创伤暴露严重程度(是否目睹或接触尸体、是否目睹死亡和恐惧程度)能够显著预测创伤后应激障碍。结论:对灾区青少年进行创伤后应激障碍的心理辅导和干预时,要对女性以及目睹过死亡和感受到强烈恐惧感的青少年给予特殊关注和干预。     

汶川地震极重灾区妇女创伤后应激症状、心理健康及其影响因素

目的:考察极重灾区妇女创伤后应激症状、心理健康问题的发生特点及影响因素。方法:对汶川地震极重灾区99名妇女(47名地震中丧亲妇女,52名未丧亲妇女)采用创伤后应激障碍检查表平民版(PCL-C)、社会支持量表(SSRS)和一般健康问卷(GHQ28)进行测查。结果:①)极重灾区妇女PTSD总检出率37.4%,丧亲妇女检出率55.3%,未丧亲妇女21.1%,心理健康问题总检出率79.8%,丧亲妇女检出率为89.3%,未丧亲妇女检出率71.2%,丧亲妇女检出率均显著高于未丧亲妇女。文化程度不同的妇女PTSD检出率有显著差异。②总体PCL-C与GHQ-28测量结果之间各维度均呈现显著正相关。③丧亲状况的主效应显著,丧亲妇女和未丧亲妇女之间创伤后应激症状总分及各维度分数均存在显著差异。④丧亲是极重灾区妇女PTSD症状和心理健康的危险因素;社会支持是保护性因素。     

青少年创伤后应激障碍症状与父母教养方式的关系:心理弹性的中介作用

目的:考察汶川地震后青少年创伤后应激障碍症状与父母教养方式、心理弹性的关系。方法:震后18个月,采用创伤后应激障碍自评量表、心理弹性量表、父母教养方式问卷、自编一般人口学及地震暴露情况调查表,对都江堰地区规模最大的某高中的二年级学生进行调查,收回有效问卷984份。结果:都江堰地区青少年震后18个月PTSD症状的检出率为13.3%,在性别、是否独生子女及不同地震暴露程度间存在显著差异;心理弹性在父母关怀、父母过度保护与PTSD症状之间存在部分中介作用,中介效应占总效应的比例分别为25.6%、15.6%,心理弹性在父母冷漠与PTSD症状之间存在完全中介作用。结论:父母对孩子较多的关怀和较少的控制干涉有利于培养青少年的心理弹性,对震后PTSD症状具有保护作用。     

地震受灾人群创伤后应激障碍危险因素的病例对照研究

目的:探讨地震3年后受灾人群中创伤后应激障碍(PTSD))的危险因素。方法:采用病例对照研究的方法,分析地震3年后云南省鲁甸县龙头山镇重灾区受灾群众155人的调查资料,以PTSD筛查阳性人群为病例组,阴性人群为对照组,对自编人口学基本信息调查表、创伤后应激障碍自评量表(PCL-C)的问卷数据进行单因素分析,采用非条件logistic回归分析探讨年龄、性别等人口学资料及灾难暴露程度、参与现场救援、地震中失去亲人与否等对创伤后应激障碍的影响。结果:病例组与对照组单因素分析比较显示,性别(χ~2=4.65,P0.05)、受教育程度(χ~2=9.63,P0.01)、灾难暴露程度(χ~2=7.15,P0.01)有统计学意义。非条件logistic回归分析显示女性(OR=4.89,P0.01)、非文盲(OR=6.30,P0.01)、高暴露者(OR=17.44,P0.05)是发生PTSD的危险因素。结论:地震三年后重灾区受灾人群中女性、非文盲、高暴露者发生PTSD的危险性大,提示应当重点对这类PTSD的高危人群进行灾后创伤相关干预。     

震后不同地区初中生的抑郁水平及创伤后症状

目的:比较汶川地震后受灾程度不同地区初中生的抑郁水平及创伤后症状,并探讨其影响因素。方法:采用青少年生活事件量表(ASLEC)、自尊量表(SES)、儿童版事件冲击量表修订版(CIES-R)、儿童抑郁量表(CDI)测量工具,对来自受灾程度不同地区的341名初中生进行测查。结果:受灾严重地区的初中生在PTSD症状上显著高于受灾一般地区的初中生,但在抑郁症状上显著低于受灾一般地区的初中生;在回归分析中,发现自尊和生活事件的学习因子对抑郁和创伤后症状的预测作用较大,但两者的预测作用相反。结论:不同受灾地区初中生的抑郁水平和创伤后症状不同,受灾严重的地区抑郁症状较轻,但PTSD症状较重。     

宜宾震后青少年身心状况

目的:考察宜宾震后青少年创伤后应激障碍、抑郁与情绪调节策略等状况及其在性别、年级上的差异,探讨PTSD、抑郁与情绪调节策略三者之间的关系,为创伤后心理危机干预提供依据。方法:采用创伤后应激障碍量表、抑郁量表、情绪调节策略量表,对宜宾震中长宁县321名青少年进行测量。结果:(1)震后2周,6.50%的青少年有PTSD倾向,46.40%的青少年有抑郁症状,表现出更多的回避性症状(维度得分3.24±0.77)以及警觉性增高症状(维度得分10.24±2.49);(2)从性别看,女生的CES-D量表得分(t=-2.804,P0.01)及发生率(χ~2=7.100,P0.05)均显著高于男生,同时其ERQ量表的认知重评维度得分(t=-2.154,P0.05)亦显著高于男生,而男生的ERQ量表表达抑制维度得分(t=2.650,P0.01)显著高于女生;从年级看,初中生PCL-5得分(t=3.147,P0.05)及发生率(χ~2=15.797,P0.01)均显著高于高中生,同时在认知重评维度(χ~2=5.747,P0.05)上高中生得分显著高于初中生;(3)被试的PCL-5量表得分与CES-D量表得分呈显著正相关(r=0.639,P0.01),与ERQ量表的认知重评维度得分呈显著负相关(r=-0.187,P0.01),与表达抑制维度得分呈显著正相关(r=0.139,P0.05);被试CES-D量表上的得分与ERQ量表的认知重评维度得分呈显著负相关(r=-0.260,P0.01),与表达抑制维度得分呈显著正相关(r=0.120,P0.05);(4)有PTSD倾向的被试在CES-D量表上得分显著高于没有PTSD倾向的被试(t=5.617,P0.01);同时,有PTSD倾向的被试在ERQ量表的认知重评维度得分显著低于没有PTSD倾向的被试(t=-2.870,P0.01),有抑郁症状的被试在PCL-5量表上得分显著高于没有抑郁症状的被试(t=12.194,P0.01);同时,有抑郁症状的被试和没有抑郁症状的被试分别在ERQ量表的两个维度上得分呈显著差异,表现为有抑郁症状的在表达抑制维度上显著高于没有抑郁症状的(t=2.021,P0.05);而认知重评维度上,有抑郁症状的则显著低于没有抑郁症状的(t=-2.780,P0.01)。结论:震后不久的灾区青少年的PTSD倾向和抑郁症状较严重,而性别、年龄的不同有较明显差异;应有重点地关注女生以及年龄偏低的青少年,注重提升他们的情绪调节策略。     

精神创伤后应激障碍与述情障碍的相关性分析

目的:研究旨在了解经历精神创伤后,创伤后应激障碍(PTSD)患者的症状特征与述情障碍的关系。方法:试验组为35名经历过精神创伤发生PTSD的患者,对照组为35名经历过精神创伤未发生PTSD的创伤暴露者,在不影响测验症状的情况下分别完成创伤后应激障碍临床筛查表平民版量表(PCL-C)及述情障碍20个条目量表(TAS-20)中文版。结果:PTSD患者述情障碍的发生率(57.14%)高于未发生PTSD的创伤幸存者(11.42%),PTSD患者的TAS-20总分(t=-5.271,P0.001)、因子1(F1:情感辩别不能)(t=-6.113,P0.001)及因子2(F2:情感描述不能)(t=-4.660,P0.001)得分高于对照组,差异有统计学意义。总分及因子分与PTSD症状的相关分析表明,PTSD患者的症状特征与TAS-20总分及F1、F2因子显著相关。结论:精神创伤暴露者中PTSD患者与未发生PTSD的创伤幸存者的述情障碍表现明显不同,TAS-20量表在临床具有较好的辅助诊断价值。     

汶川地震后青少年幸存者PTSD症状的特点及其发展

目的:本文考察了5·12汶川大地震重灾区幸存者中青少年的PTSD症状特点及其变化情况。方法:在地震半年后和一年后分别使用儿童版事件冲击量表对203名青少年进行重复施测。结果:①地震半年后,21.2%的青少年可能罹患PTSD;地震一年后,19.2%的青少年可能罹患PTSD。总体罹患率变化不显著。②地震半年后,伤残儿童PTSD检出率显著高于健全儿童;地震一年后,伤残儿童的检出率与健全儿童没有显著差异。③从得分上看,相对于地震半年后表现出的PTSD症状,地震一年后灾区青少年在事件冲击量表各维度上的得分及总分均显著降低。结论:地震一年后,灾区青少年的PTSD症状有所缓解,但仍存在较大比例的PTSD高危群体。     

汶川地震幸存者创伤后应激反应与细胞免疫的关系

目的 探讨自然灾害后创伤后应激反应与细胞免疫之间的关系.方法 在汶川地震18个月时通过PTSD症状自评量表(PCL)对205名5·12汶川地震极重灾区教师的创伤后应激反应严重程度的测评和T细胞及其亚群水平的化验和分析.结果 通过对102名PCL高分组被试和103名PCL低分组被试的T淋巴细胞及其亚群进行t检验发现,两组被试在CD3水平上存在显著差异(P=0.050),在CD4/CD8水平上存在边缘性显著差异(P=0.069).进一步的秩和相关分析发现,CD3对创伤后应激反应的4个症状都呈边缘性显著的负相关(闯入、回避、麻木和高警觉的P值分别是0.098、0.081、0.065、0.073),而CD4/CD8仅对PTSD中的高警觉症状呈显著负相关(P＜0.05).结论 地震18个月后幸存者的CD3水平可以作为PTSD的生物标记,而CD4:CD8的值则可以作为PTSD的高警觉症状的生物标记.     

汶川地震灾区1960名中学生创伤后应激障碍症状调查

目的:了解汶川大地震灾区中学生创伤后应激障碍症状(Post-Traumatic Stress Disorder,PTSD)的发生率。方法:采用方便取样。以汶川地震灾区3所中学1960名中学生为研究对象,用创伤后应激障碍(PTSD)症状清单平民版(PTSD Checklist-Civilian version,PCL-C)(分B、C、D三组症状群),进行自填式调查。结果:(1)PTSD症状群筛查总阳性率为78.3%,B组阳性率最高(68.9%)。(2)女性、高年级、少数民族、来自农村、地震中受伤、家庭财产受损学生PTSD症状总体阳性率及三组症状群阳性率均分别高于男性、低年级、汉族、来自城镇、地震中未受伤、家庭财产未受损失学生[如,PTSD总体阳性率:女82.2%,男73.9%,P0.05]。(3)女生和农村学生重度PTSD症状发生率高于男生和城镇学生(27.9%vs.19.9%,26.7%vs.21.4%,均P0.05)。结论:创伤后应激障碍症状是地震重灾区中学生主要心理问题,不同特征的中学生创伤后应激障碍症状表现及严重程度不同,应采取有针对性的干预措施。     

汶川大地震后重灾区民警应激反应调查研究

目的通过调查,了解重灾区民警的应激反应状况和强度,为后期的心理援助提供有力的实证资料。方法使用自编的民警灾后应激调查问卷,对重灾区224名一线民警和非重灾区159名民警进行调查。结果重灾区民警部分心理应激和生理应激的分值较高,北川民警最为突出;北川民警与其他重灾区民警在各因子和总均分上基本存在显著差异,安县次之;重灾区与非重灾区民警的灾后应激反应的各因子和总均分的t值均在P〈0.001条件下显著。结论①重灾区民警普遍存在较重的灾后应激反应,部分民警出现应激相关障碍,以北川民警为甚;②重灾区中不同地区民警的应激反应程度有所不同,呈灾情越重的地区的民警应激反应越强的趋势;③重灾区民警存在的应激反应强度远远大于非重灾区民警。     

地震重灾区民警灾后3个月的应激特点

目的及时了解地震重灾区民警在灾后3个月的应激特点以及变化规律，以此制定相应的计划和对策。方法使用自编的民警灾后应激调查问卷．对重灾区125名一线民警进行调查。结果重灾区民警在灾后3个月的心理应激依然突出，并存在显著差异（P〈0．01），其中北川民警的心理应激突出；对北川、安县、江油进行纵向对比，除北川在生理应激上有显著改善（P〈0．01）之外，北川的其他因子、其他地区的所有因子均无显著改善。结论①灾后3个月，地震重灾区民警心理应激和行为应激比较突出；②地震重灾区民警比较突出的是心理应激，受灾越严重，心理应激越严重，以北川为甚，而其他因子在地区上则无显著性差异；③地震重灾区民警的应激反应与灾后10天相比无大的改善，部分民警的应激特点符合创伤后应激障碍的症状和诊断标准。     

地震后灾区乡镇基层干部心理健康状况的调查

目的:了解地震后灾区乡镇基层干部心理健康状况。方法:使用创伤后应激障碍检查量表平民版、霍普金斯25项症状量表、领悟社会支持量表和创伤暴露水平问卷对乡镇基层干部进行调查。结果:①灾区乡镇基层干部创伤后应激障碍、抑郁、焦虑及共病情况较为严重;②灾区乡镇基层干部领悟社会支持较高;③极重灾区乡镇基层干部创伤后应激障碍、抑郁、焦虑及共病情况严重。结论:目前的心理援助工作很有必要加强对灾区,特别是极重灾区和重灾区乡镇基层干部的工作力度。     

Effect of stress on atopic dermatitis: investigation in patients after the great hanshin earthquake.

BACKGROUND: Although a variety of factors are responsible for atopic dermatitis (AD), very little is known about the effect of stress caused by a natural disaster on AD symptoms. OBJECTIVE: This study was conducted to assess the effect of stress or trauma on the symptoms of AD. METHODS: One thousand four hundred fifty-seven patients with AD (745 males and 712 females), diagnosed by using the criteria of the Japanese Dermatology Association, were enrolled in the study. The data were obtained from a self-administered questionnaire given to patients with AD after experiencing the Great Hanshin Earthquake. The data were analyzed by multivariate logistic regression analysis. Patients were divided into 3 groups: area A, severe damage to buildings and houses; area B, mild damage; and control area, no damage. RESULTS: Exacerbation of skin symptoms was found in 38% and 34% of patients in areas A and B, respectively, whereas similar exacerbation was seen in 7% of control patients. Nine percent and 5% of the patients in areas A and B, respectively, showed improvement in their symptoms compared with 1% in the control group. The earthquake caused stress in 63% and 48% of the patients in areas A and B, respectively, but fewer patients felt stress in undamaged areas (19%). Multiple logistic regression analysis revealed that of the factors examined here, subjective distress is the factor that is most responsible for the exacerbation of skin symptoms (odds ratio, 2.98; 95% confidence interval, 2.25-3.96). CONCLUSION: The results presented here strongly suggest that stress caused by a natural disaster influences AD symptoms.     

芦山地震后5年雅安市受灾居民心理健康状况及其相关因素

目的:了解芦山地震后五年雅安市受灾居民的心理健康状况及相关因素。方法:采用整群分层随机抽样的方法,选取雅安市年龄≥15岁受灾居民9000例,采取入户调查方式,于2019年1~5月使用自编受灾居民基本信息调查表、12项一般健康问卷(GHQ-12)评估近期心理健康状况(≥3分为心理健康状况不良)。结果:8876例居民中心理健康状况不良者(GHQ≥3分)613例(6.9%)。Logistics回归分析显示,有工作(OR=0.15,P<0.001)、居住在乡村(OR=0.48,P<0.001)、一般灾区(OR=0.62,P<0.001)、无慢性疾病(OR=0.37,P<0.001)者更不易出现心理健康状况不良,而老年(OR=1.60,P<0.001)、小学及以下受教育程度(OR=2.69,P<0.001),收入≤1万元(OR=4.8,P<0.001)及无配偶(OR=2.02,P<0.001)者更易出现心理健康状况不良。结论:有工作、居住地为乡村、受灾程度为一般灾区、无慢性疾病为芦山地震后五年雅安市受灾居民心理健康状况不良的保护因素,而老年、受教育程度低、收入低以及无配偶为危险因素。     

The changing impact of a severe disaster on the mental health and substance misuse of adolescents: follow-up of a controlled study

BACKGROUND: Disasters are believed to have large effects on the mental health of adolescents but the lack of prospective pre- and post-disaster data on affected and control populations have limited our knowledge on the validity of these claims. We examined the medium-term, 12 months' effects of a severe disaster on the mental health of adolescents, and compared them to effects after 5 months. METHOD: A café fire in The Netherlands injured 250 adolescents and killed 14. We obtained data 15 months before and 12 months after the disaster about behavioural and emotional problems (using the Youth Self-Report) and substance misuse, in 124 students of an affected school of whom 31 were present at the fire (response 77.5%) and 830 other students (56.4%); mean age at baseline, 13.8 years. RESULTS: We found differences between students from the affected school and others for excessive use of alcohol (odds ratio 3.42, 95% confidence interval 2.00-5.85, p < 0.0001), but not for behavioural and emotional problems and use of other substances. Effects had decreased compared to those after 5 months. CONCLUSIONS: In the long run, the effects of disaster decrease regarding self-reported behavioural and emotional problems, but they remain regarding alcohol misuse among those present at the disaster, and their peers.     

Community perceptions of natural disasters and post-disaster mental health services

This research was designed to examine the cognitive and affective responses of residential dwellers in the aftermath of a natural disaster (a flood). In a 2 X 3 factorial design, the effects of fear (High, Medium, and Low) and sex on perceptions of the disaster were assessed. The results indicated that respondents who were highly fearful of the disaster were more likely than moderate or low fear respondents to believe that: a) additional flooding would occur in their vicinity, and b) that they resided closer to the flood zone than they actually did. The policy implications of the results suggested that post-disaster mental health services might have to be extended to include residents of geographical areas not directly affected by natural or man-made disasters.     

汶川地震受灾民众创伤后成长及其影响因素

目的:考察经历汶川地震这一重大创伤性事件后极重灾区之一的彭州板房区受灾民众的创伤后成长及其影响因素。方法:使用IES-R、PTGI中文修订版,以及自编的调查问卷,对彭州板房区2403名受灾民众进行调查,回收有效问卷2104份。结果:被试的PTSD症状及地震对个体造成的客观和主观影响越大,其创伤后成长得分也越高;但地震造成的主、客观影响在PTSD症状进入回归模型后变得不再显著或显著性水平降低。结论:地震后个体PTSD症状是预测创伤后成长最重要的因素。     

The association between dispositional optimism and mental health problems among disaster victims and a comparison group: a prospective study

BACKGROUND: It is unclear whether the associations between the level of dispositional optimism on the one hand, and depression symptoms and other health problems on the other hand among disaster victims differ from the associations among non-affected residents. METHODS: To assess the associations between the level of dispositional optimism and health problems among disaster victims and non-affected residents, data of the longitudinal Enschede Fireworks Disaster Study was analyzed. Participants in the present study consisted of adult native Dutch victims of the disaster (N=662) and a non-affected comparison group (N=526). Both groups participated 18 months (T1) and almost four years post-disaster (T2). Multivariate logistic regression analyses were applied to examine the association between optimism and health problems among both groups. RESULTS: Results showed that pessimistic victims were more at risk for severe depression symptoms and obsessive-compulsive symptoms than optimistic victims when controlling for demographic characteristics, life events, smoking, and existing health problems at T1. However, pessimistic participants in the comparison group were also more at risk for severe anxiety symptoms, sleeping problems, somatic problems, and problems in social functioning than optimistic control participants. LIMITATIONS: We had no information on dispositional optimism before 18 months post-disaster. CONCLUSIONS: Pessimists at baseline are more at risk for health problems after 27 months than optimists. However, among non-affected residents pessimism is a stronger independent risk factor than among victims. Results suggest that professional helpers such as general practitioners, psychologists and psychiatrists should not rely too much on optimistic views of disaster victims.