汶川地震山区幸存成人急性应激障碍回顾性分析

目的:探讨汶川震后山区幸存者成人急性应激障碍(ASD)流行病学特征和MMPI-PK的最佳筛查阈值。方法:整群抽取禹里乡2433例幸存成人,采用ASDI进行访谈,并根据DSM-IV-TR诊断标准进行诊断。随机抽取70例确诊病例为研究组,91例适应良好幸存者为对照,完成PK检测并绘制ROC曲线。结果:山区幸存成人ASD发病率16.79%,女性高于男性(χ~2=10.11,P0.01),中青年高发,散居者高于集中居住者(χ~2=10.57,P0.01),受教育程度不同,发病存在差异(χ~2=6.31,P0.05);婚姻状况、经济收入不同发病率差异不显著,受损程度越高发病率越高(χ~2=34.60,P0.01)。居住状态(Wald=15.69,P0.01)、受损程度(Wald=13.54,P0.01)、年龄(Wald=9.82,P0.05)和性别(Wald=11.74,P0.01)与ASD发病显著相关。警觉性增高症状群最常见,其次是再体验症状群和一般症状群,67.55%伴有自主神经反应,女性分离性症状群和回避性症状群较男性常见(χ_(0.01(1))~2=6.63,P0.01)。PK28分时,ROC曲线下面积最大,为最佳截断点(Z=9.41,P0.01),灵敏度92.75%,特异度96.59%,约登指数89.34%,总符合率94.90%,阳性似然比=27.2010,阴性似然比=0.0750.1。结论:震后山区幸存者成人ASD流行病学显示了一定的人群特异性,需要采取针对性心理救援策略,PK对这一人群ASD的最佳筛查阈值为28分。

Retrospective Analysis on ASD of Adults Survived Wenchuan Earthquake in Mountainous Area

Objective:To investigate epidemiological characteristics of ASD of adults survivcd Wcnchuan Earthquake in mountainous area and the best threshold of MMPI-PK for ASD screening.Methods:A total of 2433 adult survivors of Yuli township were cluster sampled to be interviewed with ASDI,and diagnosed according to DSM-IV TR diagnostic criteria.We sampled 70 confirmed cases randomly,91 well-adjusted survivors as control,to accom plish PK testing and ROC curve drawing.Results:Among these survivors,the incidence of ASD of was 16.79％,fe males showed higher level than male(x2=10.11,P＜0.01),more common in youth and middle-aged compared to the elderly(P＜0.05),higher in survivors living seperately than survivors living together(x2 =10.57,P＜0.01),there were different incidences in groups of different education(x2=6.31,P＜0.05),neither diffference of incidences a mong groups educated differently nor that among groups wvith different marriage status was significant,the more people lost,the higher the incidence(x2=34.60,P＜0.01).Onset of ASD was correlated significantly with the four factors housing,losses,age and gender(P＜0.05).The symptom cluster of increased alertness was most frequently seen,followed by relived-symptom cluster and general symptom cluster,67.55％ accompanied by autonomic nervous response,both dissociative-symptom cluster and avoidance-symptom cluster were more common in women than men(x2=6.63,P＜0.01).The largest AUC(Area Under Curve)could be gotten at 28 of PK scale(P＜0.01),which was the best cut-off score of ROC,Se=92.75％,SP =96.59％,YI=89.34％,TCR=94.90％,PLR=27.20＞ 10,NLR=0.075＜0.1.Conclusion..Some degree of population-specificity can be seen in Epidemiology of ASD of adult survivors in mountainous area after Earthquake,therefore,it is necessary to take pointed psychological aid strat egy.The best screening threshold of MMPI-PK for their ASD is 28.