飞行人员事故后紧急心理干预及效果的追踪研究

目的:探讨飞行事故后紧急心理干预对飞行人员心理危机反应的影响,研究不同心理干预方法在心理危机反应早期的疗效及效果追踪。方法:采用三维危机检查分类评估量表、心理创伤后应激障碍自评量表(PTSD-SS)对经历二等飞行事故的飞行人员进行心理危机严重程度的评定,并进行心理急救、严重事件应激晤谈、认知行为疗法等方法进行心理危机干预,并于事故后3个不同时间结点对干预组飞行人员心理康复效果进行追踪观察。结果:干预组与对照组在TAF量表得分差异有统计学意义(χ2=25.4173,P<0.01);心理干预前后TAF各分量表评估结果显示,三种心理干预均能降低危机反应症状;Ridit分析显示:不同干预方法疗效不同(R=16.43,P<0.01),其中以心理晤谈组效果为最好(R=0.3518,P<0.01);连续3次的随访调查显示:早期紧急心理干预有较好的远期疗效。结论:事故后早期紧急心理干预对飞行人员应激障碍有较好的预防效果,值得推广应用。     

事故后边远雷达兵心理危机干预效果研究

目的探讨危机干预对事故后边远雷达官兵心理健康的影响。方法运用突发事件应激晤谈法(CISD)、眼动脱敏与再加工技术(EMDR)等方法进行事故后紧急心理危机干预,采用创伤后应激障碍自评量表(PTSD-SS)和临床症状自评量表(SCL-90)于危机干预前、后分别进行心理测评,研究创伤官兵心理健康状况和应激损伤的变化。结果干预前,情绪反应主要表现为恐惧、焦虑(P<0.01),伴有食欲降低、睡眠障碍生理反应;干预后,心理应激反应和危机损伤程度显著改善(P<0.01)。结论心理危机干预可明显减轻事故后边远雷达部队官兵应激反应,化解创伤带来的心理冲突,促进心理平衡。     

眼动脱敏与再加工技术对军事飞行员创伤后应激障碍及应激反应的疗效评估

目的 探讨眼动脱敏与再加工技术(EMDR)对军事飞行员创伤后应激障碍及应激反应的疗效,为战时心理创伤快速干预提供方法与依据. 方法采用焦虑水平主观不适评定单位(SUDs)、认知效度评定(VOC)和症状自评量表(SCL-90),对43名在不同时段经历飞行事故的飞机驾驶员进行评定,在此基础上采用眼动脱敏与再加工疗法、认知疗法、生物反馈疗法和心理支持法进行心理治疗干预,并分组观察和随访对比疗效. 结果 EMDR治疗组的记忆意像、暗示及躯体反应各项测验在治疗前后差异均有统计学上的显著性意义:SUDs(t=7.64,P<0.01);VOC(t=6.87,P<0.01);SCL-90(t=4.93,P<0.01).Ridit分析显示:不同疗法的治疗效果不同(Hc=9.173,P<0.05);其中以EMDR组为最好(R=0.591). 结论眼动脱敏与再加工疗法对飞行员心理创伤后应激障碍及反应有较好的疗效.     

军事飞行员心理创伤后应激反应与心理干预效果

目的　研究心理治疗干预对飞行员群体心理创伤后应激障碍及应激反应的矫治效果 ,为航空卫生保障提供依据。　方法　采用飞行人员心理健康量表 (CHI)、症状自评量表 (SCL- 90 )和心理创伤后应激症状调查表 (PTSD问卷 )对在疗养前一个月发生机毁人亡一等飞行事故部队的 44名飞行员进行评定 ,在此基础上采用认知疗法、生物反馈疗法和咨询教育法进行心理治疗干预 ,并观察和对比疗效。　结果　干预组与对照组在躯体化 (3.42 0 )、焦虑 (2 .312 )、人际敏感 (3.42 9)、抑郁(2 .0 37)等情绪应激因子上有显著性差异 (P<0 .0 5 ) ;症状学调查发现 :干预组应激反应症状 ,以持续的警觉性增加为主 ,与对照组比有非常显著性差异 (t=3.5 3,P<0 .0 1) ;Ridit分析显示 :不同疗法的治疗效果不同 (R=16 .43,P<0 .0 1) ,其中以认知治疗组为最好 (R=0 .35 18)。　结论　飞行员心理创伤后应激反应 ,以持续警觉性增高的临床症状及负性情绪为主 ,并与应激者的人格特征有关。应激状态下心理干预应首选认知疗法。     

直升机领航员创伤后应激障碍1例并文献复习

目的分析军事飞行人员创伤后应激障碍的临床特征和诊断治疗。方法报道1例创伤后应激障碍直升机领航员的临床治疗过程, 并复习相关文献。结果本例直升机领航员发病的直接诱因是单位发生一等飞行事故;以反复的创伤性体验、情绪低落、兴趣减退、持续的警觉性增高, 如入睡困难、做噩梦等为主要临床表现, 符合创伤后应激障碍诊断标准。经药物治疗, 配合心理治疗, 达到临床治愈。地面观察结束后, 航空医学鉴定结论:飞行合格。结论应重视军事飞行人员心理筛查, 提高对创伤后应激障碍的诊断意识, 药物配合心理治疗是治愈此类疾病较好的方案。     

1017例就诊飞行人员的心理干预及疗效分析

目的 研究心理干预对就诊飞行人员心理问题及应激反应症状的疗效。方法 采用PLES MHI，SMSE，SCL－90，EPIQ量表，对1017名来心理科就诊的飞行人员在心理干预前后进行评定，并比较心理教育，生物反馈疗法，个别心理治疗和团体心理咨询4种心理干预方法的疗效。结果 SCL－90测评显示心理干预前后SCL－90得分比干预前显著降低；4种方法中以个别心理治疗效果为最佳（P＜0．05）。结论 在疗养院对就诊的飞行员实施心理干预是一种缓解和消除心理问题及应激症状的有效途径。     

事故后飞行人员专项心理评估技术的研究

目的通过对事故后飞行人员心理状况进行实证量化研究,形成一套迅速、有效地针对事故后飞行人员的心理评估的专项技术。方法对580名飞行员实施流行病学调查、创伤后应激反应症状自评以及心理健康评估。结果通过流行病学调查筛查出事故亲身经历以及自评影响251例;根据心理特质将飞行人员聚为三类;PTSD-SS阳性51例,经过临床医师确诊34例,其中有28例属于反应过激型的飞行人员,符合率为82.4%。结论心理测验评估结果与临床诊断具有较好的一致性,通过三个层次的筛查与验证性研究,形成对事故后飞行人员心理状况的评估的专项技术,对飞行作战训练有着重要的临床意义。     

战时创伤后应激障碍的心理危机干预

根据国外研究[1],60.7%男性和51.2%女性一生中会遭遇强烈的创伤事件,创伤事件后10%～15%的人符合创伤后应激障碍(Posttrumatic stress disorder,PTSD)的诊断,不符合其他疾病诊断,但具有PTSD症状的人数比例更高.心理危机干预的目的:预防疾病、缓解症状、减少共病、阻止迁延.对PTSD的治疗与干预的主要目标是减轻疾病的症状,缩短疾病的自然进程,减轻患者痛苦体验,预防和阻止并发症的发生.目前的研究表明,PTSD的危机干预效果不肯定,其可能的影响因素有:(1)医师缺乏PTSD危机干预的经验,即干预技术不成熟,对不同的精神创伤选择的干预措施不恰当;(2)对PTSD干预的效果评定不全面,PTSD存在共病问题,评定不应局限于PTSD的特征性症状的消失或减少;(3)心理治疗受治疗关系的影响而效果不同;(4)有待于研究新的更有效的干预技术.     

事故后飞行人员的心理反应与心理鉴定

目的 调查飞行事故后当事机组人员及密切接触事故的群体的心理反应,并对其进行心理鉴定。方法对空军、海军航空兵、民航540份事故调查问卷进行分析。结果 一年内发生飞行事故的群体中13.2％的人存在中度以上的创伤后应激紊乱,4.5％的人存在重度应激紊乱。事故发生3个月内症状最重。应激紊乱分数与事故距调查的时间及事故等级关系较密切。事故发生时飞行人员最需要家人的关怀和帮助,对音乐治疗、放松训练等康复方法选择比较高。结论 应当重视事故后飞行人员的心理障碍,应采用综合的评价方法对3个月关键期内的当事机组人员及密切接触的群体给予特别关注和个别或群体的心理康复治疗。     

飞行事故后飞行人员的心理健康状况评定

目的 检测飞行事故后飞行人员的心理健康状况及保健疗养的效果。方法 对发生严重飞行事故部队的34名飞行人员采用症状自评量表及飞行人员心理健康量表作事故前后及疗养后的心理健康状况测验,对比其结果的变化。结果 飞行事故后5个月,该部队飞行人员的焦虑、忧郁、过度自我关心、睡眠障碍、紧张性因子平均得分升高,与事故前差异有显著性意义。疗养后紧张性、睡眠障碍因子平均得分下降,与疗养前相比差异有显著性意义。结论 严重飞行事故的心,理应激引起的心理生理变化5个月后仍存在。相应的保健疗养措施可以改善事故后飞行人员的精神紧张性及睡眠障碍。     

Acute stress reactions after submarine accidents

The aim of the present study was to explore contextual and individual factors associated with acute stress reactions in three Norwegian submarine crews exposed to different significant peacetime maneuver accidents. Approximately 2 to 3 weeks after the accidents, crew members completed the Coping Style Questionnaire, the General Health Questionnaire, the Impact of Event Scale, and the Post-Traumatic Symptom Scale. Although exposed subjects (N = 47) revealed more posttraumatic stress symptoms than nonexposed crew members on shore leave (N = 7), they showed less acute stress reactions than survivors from a surface ship accident in the Norwegian Navy. Inspection of individual cases revealed that 4% of the exposed submariners showed high loads of acute stress symptoms. Unit cohesion and habitual coping styles emerged as resilience factors, whereas previous exposure to critical incidents and personal experience of not coping in the accident situation emerged as vulnerability factors, explaining 32% of the acute stress reactions reported by submarine crew members.     

事故后飞行员团体心理辅导的效果研究

目的研究团体心理辅导对事故后飞行员心理危机及心理应激反应症状的疗效。方法对34例事故后飞行员进行团体心理辅导,并抽取37例飞行员作为对照组。采用SCL-90症状自评量表、心理辅导效果评估表对事故后飞行员团体心理辅导效果进行评估。结果辅导组与对照组相比,团体辅导后飞行员的SCL-90各因子分降低差异有显著统计学意义,其中尤以躯体化t=5.14,P<0.01;人际敏感t=4.31,P<0.01;抑郁t=4.43,P<0.01;焦虑t=3.37,P<0.01下降幅度较大,设计的5个心理辅导单元中,辅导效果满意度最好的是:同舟共济79.4%。团体辅导结束2年后追踪调查发现:辅导后改变占首位的是:有33.3%的人感到心情愉快。结论团体心理辅导能有效地改善事故后的心理健康状况,且有较好的远期干预效果。     

事故后飞行员个性特征对心理干预需求影响因素的研究

目的探讨事故后飞行员个性特征对心理干预需求的影响因素。方法对两个事故后飞行团72名飞行员采用进行MHI人格特征测量、心理干预需求问卷及心身相关疾病疾病评价因子调查。结果事故后飞行员具有"反应过激型"的个性特征者在疾病症状量表分>2分的占56.8%。并与心理干预需求密切相关。结论事故后飞行员个性特征对其心理干预需求有较大的影响。     

三大核事故应急人员心理健康后果的系统综述

目的:系统性评价三哩岛、切尔诺贝利、福岛三大核事故对应急人员心理健康状况的影响。方法:采用主题词与自由词组合检索的方式,检索PubMed、Web of Science、APA PsycINFO数据库中关于三哩岛、切尔诺贝利、福岛三大核事故应急人员心理健康后果研究的相关文献,进行系统综述。结果:共纳入37项研究。核事故后应急人员普遍存在一般心理困扰、抑郁、焦虑、创伤后应激障碍等心理问题。切尔诺贝利核事故的心理影响最为严重,引起清理人员器质性精神障碍、人格障碍等严重精神障碍。不同核事故应急人员的心理健康状况与灾难相关的应急处置工作经历、核事故伴发的社会因素相关。结论:核事故后应急人员普遍存在一般心理困扰、焦虑、抑郁、创伤后应激障碍、严重精神障碍等长期心理健康问题,应急人员的基线心理健康状况和心理干预措施有待进一步研究。     

Risk of accidents and occupational diseases among the Finnish Defence Forces

OBJECTIVES: Military activities are often considered more dangerous than civilian work, especially in crisis situations, but peacetime or even peacekeeping conditions have seldom been analyzed in this respect. According to the compensation statistics of the Finnish State Treasury, in 2001, 80% of injuries among military personnel were caused by accidents at work, 15% occurred during commuting to and from work, and 5% were attributable to occupational diseases. RESULTS: The compensated accident frequencies varied between 22 and 26 cases per 1 million work hours during the 1990s. During the past few years, the incidence rate has slightly declined. When accidents among military personnel were considered, most occurred during military exercises (57%), during other work (35%), or during work commuting (9%). One person died in an accident during a military exercise in 2001. On the basis of the data of this study, the hypothesis of a substantially higher risk during peacetime for military work, compared with civilian work, is not defensible. The accident rates in the calendar year 2000 were 25% higher for Finnish civilian work (32 cases per 1 million hours) than for the Finnish Defence Forces (22 cases per 1 million hours).     

Analysis of changes in the pilot population and general aviation accidents.

General Aviation pilots have been involved in a steadily decreasing number of accidents over the past 20 years. Changes in the age distribution, certification, and flying habits of these pilots make direct comparison of accident statistics inaccurate. This study reviews changes in the pilot population over the past 20 years to analyze their impact on accident statistics. Pilot age and certificate distributions from 1968 to 1987 were assembled from annual Federal Aviation Administration (FAA) surveys. Information about pilots involved in accidents was collected from annual National Transportation Safety Board (NTSB) reports. Trends in pilot age distribution, certification, aircraft use, flight planning, and weather were reviewed. The accident experience from the first 5 years of the study period was used to construct an adjusted plot of expected aircraft accidents. From 1968-87, the mean pilot age increased from 35 to 40 years and the number of pilots over the age of 60 increased five-fold. The number of pilots with Air Transport Pilot (ATP) certification tripled and instrument certification increased 80%. Accidents where an Instrument Flight Rules (IFR) flight plan was filed increased from 3.6% to 6.6% without a corresponding increase in the number of accidents in weather at or below instrument meteorologic conditions (IMC). The accident experience from 1968 to 1973 predicted 116,000 accidents from 1968 to 1987. The actual number of accidents was 40% less than predicted. The average pilot age has increased both due to more pilots over the age of 50 and less young student pilots.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neuroendocrine responses to psychological workload of instrument flying in student pilots.

BACKGROUND: Information processing and stress tolerance are necessary features for instrument flying (IFR), especially among student pilots. Psychological workload of IFR flight may lead to stress reactions such as neuroendocrine activity. METHODS: Neuroendocrine responses to an IFR flight with Vinka piston-engined primary trainer were studied in 35 male volunteers who participated in the basic military flying course of the Finnish Air Force (FAF). The student pilots performed a 40-min IFR flight mission and a control session on land in randomized order between 11.00 h and 15.00 h. The IFR flight included 3 NDB approaches and was evaluated by flight instructors. Blood samples were collected 15 min before, 5 min and 60 min after the flight as well as control session, and. Plasma ACTH, beta3-endorphin (BE), cortisol, prolactin, adrenaline (A) and noradrenaline (NA) were measured. Psychological evaluations included psychomotor test (Wiener), Multi Coordination and Attention Test, ability tests and personality tests (CMPS and 16 PF). The overall psychological evaluation was made by an aviation psychologist. RESULTS: Plasma ACTH was significantly higher before and 5 min after the flight compared with control levels, but plasma BE increased significantly only before the flight. Plasma cortisol was significantly elevated before and 5 min after the flight. Plasma prolactin, NA and A increases were significant 5 min after the flight. High A levels after the flight correlated significantly with poor IFR flight performance as well as with poor psychomotor test results. CONCLUSIONS: The plasma prolactin and NA increases after the flight represented a direct type of stress reaction to the flight situation. The plasma BE response to IFR flight was an anticipatory stress reaction, but plasma ACTH, cortisol and A responses included both anticipatory and direct types of stress reactions. Psychological factors, flight performance and neuroendocrine responses to IFR flight appear to be associated with each other. Therefore, neuroendocrine reactions as a response to the psychological workload of military flying could be used for identifying stress tolerance in military pilots.