地震致伤残住院儿童少年创伤后应激障碍随访研究

创伤后应激障碍(PTSD)指个体经历强烈精神创伤后出现的精神障碍[1],主要表现为反复闯入意识、梦境的创伤体验、高度惊觉状态、与社会隔离和回避行为以及注意力不集中、创伤性事件回忆困难等.患者社会功能受损,有的终身丧失工作和生活能力.本研究以从地震灾区因伤残转运到医院住院治疗的儿童少年患者这一特殊群体为对象,探讨PTSD检出率、症状特征及其影响因素.     

汶川地震后重灾区中学生创伤后应激障碍的随访研究

目的 了解汶川地震后1年内重灾区中学生创伤后应激障碍(PTSD)随时间变化趋势以及相关影响因素.方法 采用一般情况问卷和标准心理量表(PTSD自评量表、领悟社会支持量表),分别于震后3、6、9和12个月对汶川县3所中学1966名中学生进行自填式问卷随访调查,通过建立多水平随机系数模型,分析研究对象PTSD随时间的变化趋势及相关危险因素.结果 全程参与灾后PTSD随访研究并获得有效问卷者共1677名.震后3、6、9和12个月,研究对象PTSD总分分别为(35.14±11.08)、(32.90±11.03)、(30.67±11.28)和(29.75±11.22)分,筛查阳性率分别为36.6%(613/1677)、30.7%(515/1677)、24.8%(416/1677)和22.2%(373/1677).领悟社会支持系统得分中位数为60.00分,存在问题者筛查阳性率为17.20%(289/1677).震后1年内,随着时间的推移,研究对象的PTSD得分总体呈下降趋势(β时间=-1.879,x2=47.03,P＜0.05).男生4次随访平均分分别为33.71、31.61、29.66、28.83分,女生分别为36.33、33.98、31.51、30.52分,初中生分别为35.46、33.28、30.18、29.22分,高中生分别为34.89、32.62、31.04、30.15分.性别和年级因素对个体PTSD总分下降趋势有影响,其中,女生快于男生、高中学生快于初中学生(β性别-时间=-0.354,x2=4.83,P＜0.05;β年级-时间=0.622,x2=11.30,P＜0.05).结论灾后1年内调查对象PTSD患病率较高,PTSD存在随时间自行恢复的趋势,但男生和初中学生恢复速度更慢.

Abstract：

Objective This study was to identify the post-traumatic stress disorder(PTSD)changes and the relative risk factors within one year after Wenchuan earthquake among middle school students in the disaster area.Methods A total of 1966 students from 3 schools in Wenchuan earthquake region were selected as the target population.For each student,personal basic information and standard psychological scale(PCL-C,PSSS)were investigated by a self-administrated questionnaire in the 3rd,the 6th,the 9th and the 12th month after the earthquake,respectively.PTSD trends over the time and the associated risk factors were analyzed through the establishment of multi-level random coefficient model.Results There were 1677middle school students fully participated in the PTSD follow-up study by turning in the valid questionnaires.The averaged scores of PTSD at the time of the 3rd,the 6th,the 9th and the 12th month after the earthquake were 35.14 ± 11.08,32.90 ± 11.03,30.67 ± 11.28 and 29.75 ± 11.22,respectively.Meanwhile,the general incidences of PTSD were 36.6%(613/1677),30.7%(515/1677),24.8%(416/1677)and 22.2%(373/1677),respectively.The median score of perceived social support system was 60.00 and the general incidences of PSS was 17.20%(289/1677).The PTSD scores for the students had a decreasing trend during the period of our observation(βtime =-1.879,x2 = 47.03,P ＜0.05).The averaged scores for boys for the 4 follow-up studies were 33.71,31.61,29.66,28.83 ;for girls were 36.33,33.98,31.51,30.52; for junior school students were 35.46,33.28,30.18,29.22; for senior school students were 34.89,32.62,31.04,30.15.Moreover,two factors,gender and grade,were related with the decreasing trend(the trend for girls and senior school students was sharper than that for boys and junior school students)(βgender-time =-0.354,x2 = 4.83,P ＜0.05; βgrade-time = 0.622,x2 = 11.30,P ＜0.05).Conclusions The prevalence of PTSD was high.Meanwhile,there was a trend of self-recovery for adolescent's PTSD during the first year of post-earthquake,but boys and junior school students recovered more slowly.     

创伤后应激障碍与急性应激障碍对比研究

通过对创伤后应激障碍(post-traumatic stress disorder,PTSD)与急性应激障碍(acute stress disorder,ASD)进行比较,研究发现,两者在心理社会因素以及治疗预防等方面十分相似:个体的精神和人格方面影响着ASD与PTSD的发生和发展,对其影响较大的社会因素主要有文化、家庭以及社会支持等;对两者的干预皆为心理治疗和药物治疗相结合,同时要重视社会支持和预防。在发病时间以及病程上两者存在较大差异:ASD发病快、病程短,而PTSD发病慢、病程长。     

地震灾区居民创伤应激障碍调查

目的 了解汶川地震1个月后青川县灾民创伤后应激障碍(PTSD)的发生率及其分布特征,为震后心理危机干预提供依据.方法 按受灾群众居住区域和帐篷编号,随机抽取灾民409人,使用创伤后应激障碍自评量表进行调查.结果 震后1个月灾民PTSD评为阳性的发生率为62.8%;女性、有亲人死伤者、财产损失较大者、41~50岁年龄组的灾民PTSD评分阳性的发生率分别为71.1%,70.4%,66.6%和78.8%,显著高于男性、无亲人死伤者、无财产损失者较大者和其他年龄组(P<0.05).结论 地震后灾民PTSD评分阳性率较高,应针对不同灾民的特点尽早进行有效的心理危机干预.     

汶川地震后成都军区总医院住院高龄老干部创伤后应激障碍调查

目的 调查汶川地震后军队高龄老干部创伤后应激障碍(PTSD)发生情况及特点.方法 采用PTSD诊断工具、症状自评量表(SCL-90),在震后30 d对170名亲历地震的军队住院老干部进行评估.结果 根据DSM-IV诊断标准,震后30 d有20.59%的老干部发生PTSD;PTSD患者年龄与非PTSD组患者年龄相比,明显较大(P<0.05);PTSD组患者的躯体化、焦虑、抑郁因子分均显著高于非PTSD组(P<0.01).结论 地震后30 d,军队老干部PTSD的发生率是20.59%,PTSD组老干部平均年龄比非PTSD组明显更大.因此,有必要主动对受灾老干部进行精神心理干预.     

结构方程模型在汶川地震后儿童创伤后应激障碍研究中的应用

[目的]建立汶川地震后儿童创伤后应激障碍(PTSD)各症状关系的结构方程模型,分析不同性别组儿童各症状的表现。[方法]采用儿童事件影响量表(CRIES-13)调查253名汶川地震灾区儿童PTSD的相关症状信息,构建结构方程模型,通过评价修正确定最佳模型。对灾后不同性别组儿童PTSD各症状内容和形式的特点进行比较。[结果]从CRIES-13提取了3个PTSD的潜变量,即闯入症状、回避症状和警觉症状,并引入一个总因子潜变量。模型拟合效果良好,不同性别组的结构方程模型形态相同,模型能解释不同性别组儿童各症状表现的特点。[结论]CRIES-13的测量形式是适合不同性别组儿童的,参考此次研究结果有助于灾后更有效地筛查PTSD儿童,为解决灾后儿童心理卫生问题提供帮助。     

地震情景再现对灾民创伤后应激障碍影响

目的 了解汶川地震情景再现对灾民创伤后应激障碍的影响。方法 先用创伤后应激障碍自评量表(PTSD-ss)和受灾暴露情况调查表对188名灾民测试,灾民观看短片\     

创伤后应激障碍的研究现状

创伤后应激障碍具有患病率高（普通人群终身患病率为1-14%；高危人群则为3－58％）、耐受治疗和慢性病程的特点，作参阅十余篇献，从流行病学、病因及神经化学改变、临床治疗学等方面进行探讨。     

决策树在汶川地震后灾区儿童创伤后应激障碍影响因素研究中的应用

[目的]了解汶川地震后灾区儿童创伤后应激障碍(PTSD)现状,并分析其影响因素。[方法]按照分层随机抽样方法的原则抽取253例调查对象,通过Bootstrap再抽样方法扩大样本量至2000例,在对资料进行描述性分析的基础上,通过SAS Enterprise Miner软件和决策树C4.5算法建立决策树模型,分析儿童患PTSD的影响因素。[结果]对儿童是否患PTSD建立决策树模型,其对训练集,验证集,测试集有分类错误率分别为0.070,0.100,0.075,按重要性排序筛选出汶川地震后影响灾区儿童患PTSD的7个影响因素。[结论]决策树C4.5算法建立的模型效果较好。针对地震后灾区儿童患PTSD的主要影响因素,采取相应的措施,有助于降低儿童患PTSD的比例。     

汶川地震后儿童青少年创伤后应激障碍和抑郁症状及影响因素

目的 研究汶川地震对儿童青少年心理问题造成影响的相关因素.方法 样本来自成都、都江堰、北川、汶川等地,分别选取受地震影响严重的12所中、小学,采用自编的一般情况调查表、儿童事件影响量表(CRIES-13)、儿童抑郁障碍自评量表(DSRC),调查上述学校儿童青少年在震后3、6、24个月后的心理卫生状况.3、6、24个月调查有效的学生人数分别为:7341名、7387名、7395名.采用多因素logistic回归模型分析创伤后应激障碍(PTSD)和抑郁障碍的危险因素.结果 震后3、6、24个月CRIES-13量表总分分别为(27.51±12.26)、(23.54 4-12.79)、(21.35±12.59)分(F=28.842,P≤0.05);DSRSC量表总分分别为(11.79±5.73)、(10.94±5.50)、(10.75 ±5.27)分(F=17.084,P≤0.05).震后3、6、24个月时与DSRSC得分相关的危险因素是女性(OR值分别为2.14、2.72、2.31,95%CI/值分别为1.01～3.03、1.10～5.01、1.02～4.58),年龄小于12岁(OR值分别为1.97、2.22、1.93,95%CI值分别为1.43～3.17、1.02～3.54、1.32～3.27),家人伤亡(OR值分别为2.19、2.45、2.35,95%CI值分别为1.04～2.89、1.16～2.08、1.02～2.79),绝望感(OR值分别为2.24、2.09、2.16,95%CI值分别为1.00～2.54、1.70～2.58、1.00～4.56);震后3、6、24个月时与CRIES-13得分均相关的危险因素为女性(OR值分别为2.16、2.94、1.96,95%CI值分别为1.36～2.53、1.36～2.53、1.06～3.92),年龄小于12岁(OR值分别为3.51、2.62、1.92,95%CI值分别为1.22～5.40、1.14～4.93、1.08～3.35),同学老师伤亡(OR值分别为2.32、2.48、2.36,95%CI值分别为1.17～2.48、1.30～2.72、1.02～2.85),家人伤亡(OR值分别为2.73、2.21、1.85,95%CI值分别为1.67～3.61、1.04～3.15、1.05～2.38),目睹受伤(OR值分别为2.17、2.36、2.34,95%CI值分别为1.15～3.65、1.17～2.67、1.02～3.67),目睹死亡(OR值分别为1.98、2.39、1.71,95%CI值分别为1.10～2.56、1.14～3.70、1.57～3.88),绝望感(OR值分别为2.02、1.94、2.02,95%CI值分别为1.67～2.35、1.66～2.27、1.82～2.26).结论 汶川地震灾区儿童青少年幸存者PTSD及抑郁症状随时间的推移逐渐减少,年龄小于12岁、女性、家人有伤亡和震时绝望感等是影响灾后儿童青少年心理健康的主要危险因素.

Abstract：

Objective This study was to analyze the mental health status of the children and adolescents from the areas struck by Wenchuan earthquake and to understand the factors that may have impact on their mental health after exposing to the earthquake.Methods Subjects of this survey were tudents(8-16 years old)from Chendu,Dujiangyan,Beichuan and Wenchuan districts which were the most severely affected areas in the earthquake.We analyzed the subjects'mental health conditions after Wenchuan earthquake by using a general questionnaire that was composed of the Children's Revised Impact of Event Scale(CRIES-13)and Depression Self-rating Scale for Children(DSRSC).Students are investigated 7341 case,7387 case,7395 case after 3,6,24 months.The data were analyzed with logistic regression model.Results The CRIES-13 scores were(27.51±12.26),(23.54±12.79)and(21.35±12.59)(F=28.842,P≤0.05)and the DSRSC scores were(11.79±5.73),(10.94±5.50)and(10.75±5.27)(F=17.084,P≤0.05)3,6 and 24 months after the earthquake,respectively.The risk factors associated with depression 3,6,24 months after the earthquake were gender(female)(OR values were 2.14,2.72,2.31：95％CI values were 1.01-3.03,1.10-5.01,1.02-4.58),age(less than 12 years old)(OR values were 1.97,2.22,1.93;95％CI values were 1.43-3.17,1.02-3.54,1.32-3.27),having family member iniury and death(OR values ware 2.19,2.45,2.35;95％CI valves were 1.04-2.89,1.16-2.08,1.02-2.79),desperation(OR values were 2.24,2.09,2.16;95％CI values were 1.00-2.54,1.70-2.58,1.00-4.56).The risk factors associated with PTSD 3,6.24 months after the earthquake were gender(OR values were 2.16,2.94,1.96;95％CI values were 1.36-2.53,1.36-2.53,1.06-3.92),age(less than 12 years old)(OR values were 3.51,2.62,1.92;95％CI values were 1.22-5.40,1.14-4.93,1.08-3.35),having teachers and schoolmates injury and death(OR values were 2.32,2.48,2.36;95％CI values were 1.17-2.48,1.30-2.72,1.02-2.85),having family member injury and death(OR values were 2.73,2.21,1.85;95％CI valties were 1.67-3.61,1.04-3.15,1.05-2.38),witnessing injury(OR values were 2.17,2.36,2.34;95％CI values were 1.15-3.65,1.17-2.67,1.02-3.67),witnessing death(OR values were 1.98,2.39,1.71;95％CI values were 1.10-2.56,1.14-3.70,1.57-3.88),desperation(OR values were 2.02,1.94,2.02;95％CI values were 1.67-2.35,1.66-2.27,1.82-2.26).Conclusion The symotoms of PTSD and depression of young survivors from the earthquake-struck areas had gradually alleviated 3,6,24 months after the earthquake.Age(less than 12 years old),gender (female),having family member injury and death,witnessing injury and death,and desperation were the main risk factors that affected the children and adolescents mental health.     

儿童青少年血脂升高危险因素的病例对照研究

目的探讨儿童青少年血脂升高的相关因素,为进一步开展高血脂疾病的早期预防提供理论依据。方法采用分层整群的方法抽取江苏省宿迁市宿豫区和沭阳县5~15岁年龄组儿童青少年为研究对象,以每个地区各年龄组内总胆固醇(TC)和甘油三酯(TG)高于第75百分位数(P75)为升高组,低于或等于第25百分位数(P25)为对照组进行病例对照研究。以问卷结合体格检查的形式,询问调查对象家长获得高血压家族史、饮食习惯、行为方式等因素并测定调查对象血压、身高、体质指数、TC和TG等指标。结果单因素分析结果显示,高血脂家族史、午饭地点与儿童青少年TG升高,有统计学关联(P0.05);而超重、上学交通方式、午饭地点及牛奶摄入量与儿童青少年TC升高,有统计学关联(P0.05)。进一步进行分层分析结果表明,在宿豫区(城镇)对象中,午饭地点、上学交通方式、常吃零食与TC升高存在显著正相关,OR(95%CI)值分别为2.243(1.465~3.432)、2.496(1.672~3.727)和1.748(1.180~2.589);常吃零食则与TG升高呈显著负相关,OR(95%CI)为0.492(0.286~0.847)。在沭阳县(乡村)对象中,牛奶摄入与TC升高呈显著正相关,OR(95%CI)为1.568(1.091~2.255),而超重和午饭地点则分别与TC和TG呈负相关,OR(95%CI)分别为0.387(0.209~0.715)、0.689(0.481~0.988)。结论经济水平、家庭饮食、上学交通运动的能量消耗以及牛奶与零食的摄入是影响该地区儿童青少年血脂升高的重要因素。     

From soldiers to children: developmental sciences transform the construct of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) was first included in the American Psychiatric Association's Diagnostic and statistical manual of mental disorders in 1980. Long used to describe the reactions of soldiers affected by stress in combat situations, PTSD is now recognised as a disorder affecting abused and neglected infants and children, survivors of assault and domestic violence, and disaster victims of all ages. How did a construct so distinctly associated with the experiences of adult combat veterans come to describe behaviours seen in children, and even infants? This transformation can be understood by examining the way clinical researchers have applied the developmental sciences (child and adolescent development, neuroscience, and cognitive science) to the study of trauma. Each of the developmental sciences has contributed to our understanding of children's reactions to traumatic situations, and each plays an integral part in the effort to understand PTSD as a disorder of children as well as adults.     

汶川地震后儿童青少年创伤后应激障碍和抑郁症状及影响因素

Objective This study was to analyze the mental health status of the children and adolescents from the areas struck by Wenchuan earthquake and to understand the factors that may have impact on their mental health after exposing to the earthquake.Methods Subjects of this survey were tudents(8-16 years old)from Chendu,Dujiangyan,Beichuan and Wenchuan districts which were the most severely affected areas in the earthquake.We analyzed the subjects'mental health conditions after Wenchuan earthquake by using a general questionnaire that was composed of the Children's Revised Impact of Event Scale(CRIES-13)and Depression Self-rating Scale for Children(DSRSC).Students are investigated 7341 case,7387 case,7395 case after 3,6,24 months.The data were analyzed with logistic regression model.Results The CRIES-13 scores were(27.51±12.26),(23.54±12.79)and(21.35±12.59)(F=28.842,P≤0.05)and the DSRSC scores were(11.79±5.73),(10.94±5.50)and(10.75±5.27)(F=17.084,P≤0.05)3,6 and 24 months after the earthquake,respectively.The risk factors associated with depression 3,6,24 months after the earthquake were gender(female)(OR values were 2.14,2.72,2.31：95％CI values were 1.01-3.03,1.10-5.01,1.02-4.58),age(less than 12 years old)(OR values were 1.97,2.22,1.93;95％CI values were 1.43-3.17,1.02-3.54,1.32-3.27),having family member iniury and death(OR values ware 2.19,2.45,2.35;95％CI valves were 1.04-2.89,1.16-2.08,1.02-2.79),desperation(OR values were 2.24,2.09,2.16;95％CI values were 1.00-2.54,1.70-2.58,1.00-4.56).The risk factors associated with PTSD 3,6.24 months after the earthquake were gender(OR values were 2.16,2.94,1.96;95％CI values were 1.36-2.53,1.36-2.53,1.06-3.92),age(less than 12 years old)(OR values were 3.51,2.62,1.92;95％CI values were 1.22-5.40,1.14-4.93,1.08-3.35),having teachers and schoolmates injury and death(OR values were 2.32,2.48,2.36;95％CI values were 1.17-2.48,1.30-2.72,1.02-2.85),having family member injury and death(OR values were 2.73,2.21,1.85;95％CI valties were 1.67-3.61,1.04-3.15,1.05-2.38),witnessing injury(OR values were 2.17,2.36,2.34;95％CI values were 1.15-3.65,1.17-2.67,1.02-3.67),witnessing death(OR values were 1.98,2.39,1.71;95％CI values were 1.10-2.56,1.14-3.70,1.57-3.88),desperation(OR values were 2.02,1.94,2.02;95％CI values were 1.67-2.35,1.66-2.27,1.82-2.26).Conclusion The symotoms of PTSD and depression of young survivors from the earthquake-struck areas had gradually alleviated 3,6,24 months after the earthquake.Age(less than 12 years old),gender (female),having family member injury and death,witnessing injury and death,and desperation were the main risk factors that affected the children and adolescents mental health.     

汶川地震后儿童青少年创伤后应激障碍和抑郁症状及影响因素

Objective This study was to analyze the mental health status of the children and adolescents from the areas struck by Wenchuan earthquake and to understand the factors that may have impact on their mental health after exposing to the earthquake.Methods Subjects of this survey were tudents(8-16 years old)from Chendu,Dujiangyan,Beichuan and Wenchuan districts which were the most severely affected areas in the earthquake.We analyzed the subjects'mental health conditions after Wenchuan earthquake by using a general questionnaire that was composed of the Children's Revised Impact of Event Scale(CRIES-13)and Depression Self-rating Scale for Children(DSRSC).Students are investigated 7341 case,7387 case,7395 case after 3,6,24 months.The data were analyzed with logistic regression model.Results The CRIES-13 scores were(27.51±12.26),(23.54±12.79)and(21.35±12.59)(F=28.842,P≤0.05)and the DSRSC scores were(11.79±5.73),(10.94±5.50)and(10.75±5.27)(F=17.084,P≤0.05)3,6 and 24 months after the earthquake,respectively.The risk factors associated with depression 3,6,24 months after the earthquake were gender(female)(OR values were 2.14,2.72,2.31：95％CI values were 1.01-3.03,1.10-5.01,1.02-4.58),age(less than 12 years old)(OR values were 1.97,2.22,1.93;95％CI values were 1.43-3.17,1.02-3.54,1.32-3.27),having family member iniury and death(OR values ware 2.19,2.45,2.35;95％CI valves were 1.04-2.89,1.16-2.08,1.02-2.79),desperation(OR values were 2.24,2.09,2.16;95％CI values were 1.00-2.54,1.70-2.58,1.00-4.56).The risk factors associated with PTSD 3,6.24 months after the earthquake were gender(OR values were 2.16,2.94,1.96;95％CI values were 1.36-2.53,1.36-2.53,1.06-3.92),age(less than 12 years old)(OR values were 3.51,2.62,1.92;95％CI values were 1.22-5.40,1.14-4.93,1.08-3.35),having teachers and schoolmates injury and death(OR values were 2.32,2.48,2.36;95％CI values were 1.17-2.48,1.30-2.72,1.02-2.85),having family member injury and death(OR values were 2.73,2.21,1.85;95％CI valties were 1.67-3.61,1.04-3.15,1.05-2.38),witnessing injury(OR values were 2.17,2.36,2.34;95％CI values were 1.15-3.65,1.17-2.67,1.02-3.67),witnessing death(OR values were 1.98,2.39,1.71;95％CI values were 1.10-2.56,1.14-3.70,1.57-3.88),desperation(OR values were 2.02,1.94,2.02;95％CI values were 1.67-2.35,1.66-2.27,1.82-2.26).Conclusion The symotoms of PTSD and depression of young survivors from the earthquake-struck areas had gradually alleviated 3,6,24 months after the earthquake.Age(less than 12 years old),gender (female),having family member injury and death,witnessing injury and death,and desperation were the main risk factors that affected the children and adolescents mental health.     

武汉市社区妇女家庭暴力与创伤后应激障碍的相关性研究

目的 了解武汉市社区妇女家庭暴力的流行特征,分析家庭暴力与创伤后应激障碍（PTSD）的关系,为提高女性心理健康水平提供依据。方法 采用横断面研究方法,以在武汉市某社区卫生服务中心进行妇科检查的女性作为研究对象,调查其一般特征、社会支持、伤害情况、家庭暴力及PTSD流行情况。采用 χ²检验、t检验、Cochran-Armitage趋势检验分析PTSD组与健康组间差异,logistic回归分析PTSD与家庭暴力的关系。结果 家庭暴力终身发生率为29.36%,心理暴力、身体暴力和性暴力的发生率分别为28.28%、6.60%和3.55%;PTSD的总患病率为4.73%。遭受家庭暴力的女性患PTSD的风险是未遭受暴力女性的2.11倍（OR=2.11,95%CI：1.04～4.29）;同时遭受身体与心理暴力的女性发生PTSD的风险是未受暴力女性的5.06倍（OR=5.06,95%CI：1.91～13.42）。结论 家庭暴力与PTSD存在较强的相关性,对遭受家庭暴力的妇女应进行心理疏导,降低PTSD的发生风险。     

胚胎停育患者创伤后应激症状及相关因素分析

目的:了解胚胎停育患者的心理损伤情况和创伤后应激障碍(PTSD)症状阳性的相关因素。方法:对2012年10月~2013年10月就诊于宁夏医科大学总医院、银川市妇幼保健院的206对胚胎停育患者及配偶,应用创伤后应激障碍筛查量表平民版(PCL-C)对其反复创伤性体验症状、情感麻木与回避状及警觉性过强所致易激惹症状进行客观测量。结果:206名胚胎停育患者PCL-C量表分值为23.7±2.7分,PTSD筛查症状阳性率为13.6%(28/206)。多因素非条件logistic回归分析结果显示,配偶PTSD症状筛查阳性时,胚胎停育患者PTSD症状阳性率高(OR:2.9,95%CI:1.8~9.7),社会支持中从兄弟姐妹得到支持和照顾时,胚胎停育患者PTSD症状阳性率低(OR:0.5,95%CI:0.3~0.9)。结论:胚胎停育事件可能会引起孕妇产生创伤后应激障碍症状。配偶PTSD症状阳性会增加胚胎停育孕妇PTSD症状阳性率,而社会支持,尤其是从兄弟姐妹得到支持和照顾,有助于缓解胚胎停育孕妇PTSD症状。     

影响地震灾后转移伤员创伤后应激障碍症状严重程度的因素分析

目的 探讨四川省汶川地震灾后转移伤员创伤后应激障碍(PTSD)症状严重程度的影响因素.方法 采用PTSD症状自评量表,在地震灾后40d对按照多级整群抽样方法抽取转移到重庆市11所医院的386名伤员进行调查,回收有效问卷354份,探讨影响PTSD症状严重程度的相关因素.结果 共获得完整资料354份,其中男性伤员154人(43.6%),女性伤员200人(56.4%),年龄为(43.76±21.22)岁;汉族236人(66.7%),羌族114人(32.2%),其他4人(1.1%);未婚92人(26.1%),已婚253人(71.7%),其他9人(2.2%).女性伤员PTSD的症状要比男性严重,在反复而痛苦的梦及此事件(t=2.46,P=0.014)、强烈的心理痛苦烦恼(t=2.02,P=0.044)、难以集中注意力(t=2.04,P=0.042)、警觉性过高(t=2.465,P=0.014)及总分(0=2.489,P=0.013)等条目上有差异.地震中被掩埋伤员PTSD症状的严重程度大于没有被掩埋者;在避免有关此创伤的思想、感受、或谈话(0=2.661,P=0.008)、避免会促使回忆起此创伤的活动、地点、或人物(t=2.705,P=0.007)、不能回忆此创伤的重要方面(t=2.775,P=0.006)、情感范围有所限制(t=3.017,P=0.003)、对未来没有远大的设想(t=2.979,P=0.003)及总分(t=3.175,P=0.002)等条目上差异有统计学意义.目睹了地震中有人被埋或有人死亡的PTSD症状比没有目睹的严重,均在有脱离他人或觉得他人很陌生的感受,情感范围有所限制,激惹或易发怒等条目上差异有统计学意义(P<0.05或P<0.01).三大核心症状平均记分之间差异有统计学意义(F=3.350,P<0.001).结论 不同暴露条件下转移伤员的PTSD症状的严重程度不同,且症状彼此之间存在相互的关联.     

中文版儿童事件影响量表在汶川地震极重灾区中小学生中的应用及分析

目的 评价中文版(简体)儿童事件影响量表(CRIES-13)的信度和效度,探讨利用该量表筛检创伤后应激障碍(PTSD)的价值及最佳评分切割点.方法 采用分层随机整群抽样原则,选取253名汶川地震后幸存儿童作为被评估对象,采用量表白评和临床诊断相结合的方法,分析量表的内部一致性、条目间平均相关系数;总分与各因子间的相关系数、内容区分效度.临床诊断依据DSM-Ⅳ诊断标准中PTSD诊断标准确诊患者.采用受试者工作特征曲线计算曲线下面积和不同切割点下筛检PTSD的灵敏度、特异度及约登指数,以约臀指数最大的点为最佳切割点.结果 CRIES-13的Cronbach's α系数为0.903,条目间平均相关系数0.283～0.689.总分与各因子的相关系数0.836～0.868,各因子间的相关系数0.568～0.718;在总分、闯入、回避和高警觉因子评分方面,PTSD组均高于非PTSD组,差异有统计学意义(P<0.05).因子分析产生两个主成分,解释了总方差的59.68%,主要反映闯入症状和回避症状.汶川地震后7个月儿童PTSD的临床检出率为20.9%,男、女性PTSD患病率差异无统计学意义(P>0.05),CRIES-13以18分为切割点时筛检PTSD的约登指数最大,为57.6%,PTSD患者诊断预测的灵敏度为81.1%,特异度为76.5%,诊断效率81.1%.而选取32分切割点,筛查结果与临床诊断一致性较高(Kappa值=0.529).结论 CRIES-13在汶川地震后幸存儿童中具有良好的信、效度,可作为该群体一个较好的创伤后应激症状测评丁具.CRIES-13评分18分切割点可作为汶川地震后极重灾区中小学生筛检PTSD患者和确诊高危人群的切割点,而32分切割点筛检阳性率可初步预测灾后极重灾区中小学生PTSD患病率,此结论还有待于进一步研究证实.