坠楼自杀事件目击者创伤性应激障碍

目的:调查某高校自杀坠楼事件目击者急性应激障碍(ASD)和创伤后应激障碍(PTSD)状况。方法:使用一般情况及事件主观体验问卷和创伤性应激障碍临床访谈问卷,对58名事件现场目击者,分别在事件发生后第三周和第五周进行调查。结果:在事件发生后第三周,符合DSM-Ⅳ诊断标准的ASD检出率为6.9%,符合PTSD症状标准和社会功能损害标准的目击受害者共6人,检出率为10.3%。事件后三周受害人出现创伤性应激症状和功能损害的比例较高,分别为强烈恐惧害怕65.5%、创伤性分离51.0%、警觉性增高53.4%、再体验84.5%、回避70.7%、和社会功能障碍25.9%。创伤性事件发生后第三周出现分离症状的目击者比没有出现分离症状的目击者在事件后第五周时表现出了更加严重的ASD和PTSD的各组症状(如分离症状严重程度17.9vs29.7,U=128.5,P=0.001)。结论:1、创伤性事件发生后早期,受害人心理应激反应具有一定的普遍性,其中一部分受害人出现社会功能变化。2、提示对事件后早期那些不符合ASD诊断标准,但符合PTSD症状标准和社会功能变化标准的受害者应该给与心理干预。3、创伤时分离症状可能是预测受害人出现远期严重应激障碍的一个因素。

Traumatic Stress Disorder in Witnesses to a Suicide

Objective: Describe the incidence and characteristics of Acute Stress Disorder (ASD) in college-student witnesses to a suicide.Methods:Fifty-eight witnesses to a suicide by jumping were assessed 3 weeks and 5 weeks after the event using the ASD and Post-traumatic Stress Disorder (PTSD) section of the Structured Clinical Interview for DSM-IV Axis-I diagnoses (SCID).Severity scores for ASD and PTSD were developed based on the number and severity of symptoms experienced.Results:Three weeks after the event, 39 (67.2%) reported intense fear, hopelessness or horror; 30 (51.7%) traumatic dissociation; 49 (84.5%) re-experiencing of the traumatic event; 41 (70.7%) avoidance; 31 (53.4%) increased arousal; and 15 (25.9%) impairment in social functioning.Typically, the sequence of symptom occurrence was: dissociative symptoms, increased arousal, re-experiencing of the event and avoidance.Four (6.9%) met ASD criteria and 6 (10.3%) met symptomatic (but not duration) criteria of PTSD.Individuals who reported dissociative symptoms at three weeks had a higher PTSD symptom severity score at 5 weeks than those without dissociative symptoms at three weeks (29.7 v 17.9, U=128.5 P=0.001).Conclusion:Intense psychological responses to traumatic events such as witnessing a suicide are common in the early stages after the event.Some subjects who do not meet ASD diagnostic criteria can, nevertheless, have impaired social functioning and met the symptomatic criteria of PTSD; like those who met ASD criteria, these individuals also need early psychological assessment and, possibly, intervention.Early dissociative symptoms may be predictors of long-term psychological disability following traumatic events.