地震灾区大学生创伤后应激障碍及其共病

目的 了解地震灾区大学生在汶川大地震1年时患创伤后应激障碍(PISD)及其共病程度。方法 应用创伤后应激障碍自评量表(PTSD-SS)、焦虑自评量表(SAS)和抑郁自评量表(SDS)对2008年入学的191名灾区大学生进行测评,并对部分患者进行深度心理访谈。结果 灾区191名大学生中男生48名,女生143名,平均年龄为(19.80±0.84)岁;患创伤后应激障碍的学生79人,占41.4%;其中,46人患焦虑症,75人患抑郁症,44人患2种共病,分别占58.2%,94.9%和55.7%,男女生之间只在焦虑症状上差异有统计学意义(P<0.05);创伤后应激障碍的变异与所测项目之间均呈正相关(P<0.01);亲人受伤使有无创伤后应激障碍的人数差异有统计学意义(P<0.01)。结论 灾区大学生仍存在严重的创伤后应激障碍;创伤事件本身是致病的关键因素。     

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.     

矿难矿工创伤后应激障碍发生情况调查

目的 了解矿难后获救矿工创伤后应激障碍（PTSD）症状的发生特点。方法 采用基本情况调查表及创伤后应激障碍症状自评量表（PCL-C）对黑龙江龙煤集团某煤矿矿难中获救的200名矿工进行问卷调查。结果 获救矿工PTSD症状阳性发生率为19.64%;矿工年龄越大,其闯入因子（F=3.77,P=0.025）及总分（F=3.06,P=0.049）的得分越高;矿工井下工龄越长,其闯入因子（t=3.67,P=0.000）、回避因子（t=3.23,P=0.001）、警觉因子（t=2.78,P=0.003）及总分（t=3.41,P=0.000）的得分越高;矿难发生时,矿工距离事发地点越近,其闯入因子（F=4.92,P=0.008）、回避因子（F=7.37,P=0.001）、警觉因子（F=7.13,P=0.001）及总分（F=7.11,P=0.001）的得分越高;矿难发生时目睹过他人伤亡者闯入因子（t=2.28,P=0.012）、回避因子（t=1.69,P=0.047）、警觉因子（t=2.38,P=0.009）及总分（t=2.19,P=0.015）得分均高于未曾目睹他人伤亡者。结论 获救矿工PTSD症状在年龄、井下工龄、距离事发地点远近、目睹他人伤亡等变量上存在差异。     

地震救援后消防员创伤后应激障碍症状干预策略

从心理学上讲, 自然灾难的发生会给人们造成严重的心理失衡。消防员在地震救援中目睹灾难现场惨烈的场景, 会给他们的心理带来很大的阴影, 影响他们日后的正常工作。基于此, 对地震救援消防员创伤后应激障碍(post-traumatic stress disorder, PTSD)的现状调查作了回顾, 提出了对消防员PTSD的干预对策。     

创伤后应激障碍的流行病学特点及危险因素

一、创伤性事件与创伤后应激障碍威胁到个体的生命、身体或是精神世界的完整 ,带来异乎寻常痛苦的人生遭遇称为创伤性事件。创伤性事件并非罕见 ,我国仅各类自然灾害平均每年就使 2亿人受到程度不等的影响 ,加上人为事故、交通意外、暴力事件的受害者 ,构成不容忽视的一个巨大群体。经历创伤性事件带来一系列心理、生理和行为的改变 ,从多方面影响心身健康 ,并可能导致长期存在的严重心理痛苦和精神障碍。创伤后应激障碍(ｐｏｓｔｔｒａｕｍａｔｉｃｓｔｒｅｓｓｄｉｓｏｒｄｅｒ ,ＰＴＳＤ)是创伤性事件所致的严重后果之一。作为一个诊断类…     

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.     

汶川地震灾区中学生地震创伤后应激障碍与领悟社会支持的关系

目的 探讨汶川大地震灾区中学生地震创伤后应激障碍(PTSD)与领悟社会支持能力之间的关系.方法 使用创伤后应激障碍自评量表(PCL-C)和领悟社会支持量表(PSSS),对汶川地震灾区3所中学1966名中学生进行自填式问卷调查.结果 1966名中学生的PTSD筛查总阳性率为78.3%,重度PTSD占24.38%.不同领悟社会支持程度的学生PTSD阳性率差异有统计学意义(P<0.05),且PTSD严重程度与领悟社会支持高低程度呈负性相关(γ=-0.226,P<0.05);不同家庭内、外领悟社会支持程度的学生PTSD阳性率差异有统计学意义(P=0.009,P<0.05)且PTSD严重程度与家庭内、外领悟社会支持高低程度呈负性相关(γ=-0.176,P<0.05,γ=-0.214,P<0.05).结论 地震灾区中学生PTSD的发生率及严重程度与其领悟社会支持的高低程度存在一定关系,领悟社会支持越高者,PTSD发生率越低,程度越轻.对灾区中学生的心理干预应有针对性.     

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.     

汶川地震灾区中学生地震创伤后应激障碍与领悟社会支持的关系

Objective To explore the relationship between post-traumatic stress disorder (PTSD) and perceived social support (PSS)ability among middle school students in earthquake-stricken areas after the Wenchuan earthquake accident. Methods A total of 1966 students from three secondary schools of Wenchuan earthquake-stricken areas were evaluated by PTSD Checklist-Civilian Version (PCL-C) and Perceived Social Support Scale (PSSS). Results The overall incidence rate of PTSD was 78.3%, with severe PTSD as 24.38%. Significant differences on the incidence rates of PTSD were found among the students who were in different PSS levels (P<0.05) and significant negative correlation existed between the levels of severity on PTSD and PSS (γ=-0.226, P<0.05). Significant differences on PTSD incidence rates were found among those students who were from different families or out-family PSS levels (P=0.009, P<0.05). Significant negative correlation existed between the severity of PTSD and family or out-family PSS level (γ=-0.176, P<0.05, γ=-0.214, P<0.05). Conclusion Relationships between the incidence rate, severity of PTSD and PSS levels existed among the middle school students in Wenchuan earthquake-stricken areas, with higher PSS, lower incidence rate and lighter severity of PTSD. Psychological intervention for earthquake-stricken students should be carried out.     

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\     

Posttraumatic Stress Disorder and Incident Heart Failure Among a Community-Based Sample of US Veterans

Objectives. We investigated the association between posttraumatic stress disorder (PTSD) and incident heart failure in a community-based sample of veterans.Methods. We examined Veterans Affairs Pacific Islands Health Care System outpatient medical records for 8248 veterans between 2005 and 2012. We used multivariable Cox regression to estimate hazard ratios and 95% confidence intervals for the development of heart failure by PTSD status.Results. Over a mean follow-up of 7.2 years, veterans with PTSD were at increased risk for developing heart failure (hazard ratio [HR] = 1.47; 95% confidence interval [CI] = 1.13, 1.92) compared with veterans without PTSD after adjustment for age, gender, diabetes, hyperlipidemia, hypertension, body mass index, combat service, and military service period. Additional predictors for heart failure included age (HR = 1.05; 95% CI = 1.03, 1.07), diabetes (HR = 2.54; 95% CI = 2.02, 3.20), hypertension (HR = 1.87; 95% CI = 1.42, 2.46), overweight (HR = 1.72; 95% CI = 1.25, 2.36), obesity (HR = 3.43; 95% CI = 2.50, 4.70), and combat service (HR = 4.99; 95% CI = 1.29, 19.38).Conclusions. Ours is the first large-scale longitudinal study to report an association between PTSD and incident heart failure in an outpatient sample of US veterans. Prevention and treatment efforts for heart failure and its associated risk factors should be expanded among US veterans with PTSD.Posttraumatic stress disorder (PTSD) is a psychiatric illness that affects approximately 7.7 million Americans aged older than 18 years.1 PTSD typically results after the experience of severe trauma, and veterans are at elevated risk for the disorder. The National Vietnam Veterans Readjustment Study reported the prevalence of PTSD among veterans who served in Vietnam as 15.2% among men and 8.1% among women.2 In fiscal year 2009, nearly 446 045 Veterans Administration (VA) patients had a primary diagnosis of PTSD, a threefold increase since 1999.3 PTSD is of growing clinical concern as evidence continues to link psychiatric illnesses to conditions such as arthritis,4 liver disease,5 digestive disease,6 and cancer.6 When the postwar health status of Vietnam veterans was examined, those with PTSD had higher rates of diseases of the circulatory, nervous, digestive, musculoskeletal, and respiratory systems.7The evidence linking PTSD to coronary heart disease (CHD) is substantial.8–10 Veterans with PTSD are significantly more likely to have abnormal electrocardiograph results, myocardial infarctions, and atrioventricular conduction deficits than are veterans without PTSD.11 In a study of 605 male veterans of World War II and the Korean War, CHD was more common among veterans with PTSD than among those without PTSD.12 Worldwide, adults exposed to the disaster at Chernobyl experienced increased rates of CHD up to 10 years after the event,13 and studies of stressors resulting from the civil war in Lebanon found elevated CHD mortality.14,15Although the exact biological mechanism by which PTSD contributes to CHD remains unclear, several hypotheses have been suggested, including autonomic nervous system dysfunction,16 inflammation,17 hypercoagulability,18 cardiac hyperreactivity,19 altered neurochemistry,20 and co-occurring metabolic syndrome.16 One of the hallmark symptoms of PTSD is hyperarousal,21 and the neurobiological changes brought on from sustained sympathetic nervous system activation affect the release of neurotransmitters and endocrine function.22 These changes have negative effects on the cardiovascular system, including increased blood pressure, heart rate, and cardiac output.22,23Most extant literature to date examining cardiovascular sequelae has shown a positive association between PTSD and coronary artery disease.8–10 Coronary artery disease is well documented as one of the most significant risk factors for future development of heart failure.24 Despite burgeoning evidence for the role of PTSD in the development of coronary artery disease, there are few studies specifically exploring the relationship between PTSD and heart failure. Limited data suggest that PTSD imparts roughly a threefold increase in the odds of developing heart failure in both the general population5 and in a sample of the elderly.25 These investigations, however, have been limited by cross-sectional study design, a small proportion of participants with PTSD, and reliance on self-reported measures for both PTSD and heart failure.5,25 Heart failure is a uniquely large public health issue, as nearly 5 million patients in the United States are affected and there are approximately 500 000 new cases each year.26 Identifying predictors of heart failure can aid in early detection efforts while simultaneously increasing understanding of the mechanism behind development of heart failure.To mitigate the limitations of previous investigations, we undertook a large-scale prospective study to further elucidate the role of prevalent PTSD and development of incident heart failure among veterans, while controlling for service-related and clinical covariates. Many studies investigating heart failure have relied on inpatient records; we leveraged outpatient records to more accurately reflect the community burden of disease.     

汶川地震后灾区学生创伤性应激障碍及情绪症状

了解灾后不同时期学生应激状态的变化及其相关因素,为改善灾后学生人群心理健康状况提供参考.方法 分别于2012年和2014年,对整群抽取的四川省广元市青川县灾后学生心理卫生状况进行问卷调查.结果 学生创伤后应激障碍(PTSD)发生率从2012年的23.1%降到2014年的10.4%,两年间得分差异有统计学意义(F=138.439,P<0.01);抑郁症状发生率从92.3%降到了72.0%,两年间抑郁指数差异有统计学意义(F=15.097,P<0.01);焦虑症状发生率从50.2%降到27.1%,两年间焦虑症状得分差异有统计学意义(F=166.699,P<0.01).学生的人际关系和前测PTSD能较好预测以后PTSD的发生(β值为-0.13,0.13,P值均<0.05).结论 随时间推移,灾区学生心理状况有明显改善,可能是受到时间因素、社会支持、负性生活事件和学生自身心理生理成长的调节作用.     

汶川县中学生地震后1年创伤后应激障碍调查

目的了解汶川重灾区地震后1 a青少年创伤后应激障碍(Post-Traumatic Stress Disorder,PTSD)的现患情况,为制定干预措施提供科学依据。方法采用创伤后应激障碍自评量表(PTSD Checklist-Civilian Version,PCL-C),对汶川地震重灾区3所中学初一、初二、高一、高二年级的在校学生进行问卷调查,PTSD的诊断依据DSM-Ⅳ标准。结果地震后1 a重灾区中学生PTSD的筛查阳性率为6.1%,以警觉性过强所致易激惹症状(D组)阳性率最高(75.1%)。初二和高一年级,居住在农村、家庭有财产损失的学生PTSD阳性率及B,C,D 3组症候群阳性率较高;女生和地震中受伤学生B,C,D 3组症候群阳性率较高。结论地震后1 a青少年PTSD阳性筛查率仍较高,继续采取有效干预措施降低重灾区青少年PTSD造成的长期心理危害十分必要。     

中学生地震创伤后应激障碍发生情况及其影响因素分析

目的了解"5.12"地震后灾区中学生的创伤后应激障碍(PTSD)的发生率和影响因素,为青少年灾后精神卫生问题预防工作提供依据。方法采用多级整群非随机抽样方法,有效样本为来自地震灾区2个县的3所初中和1所高中的1 253名学生。采用复合性国际诊断问卷(Comprehensive International Diagnostic Interview,CIDI)中PTSD模块内容,采用一对一面谈的方式对所有调查对象进行调查,根据DSM-Ⅳ中PTSD诊断标准进行诊断,并记录一般人口学资料。结果地震后5个月,PTSD的发生率为10.21%。多因素logistic回归分析结果显示,进入方程有统计学意义的变量有少数民族(β=0.62,P=0.00,OR=1.86)、亲属伤亡(β=0.83,P=0.00,OR=2.29)和重度财产损失(β=0.98,P=0.02,OR=2.67),少数民族、有亲属伤亡、存在重度财产损失的个体PTSD危险性高。结论地震发生后5个月中学生中PTSD现患率高,中学生灾难特定相关精神卫生问题应引起足够重视和长期关注,灾后心理重建工作仍应继续加强。     

“5·12”地震后汶川县居民健康教育状况分析

目的 了解地震后居民卫生行为情况,评价健康教育效果.方法 2008-07-09/11,采用分层定群抽样方法 ,抽取汶川县七盘沟社区(城市集中安置)、威州镇铁邑村(农村分散安置)、绵池镇(农村集中安置)3个点,各点选取30户,每户抽取家庭主要成员1人,进行问卷调查.结果 居民对喝不干净水会传播疾病,饮水传播肠道传染病、寄生虫病,苍蝇传播痢疾、深部外伤应该注射破伤风类毒素的主要卫生知识知晓率均在80%以上;居民获得健康教育知识中电视、宣传资料、防疫队员讲解、广播的方式,分别是47.8%、43.3%、37.8%和35.6%,城区获得方式更多样;46.5%的被调查者在有卫生需求时首先想到从防疫队伍处获得帮助;95.2%的被调查者对饮水进行了消毒,使用煮沸消毒的占76.7%;从不喝生水的行为从地震前的41.6%上升到地震2周内的80.5%,到地震后2月的88.5%,经常喝生水的行为从地震前的27%下降到地震后的2.3%;完全做到饭前便后洗手的从地震前的3_4.1%上升到调查时的45.5%,经常不洗手的从27%下降到2.3%.结论 汶川县地震后通过多种宣传手段,居民的健康知识得到普及,健康行为与地震前相比有了很大的改善并维持到灾后2个月,行为基本形成.防疫队员讲解与帮助是健康促进的很好手段.     

Posttraumatic Stress Disorder Symptom Severity and Socioeconomic Factors Associated with Veterans Health Administration Use among Women Veterans

BackgroundThe Veterans Health Administration (VA) has historically focused on treating men. Although women veterans' VA use is increasing, they remain more likely than male veterans to receive their care in non-VA settings. To date, there is limited research on factors associated with VA use among women. We examined the relationship between demographic, civilian, military, and health-related variables with past-year VA use among women veterans.MethodsWomen veterans were recruited over the internet to participate in an anonymous national survey (n = 617) in 2013. An empirically derived decision tree was computed using signal detection software for iterative receiver operator characteristics (ROC) to identify variables with the best sensitivity/specificity balance associated with past-year VA use.ResultsROC analysis indicated that 85% of participants with high posttraumatic stress disorder (PTSD) and depressive symptoms and who were younger than 54 years of age used VA in the past year. Of those who were 54 years of age or older and had very high PTSD symptoms, 94% used the VA in the last year. By contrast, only 40% of participants with relatively lower PTSD symptoms had VA past-year use, although among these individuals, VA past-year use increased to 65% for those with a relatively lower income.ConclusionsFindings suggest that greater PTSD symptoms, depressive symptoms, and low income correlate with VA use, with very high PTSD symptoms in older groups, high PTSD symptoms coupled with high depressive symptoms in younger groups, and low income in those with lower PTSD symptoms each associated with greater past-year VA use. Ensuring PTSD assessment and treatment, and addressing socioeconomic factors, may be key strategies for health care delivered directly or through contract with VA facilities.     

地震后18个月救援武警创伤后应激障碍状况评估

目的探讨汶川地震救援后18个月救援武警创伤后应激障碍(PTSD)的发病率、症状严重程度及与人口学、创伤暴露和人格因素的关系,为制订特殊人群PTSD防治策略提供依据。方法随机整群抽取地震救援武警官兵748名,采用一般资料调查表、创伤后应激障碍症状清单—平民版(PCL-C)、艾森克人格问卷简式量表中国版(EPQ-RSC)、特质焦虑量表(TAI)评估PTSD发病率、严重程度及影响因素。结果地震救援后18个月救援武警PTSD阳性检出率1.7%(13/748),7.9%的救援官兵存在创伤重体验症状,3.1%的官兵存在警觉性增高症状,2.1%的官兵存在情感麻木和回避症状。不同暴露程度组间PCL-C总分差异有显著性(P0.01);多元线性回归分析显示,年龄、暴露水平、是否有家人受灾、神经质、特质焦虑进入方程。结论地震救援后18个月武警官兵PTSD发生率较低,但伴有PTSD症状比例仍较高。低年龄、高暴露水平、有家人受灾、神经质、高特质焦虑是创伤后应激障碍严重程度的预测因素。     

Food Patterns Among Elderly Hospitalized Alcoholics

The predisposition of elderly hospitalized alcoholic veterans to various food consumption patterns is marked by certain characteristics. Degrees of depressed and non-depressed moods and feelins were identified in this study through a standardized Adjective Check List. The number of food groups underconsumed was not shown to be related directly or significantly to the control variables. Recommended is an intervention model to enhance effective management, continuity of care and follow-up of the older patient during and after hospitalization.