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目的跟踪研究“5.12”汶川地震救援军人创伤后应激障碍(PTSD)的发生率及病程转归,分析PTSD相关危险因素。方法采用流行病学调查初筛与精神科临床确诊相结合的方法,于震后半年随机整群抽样1024名军人,使用自编救援经历量表(REQ)、急性应激状况调查表(SRQ-20)及PTSD筛查量表(PCL-C)进行初筛,由精神科医师依据DSM-Ⅳ轴Ⅰ障碍用临床定式检查(SCID-Ⅰ)对初筛结果高于划界分者进行一对一晤谈确定诊断,并对其中470名军人连续随访2年。结果 6个月时点确诊PTSD患者35例,患病率为3.42%,其中56.25%在24个月仍未痊愈;24个月时点随访,PTSD患病率为2.13%,其中90%为6个月时已确诊PTSD患者;以是否患PTSD为因变量,进行多重Logistic回归分析,进入方程变量为急性应激障碍(ASD),现场搜救、处理遗体等重任务,PCL-C总分,SDS总分,救援经历和任务对自己心理的影响等7个因素。结论 “5.12”抗震救援军事人员PTSD患病率较平时PTSD患病率显著增高,病程迁延且自然缓解率低,应当在充分关注同时加强心理干预与对症治疗。本研究还探讨了PTSD相关危险因素,为今后构建军人心理应激损伤防护策略提供了科学依据。
Objective To study the incidence and course of posttraumatic stress disorder (PTSD) in the “5.12” Wenchuan earthquake-relief military service and to analyze the risk factors related to PTSD. Methods A total of 1024 soldiers were randomly selected from the first half of the quake. The self-made rescue experience questionnaire (REQ) and the acute stress status questionnaire (SRQ- 20) and PTSD Screening Scale (PCL-C) were initially screened by a psychiatrist according to the DSM-Ⅳ Axis Ⅰ obstacle with clinical determinations (SCID-Ⅰ) of the screening results were higher than the demarcation of a pair One meeting confirmed the diagnosis, and 470 of them were followed up for 2 consecutive years. Results 35 cases of PTSD were diagnosed at 6 months, the prevalence was 3.42%, of which 56.25% were still not cured at 24 months. At 24 months, the prevalence of PTSD was 2.13%, of which 90% was 6 Month PTSD patients have been diagnosed; whether or not suffering from PTSD as a dependent variable, multiple Logistic regression analysis into the equation variables for acute stress disorder (ASD), on-site search and rescue, handling the body and other heavy tasks, PCL-C score, SDS Total score, rescue experience and the psychological impact of their tasks and other seven factors. Conclusion The prevalence of PTSD in “5.12” earthquake-resistant military personnel is significantly higher than that of normal PTSD. The course of disease is prolonged and the spontaneous remission rate is low. At the same time, we should pay more attention to psychological intervention and symptomatic treatment. This study also explored the risk factors associated with PTSD, which provided a scientific basis for the future construction of protective measures for psychological stress injury.