Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health.
Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health.
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DOI：
10.1186/1471-244x-5-21
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发表时间：
2005-04-26
期刊：
影响因子：
4.4
通讯作者：
Parslow R
中科院分区：
文献类型：
--
作者：
Howgego IM;Owen C;Meldrum L;Yellowlees P;Dark F;Parslow R
研究了创伤和创伤后应激障碍（PTSD）的比率，以便将澳大利亚公共精神卫生服务机构的客户概况与国际文献中报道的患有重大精神疾病的客户概况进行比较，并探讨这对客户健康结果的影响。在这组客户中，导致创伤/创伤后应激障碍水平增加的潜在因素，以及创伤后应激障碍与随后的精神疾病之间的因果关系问题也被探讨。使用创伤后应激诊断量表™（PDS）和选定的结果测量方法筛选29名患者的创伤和创伤后应激障碍样本。数据采用配对样本和独立样本t检验和方差分析。发现了高水平的未记录的创伤和创伤后应激障碍。20名患者（74%）报告暴露于多重创伤性事件；33.3%(9)符合DSM IV诊断标准。PTSD组在PTSD症状、严重程度和损害以及患者和临床医生评定的生活质量（QOL）结果评分方面存在显著差异。PTSD症状学对工作联盟（WA）没有影响。确定了可能影响这一群体中PTSD发病率较高的因素，包括与所研究人群相关的问题、所发现的攻击性暴力的优势以及与社会和治疗环境中再创伤相关的脆弱性和风险因素。在这个小样本客户中发现了与国际文献报道的类似的创伤和创伤后应激障碍概况，包括更高水平的创伤和创伤后应激障碍以及更差的生活质量。据推测，严重精神疾病患者的创伤/创伤后应激障碍水平的增加，包括在当前研究中发现的，主要与接受公共主流精神科服务的人群的特征有关，这些因素对服务的提供有特定的影响。并提出资源利用的效率和有效性问题，以便为患有合并PTSD的客户提供成功的公共精神卫生服务。为了在澳大利亚社区精神卫生服务机构内检验这些初步发现，需要进行更严格设计的进一步研究。
Rates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Potential factors contributing to increased levels of trauma/PTSD in this group of clients and the issue of causality between PTSD and subsequent mental illness was also explored. A convenience sample of 29 clients was screened for trauma and PTSD using the Posttraumatic Stress Diagnostic Scale™ (PDS) and selected outcome measures. Paired and independent samples t-test and ANOVA were applied to the data. High levels of undocumented trauma and PTSD were found. Twenty clients, (74%) reported exposure to multiple traumatic events; 33.3% (9) met DSM IV diagnostic criteria for PTSD. Significant difference was found for PTSD symptomatology, severity and impairment and for client and clinician-rated scores of Quality of Life (QOL) outcomes in the PTSD group. No effect for PTSD symptomatology on the Working Alliance (WA) was found. Factors that may influence higher rates of PTSD in this group were identified and included issues associated with the population studied, the predominance of assaultive violence found, and vulnerability and risks factors associated with re-traumatisation within the social and treating environments. A similar trauma and PTSD profile to that reported in the international literature, including greater levels of trauma and PTSD and a poorer QOL, was found in this small sample of clients. It is postulated that the increased levels of trauma/PTSD as reported for persons with major mental illness, including those found in the current study, are primarily related to the characteristics of the population that access public mainstream psychiatric services and that these factors have specific implications for service delivery, and raise issues of efficiency and effectiveness of resource use in achieving successful outcomes in public mental health services for clients with co-morbid PTSD. Further research with a more rigorous design is needed to test these preliminary findings within Australian Community Mental Health Services.