Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys.
Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys.
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DOI：
10.1002/da.22169
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发表时间：
2014-02
影响因子：
7.4
通讯作者：
Koenen, Karestan C.
中科院分区：
文献类型：
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作者：
Karam, Elie G.;Friedman, Matthew J.;Hill, Eric D.;Kessler, Ronald C.;McLaughlin, Katie A.;Petukhova, Maria;Sampson, Laura;Shahly, Victoria;Angermeyer, Matthias C.;Bromet, Evelyn J.;de Girolamo, Giovanni;de Graaf, Ron;Demyttenaere, Koen;Ferry, Finola;Florescu, Silvia E.;Haro, Josep Maria;He, Yanling;Karam, Aimee N.;Kawakami, Norito;Kovess-Masfety, Viviane;Medina-Mora, Maria Elena;Browne, Mark A. Oakley;Posada-Villa, Jose A.;Shalev, Arieh Y.;Stein, Dan J.;Viana, Maria Carmen;Zarkov, Zahari;Koenen, Karestan C.
临床研究表明，创伤后应激障碍（PTSD）患者暴露于多个创伤性事件（TEs）而不是单一创伤性事件（TE）会增加发病率和功能障碍。尽管美国和欧洲的流行病学调查也记录了多重TE暴露的高发生率，但没有基于人群的跨国数据研究这一问题。数据分析来自世界卫生组织世界心理健康调查倡议的20项人口调查（51,295名18岁以上的人）。综合国际诊断访谈（3.0）评估了12个月的PTSD和其他常见的DSM-IV障碍。对患有12个月PTSD的应答者进行与症状相关的单次te和多次te的评估。研究了发病年龄（AOO）、功能损害、合并症和PTSD症状计数的相关性。19.8%的12个月PTSD患者报告他们的症状与多发te相关。创伤后应激障碍与四次或四次以上创伤性精神创伤相关的病例，功能损害更严重，AOO更早，持续时间更长，与情绪和焦虑障碍合并症更高，高唤醒症状，伴侣身体虐待和其他类型的身体攻击的比例更高，与较少相关创伤性精神创伤的病例相比，亲人意外死亡的比例更低。在这个大规模的跨国数据库中观察到一个风险阈值，其中与四次或更多te相关的PTSD患者表现出更“复杂”的临床症状，其功能损害和发病率明显高于其他PTSD患者。创伤后应激障碍病例与四个或更多的te可能需要特定的和有针对性的干预策略。抑郁与焦虑，2014。
Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyper-arousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more “complex” clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies. Depression and Anxiety 31:130–142, 2014.
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影响因子：
--
作者：
KESSLER, RC;SONNEGA, A;NELSON, CB
通讯作者：
NELSON, CB
影响因子：
4.8
作者：
Nelson, Charles;Cyr, Kate St.;Richardson, J. Donald
通讯作者：
Richardson, J. Donald
影响因子：
3.3
作者：
Briere, John;Kaltman, Stacey;Green, Bonnie L.
通讯作者：
Green, Bonnie L.
影响因子：
3.3
作者：
Follette, VM;Polusny, MA;Naugle, AE
通讯作者：
Naugle, AE
影响因子：
5.1
作者：
Arata, C M
通讯作者：
Arata, C M