Trauma Exposure, Posttraumatic Stress Disorder Symptoms Trajectory, and Disability Level Among Hospitalized Injury Survivors in Kenya
Trauma Exposure, Posttraumatic Stress Disorder Symptoms Trajectory, and Disability Level Among Hospitalized Injury Survivors in Kenya
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DOI：
10.1002/jts.22373
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发表时间：
2019-02-01
影响因子：
3.3
通讯作者：
Bachani, Abdulgafoor M.
中科院分区：
文献类型：
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作者：
Hung, Yuen W.;Tol, Wietse;Bachani, Abdulgafoor M.
潜在创伤事件（PTE）一直与创伤后应激障碍（PTSD）相关。然而，与随后残疾的关联程度和归因程度各不相同，在城市低收入背景下进行的研究有限。这项纵向研究估计了因受伤住院的成年患者住院后 7 个月内 PTSD 症状的轨迹以及相关的残疾水平。肯尼亚内罗毕肯雅塔国家医院收治的成人损伤患者（N = 476）在医院接受了亲自访谈，并在出院后 1、2-3 和 4-7 个月通过电话进行了访谈。使用潜在生长曲线模型，出现了两种 PTSD 症状轨迹：(a) PTSD 症状持续升高 (9.2%)，(b) PTSD 症状较低 (90.8%)。在控制了院内抑郁症状后，经历的 PTE 数量仍与升高的轨迹呈中度相关。之前目睹过杀戮或严重伤害，AOR = 2.32，95% CI [1.07，5.05]；女性，AOR = 4.74，95% CI [4.53，4.96]；住院期间抑郁症状加重，AOR = 2.96，95% CI [1.28，6.83]；且没有家庭储蓄/资产，AOR = 1.28，95% CI [1.13，1.44]，在控制其他风险因素后与 PTSD 症状轨迹类别升高相关。在控制伤害和人口统计特征后，PTSD 轨迹升高的潜在成员与出院几个月后明显较高的残疾水平相关，p < .001。这些结果强调了住院抑郁症状、目击暴行、贫困以及创伤后应激障碍症状轨迹升高之间的关联。
Potentially traumatic events (PTEs) have been consistently associated with posttraumatic stress disorder (PTSD). However, the extent of association and attribution to subsequent disability has varied, with limited studies conducted in urban low-income contexts. This longitudinal study estimated the trajectory of PTSD symptoms up to 7 months after hospitalization and the associated disability level among adult patients who had been hospitalized due to injury. Adult injury patients (N = 476) admitted to Kenyatta National Hospital in Nairobi, Kenya, were interviewed in person in the hospital, and via phone at 1, 2-3, and 4-7 months after hospital discharge. Using latent growth curve modeling, two trajectories of PTSD symptoms emerged: (a) persistently elevated PTSD symptoms (9.2%), and (b) low PTSD symptoms (90.8%). Number of PTEs experienced remained moderately associated with the elevated trajectory after controlling for in-hospital depressive symptoms. Having previously witnessed killings or serious injuries, AOR = 2.32, 95% CI [1.07, 5.05]; being female, AOR = 4.74, 95% CI [4.53, 4.96]; elevated depressive symptoms during hospitalization, AOR = 2.96, 95% CI [1.28, 6.83]; and having no household savings/assets, AOR = 1.28, 95% CI [1.13, 1.44], were associated with the elevated PTSD symptoms trajectory class after controlling for other risk factors. Latent membership in the elevated PTSD trajectory was associated with a significantly higher level of disability several months after hospital discharge, p < .001, after controlling for injury and demographic characteristics. These results underline the associations among in-hospital depressive symptoms, witnessing atrocities, and poverty, and an elevated PTSD symptoms trajectory.