The Course of Mental Health Disorders After a Disaster: Predictors and Comorbidity
The Course of Mental Health Disorders After a Disaster: Predictors and Comorbidity
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DOI：
10.1002/jts.20663
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发表时间：
2011-08-01
影响因子：
3.3
通讯作者：
Gersons, Berthold P. R.
中科院分区：
文献类型：
--
作者：
Meewisse, Marie-Louise;Olff, Miranda;Gersons, Berthold P. R.
目前的纵向灾难研究通常只关注创伤后应激障碍（PTSD），尽管一些研究表明，其他疾病和合并症的风险增加是常见的。为了深入了解灾后精神病理学的过程，对恩斯赫德烟花灾难的幸存者进行了2-3周到4年的灾后社区样本。诊断访谈（复合国际诊断访谈[CIDI]世界卫生组织，1997年）和儿童压力源访谈管理在2年灾后（n = 260）; CIDI重复在4年灾后（n = 201，响应率77.3%）。在灾后2年，许多幸存者（40.6%）患有PTSD（21.8%），特定恐惧症（21.5%）和/或抑郁症（161%）。这些疾病高度共病。灾后4年，患病率显著下降。随着时间的推移，一些幸存者的诊断分类并没有完全康复，而是发生了变化。这导致PTSD的发病率较低，但抑郁症和特定恐惧症的发病率仍然较高。根据灾后2年和4年的诊断状态，构建4组幸存者，进一步研究了创伤后应激障碍、抑郁症和特定恐惧症3种纠缠性疾病的病程：健康、恢复、慢性和延迟发作。最初的抑郁症状，母亲的功能障碍，儿童期的身体虐待和灾难暴露被发现区分组和预测长期的精神病理学。
Current longitudinal disaster studies usually focus only on posttraumatic stress disorder (PTSD), although some studies have shown that increased risks for other disorders and comorbidity is common. To obtain an insight into the course of postdisaster psychopathology, a community sample of survivors of the Enschede fireworks disaster was followed from 2-3 weeks to 4-years postdisaster. Diagnostic interviews (Composite International Diagnostic Interview [CIDI] World Health Organization, 1997) and childhood stressor interviews were administered at 2-years postdisaster (n = 260); the CIDI was repeated at 4-years postdisaster (n = 201, response rate 77.3%). At 2-years postdisaster many survivors (40.6%) suffered from PTSD (21.8%), specific phobia (21.5%), and/or depression (161%). These disorders were highly comorbid. At 4-years postdisaster, prevalence significantly diminished. Instead of full recovery, diagnostic classifications shifted in several survivors over time. This resulted in low rates of PTSD but still elevated rates of depression and specific phobia. The course of the 3 entangled disorders of PTSD, depression, and specific phobia was further studied by constructing 4 groups of survivors based on the diagnostic status at 2- and 4-years postdisaster: healthy, recovered, chronic, and delayed-onset. Initial depressive symptoms, maternal dysfunction, childhood physical abuse, and disaster exposure were found to discriminate between the groups and predict long-term psychopathology.