Comorbidity, impairment, in subthreshold and suicidality subthreshold PTSD
Comorbidity, impairment, in subthreshold and suicidality subthreshold PTSD
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DOI：
10.1176/appi.ajp.158.9.1467
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发表时间：
2001-09-01
影响因子：
17.7
通讯作者：
Struening, EL
中科院分区：
文献类型：
--
作者：
Marshall, RD;Olfson, M;Struening, EL
目的：对精神疾病分类模型的依赖导致对创伤后后遗症的研究被忽视，这些后遗症不符合创伤后应激障碍（PTSD）的完整标准。严重残疾和自杀风险与阈下 PTSD 相关，但这种关联尚未得到充分研究。此外，还没有研究探讨合并症在解释阈下 PTSD 的残疾和损伤中的作用。 方法：1997 年全国焦虑症筛查日，在美国 1,521 个地点接受情感和焦虑症筛查的 9,358 人中，有 2,608 人报告在盛宴时出现一种至少持续 1 个月的 PTSD 症状。确定并比较筛查问卷中没有、一种、两种、三种或四种（完全创伤后应激障碍）症状的个体的损伤、共病焦虑症、重度抑郁症和自杀率。回归分析检查了阈下 PTSD 和共病障碍对损伤和自杀意念的相对贡献。结果：随着阈下 PTSD 症状数量的增加，损伤、共病障碍的数量、共病重性抑郁障碍的发生率和当前的自杀意念呈线性且显着增加。即使作者控制了共病重度抑郁症的存在，患有阈下 PTSD 的个体自杀意念的风险也更大。结论：阈下 PTSD 症状的数量越多，与更大的损伤、共病和自杀意念相关。先前对阈下 PTSD 症状的研究中发现的残疾和损伤可能部分与共病的存在有关。然而，即使作者控制了重度抑郁症，阈下 PTSD 症状的存在也会显着增加自杀意念的风险。鉴于这些发现对公共卫生的广泛影响，需要付出更多努力来识别临床人群、流行病学调查和治疗研究中的阈下 PTSD 症状。
Objective: Reliance on the categorical model of psychiatric disorders has led to neglected study of posttraumatic sequelae that fall short of full criteria for posttraumatic stress disorder (PTSD). Substantial disability and suicidal risk is associated with subthreshold PTSD, but this association has not been well studied. in addition, no studies have examined the role of comorbidity in explaining disability and impairment in subthreshold PTSD.Method: On National Anxiety Disorders Screening Day 1997, 2,608 out of 9,358 individuals screened for affective and anxiety disorders at 1,521 sites across the United States reported at feast one PTSD symptom of at least 1 month's duration. Impairment, comorbid anxiety disorders, major depressive disorder, and rates of suicidality were determined and compared for individuals with no, one, two, three, or four (full PTSD) symptoms on a screening questionnaire. Regression analyses examined the relative contribution of subthreshold PTSD and comorbid disorders to impairment and suicidal ideation.Results: Impairment, number of comorbid disorders, rates of comorbid major depressive disorder, and current suicidal ideation increased linearly and significantly with each increasing number of subthreshold PTSD symptoms. Individuals with subthreshold PTSD were at greater risk for suicidal ideation even after the authors controlled for the presence of comorbid major depressive disorder.Conclusions: Higher numbers of subthreshold PTSD symptoms were associated with greater impairment, comorbidity, and suicidal ideation. Disability and impairment found in previous studies of subthreshold PTSD symptoms may be related in part to the presence of comorbid disorders. However, the presence of subthreshold PTSD symptoms significantly raised the risk for suicidal ideation even after the authors controlled for major depressive disorder. Given the broad public health implications of these findings, more efforts are needed to identify subthreshold PTSD symptoms in clinical populations, epidemiologic surveys, and treatment studies.