Perceived threat to life predicts posttraumatic stress disorder after major trauma: Risk factors and functional outcome
Perceived threat to life predicts posttraumatic stress disorder after major trauma: Risk factors and functional outcome
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DOI：
10.1097/00005373-200108000-00010
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发表时间：
2001-08-01
影响因子：
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通讯作者：
Sieber, WJ
中科院分区：
文献类型：
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作者：
Holbrook, TL;Hoyt, DB;Sieber, WJ
背景：重大创伤后心理发病率的重要性，例如创伤后应激障碍（PTSD），在创伤结果研究中持续受到关注。创伤恢复项目是一项大型前瞻性流行病学研究，旨在检查重大创伤后的多种结果，包括生活质量 (QoL) 和创伤后应激障碍 (PTSD)。本报告的具体目标是在创伤恢复项目人群的 6、12 和 18 个月随访时间点检查 PTSD 的风险因素并评估其对生活质量的影响。方法。 1993 年 12 月 1 日至 1996 年 9 月 1 日期间，1,048 名符合条件的创伤患者被分诊到圣地亚哥区域创伤系统的四家参与创伤中心医院，参加了这项研究。该研究的入组标准包括年龄 IS 岁及以上、入院格拉斯哥昏迷量表评分为 12 或更高、住院时间 > 24 小时。受伤后使用健康质量量表测量生活质量，这是功能连续体终点的敏感指数（范围，0 = 死亡到 1.000 = 最佳功能）。使用事件影响量表评估出院时急性应激反应 (SASR) 的早期症状（分数 > 30 = SASR）。 6 个月随访时使用标准化精神障碍诊断和统计手册第 4 版标准诊断 PTSD。在出院时以及出院后 6、12 和 18 个月对患者的预后进行评估。结果。在 6 个月的随访中，32% 的患者（824 名患者中的 261 名）被诊断为 PTSD。感知生命威胁可预测 PTSD 发作（比值比 [OR]，1.6；p < 0.01）和早期 SASR（OR，2.2；p < 0.001）。女性 (39%) 比男性 (29%) 和年轻的低收入患者更容易患 PTSD。其他主要危险因素是穿透性创伤（OR，2.3；p < 0.001）和攻击（OR，1.5；p < 0.05）。 PTSD 对 6、12 和 18 个月随访时的生活质量产生重大影响（幸福质量量表评分：6 个月，0.576 vs. 0.658；12 个月，0.620 vs. 0.691；18 个月，0.620 vs. 0.700；p < 0.0001）。结论。这些结果提供了新的、具有挑战性的证据，表明感知生命威胁和机制可以预测重大创伤后的 PTSD。创伤后应激障碍（PTSD）对短期和长期结果以及生活质量有着长期而深远的影响。
Background: The importance of psychological morbidity after major trauma, such as posttraumatic stress disorder (PTSD), is continuing to gain attention in trauma outcomes research. The Trauma Recovery Project is a large prospective epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life (QoL) and PTSD. The specific objectives of the present report are to examine risk factors for PTSD and to assess the impact on QoL, at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population.Methods. Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age IS years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay > 24 hours. QoL was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = SASR). PTSD at 6-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge.Results. PTSD was diagnosed in 32% (261 of 824) patients at 6-month follow-up. Perceived threat to life predicted PTSD onset (odds ratio [OR], 1.6; p < 0.01) and early SASR (OR, 2.2; p < 0.001). PTSD was more frequent in women (39%) than in men (29%) and in younger low-income patients. Other major risk factors were penetrating trauma (OR, 2.3;p < 0.001) and assaults (OR, 1.5; p < 0.05). PTSD had a major impact on QoL at 6-, 12-, and 18-month follow-up (Quality of Well-being scale score: 6 months, 0.576 vs. 0.658; 12 months, 0.620 vs. 0.691; 18 months, 0.620 vs. 0.700; p < 0.0001).Conclusion. These results provide new and provocative evidence that perceived threat to life and mechanism predict PTSD after major traumatic injury. PTSD had a prolonged and profound impact on short- and long-term outcome and QoL.