Course and Predictors of Post-Traumatic Stress Disorder in a Cohort of Psychologically Distressed Patients With Cancer: A 4-Year Follow-Up Study
Course and Predictors of Post-Traumatic Stress Disorder in a Cohort of Psychologically Distressed Patients With Cancer: A 4-Year Follow-Up Study
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DOI：
10.1002/cncr.30980
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发表时间：
2018-01-15
期刊：
影响因子：
6.2
通讯作者：
Meyer, Fremonta
中科院分区：
文献类型：
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作者：
Chan, Caryn Mei Hsien;Ng, Chong Guan;Meyer, Fremonta
背景：关于癌症相关创伤后应激障碍（PTSD）的长期病程的证据很少。这是全球为数不多的研究之一，也是东南亚地区首个使用金标准临床访谈前瞻性评估癌症患者 PTSD 的研究。该研究的目的是评估东南亚成年癌症患者的 PTSD 病程和预测因素。方法：对 469 名在同一肿瘤转诊中心诊断后 1 个月内患有各种癌症类型的患者（年龄 >= 18 岁）连续招募的队列进行了一项前瞻性纵向研究。只有患有严重心理困扰（医院焦虑和抑郁量表总分值>= 16）的患者才会在 6 个月随访时接受《精神疾病诊断和统计手册》第四版文本修订版 (SCID) 结构化临床访谈的 PTSD 模块。所有患者均在 4 年随访评估中完成 SCID，无论其最初的医院焦虑和抑郁量表评分如何。结果：在一项对患有完全型和亚综合征型 PTSD 的患者进行的分析中，6 个月随访评估时，PTSD 发生率为 21.7%（203 名 SCID 访谈患者中，n = 44 名），4 年随访评估时，发生率降至 6.1%（245 名 SCID 访谈患者中，n = 15 名）。乳腺癌患者（与患有其他类型癌症的患者相比）在 6 个月时发生 PTSD 的可能性降低了 3.68 倍，但在 4 年随访时则不然。结论：PTSD 的总体发生率随着时间的推移而下降，但最初诊断的患者中有三分之一 (34.1%) 4 年后患有持续性或恶化的 PTSD。需要及早识别患有创伤后应激障碍 (PTSD) 的癌症患者，以设计针对风险的干预措施。 (C) 2017 年美国癌症协会。
BACKGROUND: Scant evidence exists on the long-term course of cancer-related post-traumatic stress disorder (PTSD). This is among the few studies worldwide, and the first in the South-East Asian region, to prospectively evaluate PTSD in patients with cancer using gold-standard clinical interviews. The objective of the study was to assess the course and predictors of PTSD in adult patients with cancer in a South-East Asian population. METHODS: A prospective, longitudinal study was conducted in a cohort of 469 consecutively recruited patients (aged >= 18 years) with various cancer types within 1 month of diagnosis at a single oncology referral center. Only patients who had significant psychological distress (Hospital Anxiety and Depression Scale total cutoff score >= 16) underwent the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (SCID) at at 6-months follow-up. All patients completed the SCID at the 4-year follow-up assessment regardless of their initial Hospital Anxiety and Depression Scale score. RESULTS: In an analysis combining patients who had both full and subsyndromal PTSD, there was a 21.7% incidence of PTSD at the 6-month follow-up assessment (n = 44 of 203 SCID-interviewed patients), with rates dropping to 6.1% at the 4-year follow-up assessment (n = 15 of 245 SCID-interviewed patients). Patients with breast cancer (compared with those who had other types of cancer) were 3.68 times less likely to develop PTSD at 6-months, but not at 4-years follow-up. CONCLUSIONS: The overall rates of PTSD decreased with time, but one-third of patients (34.1%) who were initially diagnosed had persistent or worsening PTSD 4 years later. There is a need for early identification of this subset of patients who have cancer with PTSD to design risk-targeted interventions. (C) 2017 American Cancer Society.