Posttraumatic stress disorder symptomatology in the course of allogeneic HSCT: a prospective study
Posttraumatic stress disorder symptomatology in the course of allogeneic HSCT: a prospective study
复制标题
DOI：
10.1007/s11764-016-0579-7
复制
发表时间：
2017-04-01
影响因子：
3.7
通讯作者：
Mehnert, Anja
中科院分区：
文献类型：
--
作者：
Esser, Peter;Kuba, Katharina;Mehnert, Anja
目的尽管异基因造血干细胞移植具有危及生命的特点，但对创伤后应激障碍(PTSD)症状学的纵向研究很少。我们调查了这一人群中创伤后应激障碍症状的患病率、时间进程和预测因素。方法对患者在条件治疗前(T0)、100天(T1)和HSCT后12个月(T2)进行评估。采用创伤后应激障碍症状自评量表(PTSD Checklist-平民版)进行评定。结果239例患者在基线时参与，150例在T1时参与，102例在T2时参与。在评估过程中，高达15%的人至少一次符合创伤后应激障碍的标准。52%的人表现出与诊断相关的侵扰水平，30%的人回避，33%的人至少一次唤醒。除了觉醒在T0和T1之间增加(Gamma=0.56，p=0.03)外，其他严重程度评分在不同时间点之间没有显著差异。考虑到所有时间点，疼痛(Gamma=2.89，p<；0.01)、疼痛程度(Gamma=0.63，p=0.02)和女性(Gamma=3.81，p<；0.01)是创伤后应激障碍症状的显著预测因素。急性和慢性移植物抗宿主病和较长的住院时间预测T2时PTSD的症状(Gamma=3.39，p=0.04；Gamma=0.1，p=0.03)。结论相当数量的异基因HSCT患者符合PTSD的标准。创伤后应激障碍症状在所有评估点都很突出。疼痛负担、女性和医疗并发症是导致PTSD症状水平升高的危险因素。对癌症幸存者的影响不仅应该在治疗后提供心理支持，而且应该在长期甚至在HSCT之前提供。专业人士应该意识到伴随着疼痛和并发症的心理后果。
Purpose Despite the life-threatening character of allogeneic hematopoietic stem cell transplantation (allogeneic HSCT), very few longitudinal research exists on posttraumatic stress disorder (PTSD) symptomatology in this patient group. We investigated prevalence, temporal course and predictors of PTSD symptomatology in this population.Methods Patients were assessed before conditioning (T0), 100 days (T1), and 12 months after HSCT (T2). PTSD symptomatology was measured with the PTSD Checklist-Civilian Version. We conducted multilevel modeling and multiple regression analyses.Results Two hundred thirty-nine patients participated at baseline, 150 at T1, and 102 at T2. Up to 15 % met the criteria for PTSD at least once during the course of assessment. Fifty-two percent showed diagnostic relevant levels of intrusion, 30 % of avoidance, and 33 % of arousal at least once. Apart from arousal, which increased between T0 and T1 (gamma = 0.56, p = 0.03), no other severity score significantly differed between time points. Being impaired by pain (gamma = 2.89, p < 0.01), pain level (gamma = 0.63, p = 0.02), and being female (gamma = 3.81, p < 0.01) emerged as significant predictors of PTSD symptomatology when taking into account all time points. Acute plus chronic graft-versus-host-disease and longer hospital stay predicted PTSD symptomatology at T2 (gamma = 3.39, p = 0.04; gamma = 0.1, p = 0.03).Conclusions A considerable number of patients undergoing allogeneic HSCT met the criteria for PTSD. PTSD symptomatology is prominent at all assessment points. Burden of pain, being female, and medical complications are risk factors for elevated levels of PTSD symptomatology.Implications for cancer survivors Psychological support should be offered not only after treatment but also in the long-term and even before HSCT. Professionals should be aware of the psychological consequences accompanied by pain and complications.