How should we screen for depression following a natural disaster? An ROC approach to post-disaster screening in adolescents and adults.
How should we screen for depression following a natural disaster? An ROC approach to post-disaster screening in adolescents and adults.
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DOI：
10.1016/j.jad.2016.05.034
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发表时间：
2016-09-15
影响因子：
6.6
通讯作者：
Danielson CK
中科院分区：
文献类型：
--
作者：
Cohen JR;Adams ZW;Menon SV;Youngstrom EA;Bunnell BE;Acierno R;Ruggiero KJ;Danielson CK
本研究的目的是提供一个有效的，经验为基础的协议抑郁症筛查自然灾害后的基础。利用受试者操作特征（ROC）分析方法，该研究测试了a）哪些特定的灾害相关压力源（即，财产损失、基本服务损失）和与个人有关的结构（即，PTSD症状、创伤史、社会支持）传达了自然灾害后抑郁的最大风险，B）这些测量的具体截止分数，以及c）每个结构的显著性或截止分数在青少年和成人之间是否不同。研究人员对2,000名经历过龙卷风的青少年和1,543名在飓风中幸存的成年人进行了结构化的电话临床访谈。研究结果表明，在青少年和成年人中，与自然灾害相关的压力相比，个人相关的结构预测自然灾害后抑郁症状的风险更大。此外，与成人抑郁症状相比，创伤史和创伤后应激障碍症状是青少年抑郁症状的特别强有力的指标。报告社会支持，创伤史和终生PTSD症状的脆弱分数的青少年和成年人在自然灾害后出现抑郁的可能性约为两倍。本研究的结果仅限于灾后评估，并基于自然灾害发生后6-12个月自我报告的功能。本研究综合了大量的灾后功能研究，提供了一个明确的框架，在自然灾害后筛查抑郁症时，提出的问题可能是最重要的。
The present study’s aim was to provide the foundation for an efficient, empirically based protocol for depression screening following a natural disaster. Utilizing a Receiver Operating Characteristic (ROC) analytic approach, the study tested a) what specific disaster-related stressors (i.e., property damage, loss of basic services) and individual-related constructs (i.e., PTSD symptoms, trauma history, social support) conveyed the greatest risk for post-natural disaster depression, b) specific cutoff scores across these measures, and c) whether the significance or cutoff scores for each construct varied between adolescents and adults. Structured phone-based clinical interviews were conducted with 2,000 adolescents who lived through a tornado and 1,543 adults who survived a hurricane. Findings suggested that in both adolescents and adults, individual-related constructs forecasted greater risk for depressive symptoms following a natural disaster compared to disaster-related stressors. Furthermore, trauma history and PTSD symptoms were particularly strong indicators for adolescent depressive symptoms compared to adult depressive symptoms. Adolescents and adults who reported vulnerable scores for social support, trauma history, and lifetime PTSD symptoms were approximately twice as likely to present as depressed following the natural disaster. Findings from the present study were limited to post-disaster assessments and based on self-reported functioning 6–12 months following the natural disaster. The present study synthesizes the extensive body of research on post-disaster functioning by providing a clear framework for which questions may be most important to ask when screening for depression following a natural disaster.