Twelve-month trajectories of depressive and anxiety symptoms and associations with traumatic exposure and ongoing adversities: a latent trajectory analysis of a community cohort exposed to severe conflict in Sri Lanka
Twelve-month trajectories of depressive and anxiety symptoms and associations with traumatic exposure and ongoing adversities: a latent trajectory analysis of a community cohort exposed to severe conflict in Sri Lanka
复制标题
抑郁和焦虑症状的十二个月轨迹以及与创伤经历和持续逆境的关联：对斯里兰卡遭受严重冲突的社区群体的潜在轨迹分析
作者：
A. Tay;R. Jayasuriya;D. Jayasuriya;D. Silove
我们对暴露于斯里兰卡高水平大规模冲突地区(Mannar、Killinochi、Mullaitivu和Jaffna)的成年人样本进行了为期12个月的跟踪调查，本分析的目的是确定抑郁和焦虑症状的轨迹及其与暴露在心理创伤和持续生活逆境中的关系。2015年跟踪调查的1275名成年人(86%)是从2014年在斯里兰卡25个地区进行的具有全国代表性的基线调查中抽取的结构化亚样本。现场工作人员使用电子平板电脑进行访谈，应用了创伤暴露、持续逆境以及抑郁和焦虑症状的背景适应指数。潜伏期转移分析显示了一个三级纵向模型，并由此衍生出4个复合轨迹，包括持续症状轨迹(n=555，43.5%)、突发或新发病轨迹(n=170，13.3%)、恢复轨迹(n=299，23.5%)和持续低症状轨迹(n=251，19.7%)。与持续症状和事件轨迹相关的因素包括女性性别、既往创伤暴露和无法获得卫生服务。失业与随访中持续的轨迹是唯一相关的。复苏轨迹包括较高比例的男子、老年人和没有风险因素的人。我们的研究结果有助于将流行病学数据转化为公共政策和实践，指出稳定就业和提供医疗保健作为可能在冲突后阶段减少焦虑和抑郁症状的关键因素的重要性。研究结果还证实，女性精神困扰的风险很高。在暴露于大规模冲突的高水平人群中对创伤暴露进行简单筛查，可能有助于确定那些有持续焦虑和抑郁症状的人。
We conducted a 12-month follow-up of a population sample of adults from districts (Mannar, Killinochi, Mullaitivu and Jaffna) exposed to high levels of mass conflict in Sri Lanka, the aim of the present analysis being to identify trajectories of depression and anxiety symptoms and their associations with exposure to psychological trauma and ongoing living adversities. The cohort of 1275 adults (response 86%) followed-up in 2015 was a structured subsample drawn from the baseline nationally representative survey conducted in 2014 across 25 districts in Sri Lanka. Interviews were conducted using electronic tablets by field workers applying contextually adapted indices of trauma exposure, ongoing adversities and symptoms of depression and anxiety. Latent transition analysis revealed a three-class longitudinal model from which four composite trajectories were derived, comprising a persistent symptom trajectory (n=555, 43.5%), an incident or new onset trajectory (n=170, 13.3%), a recovery trajectory (n=299, 23.5%) and a persistently low-symptom trajectory (n=251, 19.7%). Factors associated with both the persistent symptom and incident trajectories were female gender, past trauma exposure and lack of access to health services. Loss of a job was uniquely associated with the persisting trajectory at follow-up. The recovery trajectory comprised a higher proportion of men, older persons and those without risk factors. Our findings assist in translating epidemiologic data into public policy and practice by indicating the importance of stable employment and the provision of healthcare as key factors that may act to reduce anxiety and depressive symptoms in the post-conflict phase. The findings also confirm that women are at high risk of mental distress. Brief screening for trauma exposure in populations with high levels of exposure to mass conflict may assist in defining those at risk of ongoing symptoms of anxiety and depression.
影响因子：
120.7
作者：
Kessler, RC;Berglund, P;Wang, PS
通讯作者：
Wang, PS