Lifetime events and posttraumatic stress disorder in 4 postconflict settings
Lifetime events and posttraumatic stress disorder in 4 postconflict settings
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DOI：
10.1001/jama.286.5.555
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发表时间：
2001-08-01
影响因子：
120.7
通讯作者：
Somasundaram, D
中科院分区：
文献类型：
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作者：
de Jong, JTVM;Komproe, IH;Somasundaram, D
背景
在人们经历了多种创伤经历的冲突后低收入国家，创伤的影响鲜为人知。
目的
确定4个冲突后低收入国家创伤后应激障碍（PTSD）的患病率及风险因素。
设计、地点和参与者
1997年至1999年在阿尔及利亚（n = 653）、柬埔寨（n = 610）、埃塞俄比亚（n = 1200）和加沙（n = 585）从社区人群中随机选取的战争或大规模暴力幸存者（年龄≥16岁）中进行的流行病学调查。
主要观察指标
使用复合性国际诊断访谈第2.1版的PTSD模块评估PTSD患病率，并结合创伤事件进行评估，创伤事件使用生活事件和社会史问卷的改编版进行评估。
结果
阿尔及利亚评估的PTSD患病率为37.4%，柬埔寨为28.4%，埃塞俄比亚为15.8%，加沙为17.8%。12岁以后与冲突相关的创伤是所有4个样本中唯一存在的PTSD风险因素。除柬埔寨外，所有样本中酷刑都是一个风险因素。精神病史和现患疾病是柬埔寨（校正比值比[OR]，3.6；95%置信区间[CI]，2.3 - 5.4和校正OR，1.6；95%CI，1.0 - 2.7）和埃塞俄比亚（校正OR，3.9；95%CI，2.0 - 7.4和校正OR，1.8；95%CI，1.1 - 2.7）的风险因素。营地质量差与阿尔及利亚（校正OR，1.8；95%CI，1.3 - 2.5）和加沙（校正OR，1.7；95%CI，1.1 - 2.8）的PTSD有关。日常烦心事与阿尔及利亚的PTSD有关（校正OR，1.6；95%CI，1.1 - 2.4）。青少年家庭压力、家庭中的死亡或分离以及父母酗酒与柬埔寨的PTSD有关（校正OR，1.7；95%CI，1.1 - 2.6；校正OR，1.7；95%CI，1.0 - 2.8；校正OR，2.2；95%CI，1.1 - 4.4）。
结论
使用相同的评估方法，在经历过战争、冲突或大规模暴力的4个低收入人群中发现了PTSD症状的多种患病率。我们确定了每个国家特定的风险因素模式。我们的研究结果表明了在创伤应激和侵犯人权研究中背景差异的重要性。
Context Little is known about the impact of trauma in postconflict, low-income countries where people have survived multiple traumatic experiences.Objective To establish the prevalence rates of and risk factors for posttraumatic stress disorder (PTSD) in 4 postconflict, low-income countries.Design, Setting, and Participants Epidemiological survey conducted between 1997 and 1999 among survivors of war or mass violence (aged greater than or equal to 16 years) who were randomly selected from community populations in Algeria (n=653), Cambodia (n=610), Ethiopia (n=1200), and Gaza (n=585).Main Outcome Measure Prevalence rates of PTSD assessed using the PTSD module of the Composite International Diagnostic Interview version 2.1 and evaluated in relation to traumatic events, assessed using an adapted version of the Life Events and Social History Questionnaire.Results The prevalence rate of assessed PTSD was 37.4% in Algeria, 28.4% in Cambodia, 15.8% in Ethiopia, and 17.8% in Gaza. Conflict-related trauma after age 12 years was the only risk factor for PTSD that was present in all 4 samples. Torture was a risk factor in all samples except Cambodia. Psychiatric history and current illness were risk factors in Cambodia (adjusted odds ratio [OR], 3.6; 95% confidence interval [CI], 2.3-5.4 and adjusted OR,1.6; 95% CI, 1.0-2.7, respectively) and Ethiopia (adjusted OR, 3.9; 95% CI, 2.0-7.4 and adjusted OR, 1.8; 95% CI, 1.1-2.7, respectively). Poor quality of camp was associated with PTSD in Algeria (adjusted OR, 1.8; 95% CI, 1.3-2.5) and in Gaza (adjusted OR, 1.7; 95% CI, 1.1-2.8). Daily hassles were associated with PTSD in Algeria (adjusted OR, 1.6; 95% CI, 1.1-2.4). Youth domestic stress, death or separation in the family, and alcohol abuse in parents were associated with PTSD in Cambodia (adjusted OR, 1.7; 95% CI, 1.1-2.6; adjusted OR, 1.7; 95% CI, 1.0-2.8; and adjusted OR, 2.2; 95% CI, 1.1-4.4, respectively).Conclusions Using the same assessment methods, a wide range of rates of symptoms of PTSD were found among 4 low-income populations who have experienced war, conflict, or mass violence. We identified specific patterns of risk factors per country. Our findings indicate the importance of contextual differences in the study of traumatic stress and human rights violations.