Diseases among men 20 years after exposure to severe stress: Implications for clinical research and medical care
Diseases among men 20 years after exposure to severe stress: Implications for clinical research and medical care
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DOI：
10.1097/00006842-199711000-00008
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发表时间：
1997-11-01
影响因子：
3.3
通讯作者：
Boscarino, JA
中科院分区：
文献类型：
--
作者：
Boscarino, JA
目的：流行病学研究表明，暴露于严重的环境压力，如自然灾害和作战行动，与特定精神疾病的发病有关。一些研究还表明，这些接触也可能与慢性疾病的发病有关。然而，这些慢性疾病结局研究往往被偏倚和混杂所掩盖。方法：对1399名男性越战老兵在战斗暴露后约20年（平均年数= 17）的病史进行了终身创伤后应激障碍（PTSD）状态（终身PTSD = 332例）分析。这些人被纳入了一项对越南战争中的美国陆军退伍军人进行的全国性随机面对面研究（研究完成率= 65%）。结果如下：在控制了离职、在职和离职因素后，（包括智力、种族、出生地区、入伍状态、志愿者状态、军队婚姻状况、军队医疗概况、低血糖、年龄、吸烟史、药物滥用、教育和收入），发现循环系统[比值比（OR）= 1.62，p = .007]、消化系统[比值比（OR）= 1.62，p = .007]、（OR = 1.47，p = .036），肌肉骨骼（OR = 1.78，p = .008），内分泌-营养-代谢（OR = 1.58，p = .10），神经系统（OR = 2.47，p <0.001）、呼吸道疾病（OR = 1.54，p = 0.042）和非性传播感染性疾病（OR = 2.14，p <0.004）。结论：虽然这项研究有一些局限性，但它表明严重的压力暴露与广泛的人类疾病之间存在直接联系。在未来，医学研究人员和临床医生应该更多地关注暴露于严重的环境压力的医疗后果，并寻求更好地整合疾病发病机制的心理生物学模型。
Objective: Epidemiologic studies have linked exposure to severe environmental stress, such as natural disasters and combat operations, to the onset of specific psychiatric disorders. Some research also suggests that these exposures may be associated with the onset of chronic diseases as well. However, these chronic disease outcome studies often have been obscured by bias and confounding. Method: The medical histories of 1399 male Vietnam veterans approximately 20 years after combat exposure (mean years = 17) were analyzed by lifetime posttraumatic stress disorder (PTSD) status (Lifetime PTSD = 332 cases). These men were included in a national, random in-person study of United States Army veterans of the Vietnam War (study completion rate = 65%). Results: After controlling for preservice, in-service, and postservice factors (including intelligence, race, region of birth, enlistment status, volunteer status, Army marital status, Army medical profile, hypochondriasis, age, smoking history, substance abuse, education, and income), associations were found for reported circulatory [odds ratio (OR) = 1.62, p = .007], digestive (OR = 1.47, p = .036), musculoskeletal (OR = 1.78, p = .008), endocrine-nutritional-metabolic (OR = 1.58, p = .10), nervous system (OR = 2.47, p < .001), respiratory (OR = 1.54, p = .042), and nonsexually transmitted infectious diseases (OR = 2.14, p < .004) after military service. Conclusion: Although this study has some limitations, it suggests that there is a direct Link between severe stress exposures and a broad spectrum of human diseases. In the future, medical researchers and clinicians should focus more on the medical consequences of exposure to severe environmental stress and seek to better integrate psychobiologic models of disease pathogenesis.