Traumatic life events in primary care patients -: A study in an ethnically diverse sample
Traumatic life events in primary care patients -: A study in an ethnically diverse sample
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DOI：
10.1001/archfami.9.9.802
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发表时间：
2000-09-01
期刊：
影响因子：
--
通讯作者：
Waitzkin, H
中科院分区：
文献类型：
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作者：
Holman, EA;Silver, RC;Waitzkin, H
目的：在移民和其他寻求初级保健的人中研究：（1）创伤性生活事件的患病率、类型和预测因素;（2）创伤性生活事件、精神障碍和初级保健服务利用之间的关系。设计：调查与结构化诊断访谈。设置：加州南部以社区为基础的大学附属初级保健诊所。参与者：代表4个种族组的1400例五十六成人患者（墨西哥移民，中美洲移民，美国出生的墨西哥血统的拉丁美洲人，和美国出生的非拉丁美洲白人）。依赖措施：创伤事件的比率与创伤后应激障碍部分的诊断面试时间表测量;采用《精神疾病诊断与统计手册》修订版第三版标准，通过复合国际诊断访谈确定的精神疾病;身体功能（简表健康调查）;以及在一个月期间到诊所就诊的次数。近10%的患者在前一年经历过创伤事件，57%的患者在其一生中至少经历过1次创伤事件。最常见的创伤形式是发生在家庭以外的人际暴力（21%），急性损失或事故（17%），目睹死亡或暴力（13%）和家庭暴力（12%）。与美国出生的非拉丁裔白人相比，墨西哥移民经历创伤事件的可能性只有一半，中美洲移民的可能性高出76%。已婚人士报告创伤的可能性明显较低。创伤经历、女性和非拉丁裔与精神疾病的存在相关。一年和终身精神疾病与较差的身体功能和增加的门诊次数在6个月的periods.Conclusions：创伤性生活事件是常见的，并与精神疾病以外的创伤后应激障碍在种族多样性样本的初级保健患者。精神疾病，反过来，与身体机能不良和初级保健利用率较高密切相关。对创伤经历的筛查应与对精神障碍的评估同时进行，以确保寻求初级保健服务的病人得到适当的治疗。
Objective: To examine among immigrants and others seeking primary care: (1) the prevalence, types, and predictors of traumatic life events; and (2) the relations among traumatic life events, psychiatric disorders, and utilization of primary care services.Design: Survey with structured diagnostic interview.Setting: Community-based, university-affiliated primary care clinic in southern California.Participants: Fourteen hundred fifty-six adult patients representing 4 ethnic groups (Mexican immigrants, Central American immigrants, US-born Latinos of Mexican descent, and US-born non-Latino whites).Dependent Measures: Rates of traumatic events measured with the Posttraumatic Stress Disorder section of the Diagnostic Interview Schedule; psychiatric disorders identified by the Composite International Diagnostic Interview using Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria; physical functioning (Short Form Health Survey); and the number of medical clinic visits during a g-month period.Results: Nearly 10% of patients had experienced a traumatic event in the previous year, and 57% had experienced at least 1 during their lifetimes. The most common forms of trauma were interpersonal violence occurring outside the family (21%), acute losses or accidents (17%), witnessing death or violence (13%), and domestic violence (12%). When compared with the US-born non-Latino whites, Mexican immigrants were half as likely, and Central American immigrants were 76% more likely, to report having experienced a traumatic event. Married individuals were significantly less likely to report traumas. Traumatic experiences, female gender, and non-Latino ethnicity were associated with the presence of a psychiatric disorder. One-year and lifetime psychiatric disorders were associated with poorer physical functioning and an increased number of clinic visits during a 6-month period.Conclusions: Traumatic life events are common and associated with psychiatric disorders other than posttraumatic stress disorder in an ethnically diverse sample of primary care patients. Psychiatric disorders, in turn, are strongly associated with poor physical functioning and higher rates of primary care utilization. Screening for traumatic experiences should accompany assessments of psychiatric disorders to ensure adequate treatment of patients seeking primary care services.