Risk factors for depression in the survivors of the 1988 earthquake in Armenia
Risk factors for depression in the survivors of the 1988 earthquake in Armenia
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DOI：
10.1093/jurban/79.3.373
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发表时间：
2002-09-01
影响因子：
6.6
通讯作者：
Akiskal, HS
中科院分区：
文献类型：
--
作者：
Armenian, HK;Morikawa, M;Akiskal, HS
大多数灾难后的精神病理学研究都与创伤后应激障碍(PTSD)有关。目前的分析试图评估1988年亚美尼亚地震的成年幸存者患抑郁症的比率和决定因素。与以前对地震的研究不同，目前的分析来自一组定义明确的幸存者，他们接受了诊断性访谈，以表征精神疾病的发病率。作为对1988年亚美尼亚地震的32,743名幸存者的队列研究的一部分，在灾难发生约两年后，对1,785人进行了分层抽样，使用基于国家精神卫生研究所灾难访谈时间表/灾难补编的特别问卷进行了访问。52%的人符合严重抑郁症的标准。在这些人中，共有177例没有其他精神疾病诊断或共病的抑郁症患者与来自同一受访组的583名不符合任何精神障碍标准的对照组进行了比较。将病例和对照与灾后独立获得的关于与地震有关的若干暴露和特征的数据进行了比较。更多的病例涉及女性(男性的优势比[OR]为0.7[95%可信区间[CI]0.5-0.9])和一些破坏最严重的古姆里市(Gumri的居民优势比为5.9[95%CI 4.0-8.8])。地震发生时和某人在同一栋楼里可以预防抑郁(或其他人在场时为0.5[95%可信区间0.3-0.6])，且抑郁风险随着家庭在地震中遭受的损失越大而增加(或最高损失水平为2.5[95%可信区间1.3-4.8])。酒精的使用对抑郁有保护作用(或对饮酒0.5的人[95%CI 0.3-0.8])。在多变量调整和分析的各种模型中，抑郁的风险随着丢失、地理位置和女性性别的增加而保持不变。此外，在这些多变量分析中，在灾难期间与某人在一起、在地震后接受帮助和支持、以及饮酒对抑郁有保护作用。抑郁通常是地震的后遗症。与我们之前对创伤后应激障碍的研究一样，我们能够在普通人群样本中将灾难和损失的强度与抑郁的风险联系起来。再次强调了灾害期间和灾后社会支持作为防止不利心理后果的保护机制的作用。
Most studies of psychopathology following disasters are concerned with posttraumatic stress disorder (PTSD). The present analyses sought to assess the rate and determinants of depression in adult survivors of the 1988 earthquake in Armenia. Unlike previous studies of earthquakes, the present analyses derive from a well-defined cohort of survivors who underwent diagnostic interviewing to characterize psychiatric morbidity. As part of a cohort study of 32,743 survivors of the 1988 earthquake in Armenia, a stratified population sample of 1,785 persons was interviewed about 2 years following the disaster using a special questionnaire based on the National Institute of Mental Health (NIMH) Disaster Interview Schedule/Disaster Supplement. 52% met the criteria for major depression. Of these, a total of 177 cases of depression with no other psychiatric diagnosis or comorbidity were compared with 583 controls from the same interviewed group who did not fulfill the criteria for any psychiatric disorder. Cases and controls were compared as to data obtained independently at the aftermath of the disaster on a number of exposures and characteristics related to the earthquake. More of the cases involved females (odds ratio [OR] for males 0.7 [95% confidence interval [CI] 0.5-0.9]) and from the city of Gumri, which had some of the worst destruction (OR for residents of Gumri 5.9 [95% CI 4.0-8.8]). Being with someone in the same building at the moment of the earthquake was protective for depression (OR for presence of other people 0.5 [95% CI 0.3-0.6]), and the risk of depression increased with the amount of loss that the family sustained as a result of the earthquake (OR for highest level of loss 2.5 [95% CI 1.3-4.8]). The use of alcohol was protective for depression (OR for those who drink 0.5 [95% CI 0.3-0.8]). In various models of multivariate adjustment and analysis, the increased risk of depression with loss, geographic location, and female gender was maintained. Also, being with someone during the disaster, receiving assistance and support after the earthquake, and alcohol use were protective for depression in these multivariate analyses. Depression is a common sequel to an earthquake. As with our previous study of PTSD, we were able to relate intensity of the disaster and loss to the risk of depression in a general population sample. The role of social support during and after the disaster as a protective mechanism against adverse psychological outcome was highlighted again.