Psychiatric disorders among survivors of the Oklahoma City bombing
Psychiatric disorders among survivors of the Oklahoma City bombing
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DOI：
10.1001/jama.282.8.755
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发表时间：
1999-08-25
影响因子：
120.7
通讯作者：
Smith, EM
中科院分区：
文献类型：
--
作者：
North, CS;Nixon, SJ;Smith, EM
灾害使受影响的人群暴露于创伤性事件，并可用于研究心理健康影响。俄克拉何马州俄克拉荷马州爆炸案对创伤后精神健康后遗症的研究具有重要意义，因为其极端的强度和范围已被预测会对幸存者产生深远的精神影响。目的测量俄克拉荷马州市Alfred P. Murrah联邦大楼爆炸案对直接爆炸幸存者的精神影响，特别是检查创伤后应激障碍（PTSD）的发生率。设计、设置和参与者在从保密登记处选择的255名合格的成年幸存者中，182名（71%）在灾难后约6个月通过访谈进行系统评估。主要指标8种精神疾病的诊断、人口统计学资料、功能治疗水平、事件暴露。结果45%的受试者有灾后精神障碍，34.3%的受试者有PTSD。预测因素包括灾难暴露、女性（对于任何灾后诊断，女性为55%，男性为34%; chi（1）（2）= 8.27; P = 0.004）和灾前精神障碍（对于PTSD，45%，而对于没有灾前障碍的人为26%; chi（1）（2）= 6.86; P = 0.009）。PTSD的发病迅速，76%的患者报告当天发病。相对罕见的回避和麻木症状实际上决定了PTSD的诊断（94%符合回避和麻木标准的人有完整的PTSD诊断），并进一步与精神病合并症，功能障碍和接受的治疗相关。侵入性的再体验和过度觉醒症状几乎是普遍的，但本身一般与其他精神病理学或功能障碍，在functioning.Conclusions我们的数据表明，重点是避免和麻木的症状可能提供了一个有效的筛选程序创伤后应激障碍，并可以确定大多数精神病病例早期在急性灾后时期。精神共病进一步确定那些功能残疾和治疗需要。在大多数非精神病患者中，几乎普遍但令人痛苦的侵入性再体验和过度觉醒症状可以通过安慰和支持的非医疗干预来解决。
Context Disasters expose unselected populations to traumatic events and can be used to study the mental health effects. The Oklahoma City, Okla, bombing is particularly significant for the study of mental health sequelae of trauma because its extreme magnitude and scope have been predicted to render profound psychiatric effects on survivors.Objective To measure the psychiatric impact of the bombing of the Alfred P. Murrah Federal Building in Oklahoma City on survivors of the direct blast, specifically examining rates of posttraumatic stress disorder (PTSD), diagnostic comorbidity, functional impairment, and predictors of postdisaster psychopathology.Design, Setting, and Participants Of 255 eligible adult survivors selected from a confidential registry, 182 (71%) were assessed systematically by interviews approximately 6 months after the disaster. between August and December 1995.Main Outcome Measurer Diagnosis of 8 psychiatric disorders, demographic data, level of functioning treatment, exposure to the event. involvement of family and friends, and physical injuries, as ascertained by the Diagnostic Interview Schedule/Disaster Supplement,Results Forty-five percent of the subjects had a postdisaster psychiatric disorder and 34.3% had PTSD. Predictors included disaster exposure, female sex (for any postdisaster diagnosis, 55% vs 34% for men; chi(1)(2) = 8.27; P = .004), and predisaster psychiatric disorder (for PTSD, 45% vs 26% for those without predisaster disorder; chi(1)(2) = 6.86; P = .009). Onset of PTSD was swift, with 76% reporting same-day onset. The relatively uncommon avoidance and numbing symptoms virtually dictated the diagnosis of PTSD (94% meeting avoidance and numbing criteria had full PTSD diagnosis) and were further associated with psychiatric comorbidity, functional impairment, and treatment received. Intrusive reexperience and hyperarousal symptoms were nearly universal, but by themselves were generally unassociated with other psychopathology or impairment in functioning.Conclusions Our data suggest that a focus on avoidance and numbing symptoms could have provided an effective screening procedure for PTSD and could have identified most psychiatric cases early in the acute postdisaster period. Psychiatric comorbidity further identified those with functional disability and treatment need. The nearly universal yet distressing intrusive reexperience and hyperarousal symptoms in the majority of nonpsychiatrically ill persons may be addressed by nonmedical interventions of reassurance and support.