Post-traumatic stress disorder associated with natural and human-made disasters in the World Mental Health Surveys.
Post-traumatic stress disorder associated with natural and human-made disasters in the World Mental Health Surveys.
复制标题
DOI：
10.1017/s0033291716002026
复制
发表时间：
2017-01
影响因子：
6.9
通讯作者：
Kessler RC
中科院分区：
文献类型：
--
作者：
Bromet EJ;Atwoli L;Kawakami N;Navarro-Mateu F;Piotrowski P;King AJ;Aguilar-Gaxiola S;Alonso J;Bunting B;Demyttenaere K;Florescu S;de Girolamo G;Gluzman S;Haro JM;de Jonge P;Karam EG;Lee S;Kovess-Masfety V;Medina-Mora ME;Mneimneh Z;Pennell BE;Posada-Villa J;Salmerón D;Takeshima T;Kessler RC
关于自然和人为灾难后的创伤后应激障碍(PTSD)的研究已经进行了30多年。尽管创伤后应激障碍的患病率估计差异很大，但在以灾害为重点的研究中，大多数都在20%-40%的范围内，但在作为更广泛的临床评估的一部分评估与灾害相关的创伤后应激障碍的少数一般人口流行病学调查中，这一比例要低得多(3%-5%)。世界精神卫生(WMH)调查提供了一个机会，可以在具有代表性的一般人口调查中检查与灾害有关的创伤后应激障碍，调查的地点比以前的研究要广泛得多。尽管在18项WMH调查中对与灾害相关的创伤后应激障碍进行了评估，但在高收入国家中，只有6项调查有足够的受访者进行风险因素分析。被考虑的预测因素是社会人口结构、灾害特征和灾前脆弱性因素(童年家庭逆境、既往创伤经历和既往精神障碍)。在成年(18岁以上)WMH受访者中，与灾害相关的创伤后应激障碍患病率为0.0%-3.8%，与高学历、亲人重伤或死亡、被迫背井离乡以及先前存在的脆弱性(儿童以前的家庭逆境、其他创伤和精神障碍)显著相关。在创伤后应激障碍病例中，44.5%的受访者被该模型归类为创伤后应激障碍风险最高的5%。与灾害相关的创伤后应激障碍在WMH高收入国家并不常见。风险因素与先前的研究一致：暴露的严重程度，先前的压力暴露史，以及先前存在的精神障碍。在我们的模型中，具有高预测风险的受访者中创伤后应激障碍的高度集中支持了筛选评估的重点，该评估旨在确定最需要预防性干预的灾难幸存者。
Research on post-traumatic stress disorder (PTSD) following natural and human-made disasters has been undertaken for more than three decades. Although PTSD prevalence estimates vary widely, most are in the 20–40% range in disaster-focused studies but considerably lower (3–5%) in the few general population epidemiological surveys that evaluated disaster-related PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide an opportunity to examine disaster-related PTSD in representative general population surveys across a much wider range of sites than in previous studies. Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-income countries had enough respondents for a risk factor analysis. Predictors considered were socio-demographics, disaster characteristics, and pre-disaster vulnerability factors (childhood family adversities, prior traumatic experiences, and prior mental disorders). Disaster-related PTSD prevalence was 0.0–3.8% among adult (ages 18+) WMH respondents and was significantly related to high education, serious injury or death of someone close, forced displacement from home, and pre-existing vulnerabilities (prior childhood family adversities, other traumas, and mental disorders). Of PTSD cases 44.5% were among the 5% of respondents classified by the model as having highest PTSD risk. Disaster-related PTSD is uncommon in high-income WMH countries. Risk factors are consistent with prior research: severity of exposure, history of prior stress exposure, and pre-existing mental disorders. The high concentration of PTSD among respondents with high predicted risk in our model supports the focus of screening assessments that identify disaster survivors most in need of preventive interventions.