Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults
Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults
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DOI：
10.1176/appi.ajp.162.7.1320
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发表时间：
2005-07-01
影响因子：
17.7
通讯作者：
Wittchen, HU
中科院分区：
文献类型：
--
作者：
Perkonigg, A;Pfister, H;Wittchen, HU
目的：很少有研究关注创伤后应激障碍（PTSD）的自然过程及其在普通人群样本中的决定因素。作者在前瞻性社区样本中研究了PTSD缓解和慢性的决定因素以及与其他疾病的关联。方法：数据来自德国慕尼黑青少年（14-24岁）的前瞻性、纵向流行病学研究（N = 2548）。研究125名基线时患有DSM-IV PTSD或阈下PTSD的被调查者从基线至随访34-50个月后的PTSD病程。结果：虽然52%的PTSD病例在随访期间得到缓解，但48%的PTSD症状没有明显缓解。慢性病程的受访者在随访期间更有可能经历新的创伤事件（优势比= 5.21,95%可信区间[CI] = 1.95-13.92），在基线时有更高的回避症状率（优势比= 10.16,95% CI = 1.73-59.51），并且与缓解的受访者相比，报告更多的寻求帮助（优势比= 5.50,95% CI = 1.04-29.05）。躯体形式障碍（优势比= 4.24,95% CI = 1.60-11.19）和其他焦虑障碍（优势比= 4.07,95% CI = 1.15-14.37）的发生率也与慢性病程显著相关。结论：创伤后应激障碍通常是一种持续的慢性疾病。特定的症状群——尤其是回避型症状——可能与PTSD的病程有关。此外，新的创伤性事件的发生将PTSD的慢性病程与缓解期区分开来。
Objective: Few studies have focused on the natural course of posttraumatic stress disorder ( PTSD) and its determinants in samples of the general population. The authors examined determinants of remission and chronicity of PTSD and associations with other disorders in a prospective community sample.Method: The data were drawn from a prospective, longitudinal epidemiological study of adolescents and young adults ( age 14-24 years) in Munich, Germany (N = 2,548). The course of PTSD from baseline to follow-up 34-50 months later was studied in 125 respondents with DSM-IV PTSD or subthreshold PTSD at baseline.Results: Although 52% of the PTSD cases remitted during the follow-up period, 48% showed no significant remission of PTSD symptoms. Respondents with a chronic course were more likely to experience new traumatic event(s) during follow-up (odds ratio = 5.21, 95% confidence interval [CI] = 1.95-13.92), to have higher rates of avoidant symptoms at baseline (odds ratio = 10.16, 95% CI = 1.73-59.51), and to report more help seeking (odds ratio = 5.50, 95% CI = 1.04-29.05), compared to respondents with remission. Rates of incident somatoform disorder (odds ratio = 4.24, 95% CI = 1.60-11.19) and other anxiety disorders (odds ratio = 4.07, 95% CI = 1.15-14.37) were also significantly associated with a chronic course.Conclusions: PTSD is often a persistent and chronic disorder. Specific symptom clusters-especially avoidant symptoms-might be associated with the course of PTSD. In addition, the occurrence of new traumatic events differentiates PTSD cases with a chronic course from those with remission.