Longitudinal course of disaster-related PTSD among a prospective sample of adult Chilean natural disaster survivors
Longitudinal course of disaster-related PTSD among a prospective sample of adult Chilean natural disaster survivors
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DOI：
10.1093/ije/dyw094
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发表时间：
2017-04-01
影响因子：
7.7
通讯作者：
Buka, Stephen L.
中科院分区：
文献类型：
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作者：
Fernandez, Cristina A.;Vicente, Benjamin;Buka, Stephen L.
背景：随着越来越多的人在自然灾害中幸存下来，了解谁患创伤后应激障碍(PTSD)的风险最大是至关重要的。这项研究的目的是前瞻性地检验预先存在的精神病理学在灾难后发生创伤后应激障碍中所起的作用。方法：这项研究使用了来自10个医疗中心(N=1708)的智利成年人的前瞻性5波纵向队列数据。在基线时，参与者完成了综合国际诊断访谈(CIDI)，这是一种综合精神诊断工具。2010年，有记录以来第六大地震袭击了智利。一年后，实施了CIDI创伤后应激障碍模块的修改版本。结果：受试者以女性为主(75.9%)，高中/大专学历(66.9%)。在控制了灾前创伤后应激障碍后，既往存在的恶劣心境[优势比(OR)=2.21；95%可信区间(CI)=1.39-3.52]、短暂精神障碍(OR=2.67；95%CI=1.21-5.90)、焦虑症(不包括创伤后应激障碍；OR=1.49；95%CI=1.27-1.76)、惊恐障碍(OR=2.46；95%CI=1.37-4.42)、广场恐怖症(OR=2.23；社交恐怖(OR=1.86；95%CI=1.06~3.29)、特殊恐怖(OR=2.07；95%CI=1.50~2.86)、疑病症(OR=2.10；95%CI=1.05~4.18)是灾后创伤后应激障碍的预测因素。在控制了灾前焦虑障碍、心境恶劣和非情感性精神障碍后，有灾前创伤后应激障碍的个体(与没有灾前创伤后应激障碍的人相比)患灾后创伤后应激障碍的几率更高(OR=2.53；95%CI=1.37-4.65)。结论：这是智利第一项前瞻性研究表明，灾前精神障碍与其他精神障碍的既往病史无关，增加了在重大自然灾害后发生创伤后应激障碍的易感性。
Background: With an increasing number of individuals surviving natural disasters, it is crucial to understand who is most at risk for developing post-traumatic stress disorder (PTSD). The objective of this study was to prospectively examine the role that preexisting psychopathology plays in developing PTSD after a disaster.Methods: This study uses data from a prospective 5-wave longitudinal cohort (years 2003-11) of Chilean adults from 10 health centres (N = 1708). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument. In 2010, the sixth most powerful earthquake on record struck Chile. One year later, a modified version of the PTSD module of the CIDI was administered. Marginal structural logistic regressions with inverse probability censoring weights were constructed to identify pre-disaster psychiatric predictors of post-disaster PTSD.Results: The majority of participants were female (75.9%) and had a high-school/college education (66.9%). After controlling for pre-disaster PTSD, pre-existing dysthymia [odds ratio (OR) = 2.21; 95% confidence interval (CI) = 1.39-3.52], brief psychotic disorder (OR = 2.67; 95% CI = 1.21-5.90), anxiety disorders (not including PTSD; OR = 1.49; 95% CI = 1.27-1.76), panic disorder (OR = 2.46; 95% CI = 1.37-4.42), agoraphobia (OR = 2.23; 95% CI = 1.22-4.10), social phobia (OR = 1.86; 95% CI = 1.06-3.29), specific phobia (OR = 2.07; 95% CI = 1.50-2.86) and hypochondriasis (OR = 2.10; 95% CI = 1.05-4.18) were predictors of post-disaster PTSD. After controlling for pre-disaster anxiety disorders, dysthymia, and non-affective psychotic disorders, individuals with pre-disaster PTSD (vs those without pre-disaster PTSD) had higher odds of developing post-disaster PTSD (OR = 2.53; 95% CI = 1.37-4.65).Conclusions: This is the first Chilean study to demonstrate prospectively that pre-disaster psychiatric disorders, independent of a prior history of other psychiatric disorders, increase the vulnerability to develop PTSD following a major natural disaster.