Prospective study of posttraumatic stress disorder and depression following trauma
Prospective study of posttraumatic stress disorder and depression following trauma
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DOI：
10.1176/ajp.155.5.630
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发表时间：
1998-05-01
影响因子：
17.7
通讯作者：
Pitman, RK
中科院分区：
文献类型：
--
作者：
Shalev, AY;Freedman, S;Pitman, RK
目的：本研究的目的是前瞻性地评估创伤后应激障碍（PTSD）和重性抑郁症的发生，重叠和过程中的创伤事件。方法：在综合医院急诊室招募的211名创伤幸存者中评估了创伤后应激障碍和重性抑郁症的发生率以及相关症状的强度。在创伤事件发生后1周、1个月和4个月进行心理测量和结构化临床访谈（DSM-III-R的结构化临床访谈和临床医生管理的PTSD量表）。在到达急诊室时，评估轻微身体损伤受试者的心率。23例PTSD受试者和35例匹配的对照受试者随访1年。结果如下：重度抑郁症和创伤后应激障碍在创伤后早期发生;具有这些诊断的患者具有相似的恢复率：63名幸存者（29.9%）在1个月时符合创伤后应激障碍的标准，37名（17.5%）在4个月时患有创伤后应激障碍。40例受试者（19.0%）在1个月时符合重度抑郁症标准，30例（14.2%）在4个月时患有重度抑郁症。PTSD患者1个月时共病抑郁发生率为44.5%，4个月时共病抑郁发生率为43.2%。合并症与更严重的症状和更低的功能水平相关。PTSD幸存者在急诊室有更高的心率水平，并报告了更多的侵入性症状，夸张的惊吓和创伤周围的分离比重度抑郁症。先前的抑郁症与更高的抑郁症患病率和更多的症状报告有关。结论：重度抑郁症和创伤后应激障碍是创伤事件的独立后遗症，具有相似的症状，并相互作用以增加痛苦和功能障碍。两者都应该是早期治疗干预和神经生物学研究的目标。
Objective: The purpose of this study was to prospectively evaluate the onset, overlap, and course of posttraumatic stress disorder (PTSD) and major depression following traumatic events. Method: The occurrence of PTSD and major depression and the intensity of related symptoms were assessed in 211 trauma survivors recruited from a general hospital's emergency room. Psychometrics and structured clinical interview (the Structured Clinical Interview, for DSM-III-R and the Clinician-Administered PTSD Scale) were administered 1 week, 1 month, and 4 months after the traumatic event. Heart rate was assessed upon arrival at the emergency room for subjects with minor physical injury. Twenty-three subjects with PTSD and 35 matched comparison subjects were followed for 1 year. Results: Major depression and PTSD occurred early on after trauma; patients with these diagnoses had similar recovery rates: 63 survivors (29.9%) met criteria for PTSD at 1 month, and 37 (17.5%) had PTSD at 4 months. Forty subjects (19.0%) met criteria for major depression at 1 month, and 30 (14.2%) had major depression at 4 months. Comorbid depression occurred in 44.5% of PTSD patients at 1 month and in 43.2% at 4 months. Comorbidity was associated with greater symptom severity and lower levels of functioning. Survivors with PTSD had higher heart rate levels at the emergency room and reported more intrusive symptoms, exaggerated startle, and peri-traumatic dissociation than those with major depression. Prior depression was associated with a higher prevalence of major depression and with more reported symptoms. Conclusions: Major depression and PTSD are independent sequelae of traumatic events, have similar prognoses, and interact to increase distress and dysfunction. Both should be targeted by early treatment interventions and by neurobiological research.