严重急性呼吸系统综合征创伤后应激障碍及其相关因素分析

Post-traumatic stress disorder and related factors following the severe acute respiratory syndrome

目的:分析严重急性呼吸系统综合征(SevereAcuteRespiratorySyndrome,SARS)后医护人员创伤后应激障碍的发生情况及相关因素。方法:于2003-12/2004-01采取整群抽样的方法抽取2003-03/05辽宁省SARS确诊患者和不同程度受到SARS威胁的医护人员以及医学院在校学生为观察对象。包括5组,患者组:辽宁省健在的SARS患者4例(其中大连3例,葫芦岛1例);一线医护组(直接治疗和护理SARS患者)60人;二线医护组(参与SARS排查并在发热门诊和发热病房从事医疗和护理)50人;普通医护组(在普通病房工作)30人;在校大学生组(指SARS封校期间的医学院校在校学生)30人。采用自行设计的半开放式基本情况问卷进行一般情况调查。采用美国的创伤后应激量表中文译本及创伤后应激障碍检查量表平时版的中文译本进行创伤后应激障碍的诊断。采用症状自评量表评定心理健康水平。采用艾森克人格问卷来评估人格特征。采用特质应对方式问卷反映个体具有特质属性的并与健康有关的应对方式。对所有观察对象进行面对面访谈、心理测量和记录。对所得数据资料用秩和检验、Spearman相关分析、多元回归分析、Logistic回归分析等分析方法进行处理。结果:将174例观察对象的资料整理、按标准剔除无效问卷12份,获得合格问卷162份。有效率93.1%。162例SARS相关观察对象创伤后应激障碍患病率为5.56%。对创伤后应激障碍检查量表平时版的相关分析结果为:①与艾森克人格问卷各量表的相关分析:神经质的、精神质的个体创伤后应激障碍检查量表平时版分值高,而越掩饰的人分值越低。②与症状自评量表的相关分析:创伤后应激障碍检查量表平时版评分值与心理健康水平明显相关,受各个方面的综合影响,是心理健康因素各方面的综合反应。③与特质应对方式问卷的相关性分析:积极应对困难者创伤后应激障碍检查量表平时版的分值高,即与积极应对呈负相关,而与消极应对呈正相关。④与应激强度相关分析:SARS相关观察对象的创伤后应激障碍检查量表平时版与工作环境、是否在SARS期间患病并接受治疗(F=3.416P=0.020)、不同工作的城市(F=5.393,P=0.006)而有明显差异,即应激强度增大,创伤后应激障碍检查量表平时版分值增高。⑤多元回归分析:创伤后应激障碍检查量表平时版的分值与症状自评量表中的强迫症、躯体化、人际关系敏感、消极应对因子以及SARS期间患病且接受过治疗呈正相关。多元Logistic回归分析表明创伤后应激障碍检查量表平时版分值越高,家庭人口数越多,SARS期间曾被隔离的人易患创伤后应激障碍。结论:应激事件的性质、强度、观察对象的身心健康程度是创伤后应激障碍的易患因素,影响创伤后应激障碍检查量表平时版的因素具体可概括为:个性特征(神经质、精神质)、较高的应激强度、消极应对方式、心理健康状况(强迫症、躯体化、人际关系敏感)等。

AIM： To investigate the effects on psychology by the severe acute respiratory syndrome （SARS） in relevant suffers and medical staffs,especially the occurrence of Post-traumatic stress disorder and involved factors, and further provide theoretical evidences for crisis intervene for patients with post-traumatic stress disorder. METHODS： Between December 2003 and January 2004, cluster-sampling was used to select patients with SARS, medical staffs as well as the medical university students in Liaoning province, who were all involved in SARS crisis or whose life were directly influenced by SARS under different condition, including 4 patients with SARS from Liaoning province, 60 medical staffs caring directly for SARS patients, 50 medical staffs working in the fever clinic or ward to screen SARS patients, 30 medical staffs working in ordinary ward and 30 university students who were isolated during SARS outbreak. All the subjects had no psychological disorder history aged from 20-40 years. The questionnaire, assessment tools were employed, which included： Post-traumatic stress disorder checklist -civilian version, clinician-administered post-traumatic stress disorder scale, symptom checklist-90, Eysenck personality questionnaire, coping style questionnaire and the self-designed general questionnaire sheets. After compiling and coding the qualified information from sampled subjects, the database was established and data processing was carried out by the way of statistic methods with SPSS 10.0 software. RESULTS; The 174 data were sorted, 12 invalid questionnaires were deleted, and 162 valid ones were obtained, the effective rate was 93.1%. The post-traumatic stress disorder morbidity rate was 5.56%. Further correlation analysis to scale of post-traumatic stress disorder checklistcivilian version, the post-traumatic stress disorder related danger factors could be identified as the followings： individual characters, stress strength, response manner and mental health etc. ①The correlation analysis between post-traumatic stress disorder checklist-civilian version and Eysenck personality questionnaire showed that higher points were found in neuroticand psychopathic individual, lower points in concealing individual. The correlation analysis between post-traumatic stress disorder checklist-civilian version for non-post-traumatic stress disorder and symptom checklist-90 showed that point of post-traumatic stress disorder checklist- civilian version was obviously related with level of psychology health, and influenced by comprehensive aspects of psychology health rather than certain aspect. The correlation analysis between post-traumatic stress disorder checklist-civilian version and coping style questionnaire showed that the point of post-traumatic stress disorder checklist-civilian version was negatively correlated with active activity and positive correlation with inactive activity, such as higher post-traumatic stress disorder checklist - civilian version point was found in more active people. ② Correlation analysis between post-traumatic stress disorder checklist-civilian version and stress strength showed： During time of SARS, the studied subjects existed post-traumatic stress disorder checklist -civilian version differences with reference to the working environment, SARS suffering or not （F =3.416, P=0.020）, different working cities （F=5.393, P=0.006）, and with stress strength increasing, the higher point of post-traumatic stress disorder checklist -civilian version was obtained. ③ The multi-element regress analysis showed： the point of post-traumatic stress disorder checklist - civilian version was positively correlated with the elements in symptom checklist-90 including： compulsion, somatization, sensitivity of human relation, factor of inactive response, suffered and treated during SARS. The multi-element Logistic regress analysis showed that people with higher point of post-traumatic stress disorder checklist -civilian version, more family members, and being isolated during SARS was apt to be post- traumatic stress disorder. CONCLUSION： The identified relevant risk factors of post-traumatic stress disorder are the character and intensity of stress events and the degree of physical and mental health, and the factors that affect the post-traumatic stress disorder checklist-civilian version were personality characteristics （neuroticism, psychoticism）, higher stress intensity, negative coping style, psychological health status （compulsion-obsession, somatization, interpersonal sensitivity）, etc.