汶川地震后急性应激障碍发生率及影响因素

Prevalence and predictors of acute stress disorder after earthquake： findings from Wenchuan earthquake in China

目的研究地震后急性应激障碍（ASD）的发生率及影响因素。方法用整群随机抽样方法，采用自行设计的ASD结构式访谈问卷对四川地震灾区891名群众进行ASD症状（包括：一般症状群、分离性症状群、再体验症状群、焦虑．警觉性增高症状群和回避症状）评估，并记录一般人口学资料。根据美国精神病学会出版的精神神经病诊断统计手册第4版进行ASD诊断，最后完成评估诊断和干预共874名。结果ASD的发生率为12．59％（110／874），其中男性为9．52％（38／399）、女性为15．16％（72／475），女性发生率显著高于男性（X2=6．26，P=0．01）。logistic回归分析结果显示，进入方程有统计学意义的变量有性别（β=0．58，P=0．01，OR=1．79）、亲属伤亡（β=0．60，P=0．01，OR=1．82）和重度财产损失（β=1．02，P=0．01，OR=2．76），女性、有亲属伤亡、存在重度财产损失的个体ASD危险性高。结论地震对灾区群众心理产生了严重的影响，灾后减少伤亡、降低灾区群众财产损失有助于降低ASD的发生率。灾害后心理行为反应的性别差异的原因仍需进一步研究。

Objective To investigate the prevalence and predictors of acute stress disorder （ASD） in the victims affected by Wenchuan earthquake in China. Methods A random clustered sampling method was used. Of 891 victims enrolled in the study, 874 were completely assessed with the ASD constructive questionnaire and diagnosed with DSM-Ⅳ criteria. Sociodemographic variables were obtained. Also,the major symptoms of ASD （ i. e. , general symptoms to a traumatic event; dissociative symptoms; re-experiencing symptoms; hyper-arousal symptoms; avoidance symptoms） were recorded. Results The incidence rate of ASD was 12. 59% （110/874）. The incidence rates of ASD for female and male were 15. 16% （72/475） and 9. 52% （38/399） respectively. There was a significant difference between female and male on the incidence rate of ASD （ X2 = 6. 26, P -- 0. 01 ）. Logistic regression indicated that the ASD diagnosis was predicted by gender （β = 0. 58 ,P = 0. 01, OR = 1.79 ）, the condition of casualties of family members （β= 0. 60,P = 0.01, OR = 1.82）, and the condition of sharp properties loss （β = 1.02, P = O. 01, OR = 2. 76）. Conclusion The major earthquake should have great influence on mental health of victims. The efforts to reduce casualties and property loss might help to prevent ASD. Further research is needed on gender difference among traumatic events.