汶川地震后第13及31个月时重灾区儿童少年焦虑症状检出率及其相关因素分析

Anxiety symptoms and correlated factors among child and adolescent survivors at the 13th month and 31th month after the Wenchuan earthquake

目的 了解汶川地震后第13及31个月时儿童少年焦虑症状检出率的变化及其与地震创伤性经历之间的相关性.方法 对汶川地震重灾区之一的四川省青川县清溪镇中小学的学生在地震发生后第13个月进行普查,在第31个月时进行方便抽样调查,使用自编量表收集相关的人口学资料及地震创伤性暴露经历,使用儿童焦虑量表修订版（Revised Children＇s Manifest Anxiety Scale,RCMAS）问卷检测焦虑症状.RCMAS总分≥19分定义为有焦虑症状.采用多元Logistic回归分析焦虑症状与性别、年龄及地震相关创伤性暴露指标之间的相关性.结果 （1）共719名学生参与2次调查,第13个月调查时年龄7～15岁,平均（10.9±2.0）岁,男325（45.2％）名.（2）地震发生后第31个月时中小学学生焦虑症状检出率（26.8％）较地震发生后第13个月时（43.1％）降低.（3）回归分析显示,第13个月焦虑症状的检出率与性别（OR=1.396,95％CI：1.016～1.918,P=0.040）、地震期间“看到有人受伤或者死亡”（OR=1.738,95％CI：1.252～2.412,P=0.001）、“被围困了很久”（OR=1.578,95％CI：1.113～2.236,P=0.010）、“失去了房子或很重要的东西”（OR=1.625,95％CI：1.189～2.220,P=0.002）及“在地震中受伤”（OR=1.988,95％CI：1.065～3.709,P=0.031）相关;第31个月焦虑症状检出率仅与年龄（OR=1.605,95％CI：1.123～2.294,P=0.009）相关;年龄（OR=0.398,95％CI：0.234～0.676,P=0.001）和地震期间没有“觉得家人有生命危险”（OR=0.531,95％ CI：0.307～0.917,P=0.023）与第13个月时检出焦虑症状而第31个月时未检出焦虑症状相关;而第31个月时新检出的焦虑症状与性别、年龄及地震相关的创伤性暴露指标均无相关性.结论 汶川地震后第31个月时重灾区儿童少年中焦虑症状的检出率较第13个月时降低.部分地震创伤性暴露经历与第13个月时检出的焦虑症状及其后续的症状缓解相关.

Objective To investigate the changing of anxiety symptoms and their associations with the earthquake exposure experiences among child and adolescent survivors at the 13th month and 31th month after the ＂5.12＂ Wenchuan earthquake.Methods The primary and middle school students in Qingchuan County,one of the worst hit areas in the Wenchuan earthquake,were followed-up at the 13th month and 31th month after the earthquake.The self-reported demographic data and the earthquake exposure experiences were collected using a self-edited questionary.The self-reported anxiety symptoms were assessed by the Revised Children＇s Manifest Anxiety Scale （RCMAS）.The individuals with RCMAS score ≥19 were defined as having anxiety symptoms.Binary logistic regression analysis was used to explore the correlation of the anxiety symptom with gender,age,and the earthquake traumatic exposure indexes.Results （1） There were 719 students completed the two self-reported surveys.They aged from 7 to 15 years with mean of （10.9±2.0） year at the 13^th month survey,and 325 （45.2%） of them were males.（2） The overall rates of self-reported anxiety symptoms were 43.1% and 26.8% at the 13^th month and 31^th month survey respectivel.（3）The binary logistic regression analysis showed that the detectable anxiety symptom at the 13^th month survey was significantly associated with sex （OR=1.396,95%CI：1.016-1.918,P=0.040）,and some earthquake exposures including that ＂saw any one dead or injured＂ （OR=1.738,95% CI：1.252-2.412,P=0.001）,＂trapped for a longer time＂（OR=1.578,95% CI：1.113-2.236,P=0.010）,＂lost house or important belongings＂ （OR=1.625,95%CI：1.189-2.220,P=0.002） and＂been injured during the earthquake＂ （OR=1.988,95%CI：1.065-3.709,P=0.031） during the earthquake,but at the 31th month survey only the sex was significantly associated with anxiety symptom （OR=1.605,95% CI：1.123-2.294,P=0.009）.The remission of anxiety symptom was significantly associated with age group（OR=0.398,95% CI：0.234-0.676,P=0.001） and the earthquake exposure that ＂didn＇t feel one＇s own or a family member＇s life to be in danger＂（OR=0.531,95% CI：0.307-0.917,P=0.023） during the earthquake.And the new-detected anxiety symptom at the 31^th month survey was not significantly associated with sex,age,and those earthquake exposure experiences.Conclusions The detectable rate of anxiety symptoms was decreased from the 13^th month to the 31^th month after the earthquake.Parts of the earthquake exposure experiences may be significantly associated with the detectable anxiety symptom at the 13^th month after the earthquake and its remission in future.