震后人群心理健康状况评估工具的卫生技术评估之一:评估工具的使用现状

A Health Technology Assessment for Population Psychological Assessment after Earthquakes:Ⅰ.Using Status of Assessment Instruments

目的系统分类国内外地震灾害常用心理健康评估工具,深入分析目前工具的使用现状。为后续建立针对灾后人群/个体心理健康评估工具的统一方法、标准及流程提供基线数据。方法计算机检索Wan Fang Data、CNKI、VIP、Pub Med、EMbase、The Cochrane Library、Ci Nii及心理、地震和灾害管理的相关网站,检索时间从建库至2014年7月,纳入研究中明确提及采用心理健康评估工具对震后人群心理健康进行评估的文献。分析地震的国家/地点、主体评估机构、评估时间、评估对象、评估工具名称。结果共纳入794篇文献,中国大陆发表文献占87.4%,汶川地震相关研究占78.0%。主体评估机构以高校(47.9%)和医院(46.9%)为主,集中在四川、北京、广东地区。开展心理健康评估的时间主要在震后第1年(537篇,其中第1月244篇,占45.4%)。评估对象前5位依次为儿童/青少年、灾民、伤员、救援官兵和医务人员,震后第1月心理健康状况最关注伤员,其次是儿童/青少年,再次是灾民。794篇文献共涉及心理健康评估工具217种。震后1月内244篇文献共涉及使用73种工具,其中122篇文献使用1种评估工具,122篇使用2种及以上评估工具。工具种类繁多,以翻译量表和针对精神障碍患者的量表为主。使用频率最高的前5位量表依次为90项症状自评量表(SCL-90)、抑郁自评量表(SDS)、焦虑自评量表(SAS)、创伤后应激障碍症状清单平民版(PCL-C)和事件影响量表(IES-R)。结论 1震后人群心理健康状况评估工具缺乏针对性,均不是针对地震的特殊情况编制,不适用于震后特殊情况;2亟需编制一个专门针对灾后人群心理健康评估的简便、经济、可行的评估量表;3须组织专业人员编写本土化指南,撰写培训材料和震后人群心理健康教育材料,建立规范、常态的培训基地和师资队伍,制定灾后心理卫生服务管理工作规范。

Objectives To explore the using status of psychological assessment instruments including checklists, questionnaires and scales after earthquake, so as to provide baseline data for establishing a standard method and process in developing earthquake-related population psychological screening and assessment instruments in future. Methods We searched WanFang Data, CNKI, VIP, PubMed, EMbase, The Cochrane Library and CiNii databases, as well as special websites about earthquake and disaster management from inception to July 30~, 2014 to collect studies evaluating the population psychological health conditions with assessment instruments after earthquakes. The earthquake countries/regions, the main assessment institutions, the time of assessment, the objects of assessment, and the instruments used were analyzed. Results A total of 794 studies were included, of which 87.4% were from China's Mainland, and 78.0% were related to the Wenchuan earthquake. Most of assessments were conducted by universities （47.9%） and hospitals （46.9%） in Sichuan, Beijing and Guangdong provinces of China. The psychological assessments conducted in the first year after quake were found in 537 studies （67.6%）, of which 244 studies （45.4%） reported the psychological assessments results in the first month after quake. The top five assessment objects were children/teenagers, survivors, wounded, military rescuers, and medical staff. In the 794 included studies, a total of 217 instruments were used, In the 244 studies reported the assessment results in the first month after quake, a total of 73 instruments were used. 122 of the 244 studies reported only one instrument was used, and the other 122 of the 244 studies reported two or more instruments were used. Most of the instruments were translation versions and developed for mental disorders. The top 5 instruments were Symptom Checklist 90, Self-Rating Depression Scale, Self-Rating Anxiety Scale, PTSD Checklist-Civilian Version and Impact of Event Scale Revised, respectively. Conclusions All the psychological assessment instruments are not developed for assessing earthquake-related psychological health problem, so a simple, economic, feasible and specialized instrument for earthquake-related population should be developed. It＇s needed to organize professionals to design a local guideline and training material for earthquake survivors and rescuers, and to establish a standardized, sustainable normal training base and trainer＇s team, so as to standardize the psychological aid work.