汶川地震山区幸存成人急性应激障碍回顾性分析

Retrospective Analysis on ASD of Adults Survived Wenchuan Earthquake in Mountainous Area

目的:探讨汶川震后山区幸存者成人急性应激障碍(ASD)流行病学特征和MMPI-PK的最佳筛查阈值。方法:整群抽取禹里乡2433例幸存成人,采用ASDI进行访谈,并根据DSM-IV-TR诊断标准进行诊断。随机抽取70例确诊病例为研究组,91例适应良好幸存者为对照,完成PK检测并绘制ROC曲线。结果:山区幸存成人ASD发病率16.79%,女性高于男性(χ~2=10.11,P<0.01),中青年高发,散居者高于集中居住者(χ~2=10.57,P<0.01),受教育程度不同,发病存在差异(χ~2=6.31,P<0.05);婚姻状况、经济收入不同发病率差异不显著,受损程度越高发病率越高(χ~2=34.60,P<0.01)。居住状态(Wald=15.69,P<0.01)、受损程度(Wald=13.54,P<0.01)、年龄(Wald=9.82,P<0.05)和性别(Wald=11.74,P<0.01)与ASD发病显著相关。警觉性增高症状群最常见,其次是再体验症状群和一般症状群,67.55%伴有自主神经反应,女性分离性症状群和回避性症状群较男性常见(χ_(0.01(1))~2=6.63,P<0.01)。PK28分时,ROC曲线下面积最大,为最佳截断点(Z=9.41,P<0.01),灵敏度92.75%,特异度96.59%,约登指数89.34%,总符合率94.90%,阳性似然比=27.20>10,阴性似然比=0.075<0.1。结论:震后山区幸存者成人ASD流行病学显示了一定的人群特异性,需要采取针对性心理救援策略,PK对这一人群ASD的最佳筛查阈值为28分。

Objective：To investigate epidemiological characteristics of ASD of adults survived Wenchuan Earthquake in mountainous area and the best threshold of MMPI-PK for ASD screening.Methods：A total of 2433 adult survivors of Yuli township were cluster sampled to be interviewed with ASDI,and diagnosed according to DSM-IV-TR diagnostic criteria.We sampled 70 confirmed cases randomly,91 well-adjusted survivors as control,to accomplish PK testing and ROC curve drawing.Results：Among these survivors,the incidence of ASD of was 16.79%,females showed higher level than male（χ~2=10.11,P〈0.01）,more common in youth and middle-aged compared to the elderly（P〈0.05）,higher in survivors living seperately than survivors living together（χ~2=10.57,P〈0.01）,there were different incidences in groups of different education（χ~2=6.31,P〈0.05）,neither diffference of incidences among groups educated differently nor that among groups with different marriage status was significant,the more people lost,the higher the incidence（χ~2=34.60,P〈0.01）.Onset of ASD was correlated significantly with the four factors-housing,losses,age and gender（P〈0.05）.The symptom cluster of increased alertness was most frequently seen,followed by relived-symptom cluster and general-symptom cluster,67.55% accompanied by autonomic nervous response,both dissociative-symptom cluster and avoidance-symptom cluster were more common in women than men（χ~2=6.63,P〈0.01）.The largest AUC（Area Under Curve）could be gotten at 28 of PK scale（P〈0.01）,which was the best cut-off score of ROC,Se=92.75%,SP=96.59%,YI=89.34%,TCR=94.90%,PLR=27.20〉10,NLR=0.075〈0.1.Conclusion：Some degree of population-specificity can be seen in Epidemiology of ASD of adult survivors in mountainous area after Earthquake,therefore,it is necessary to take pointed psychological aid strategy.The best screening threshold of MMPI-PK for their ASD is 28.