交通事故幸存者人群中急性应激障碍对后期创伤后应激障碍的预测研究

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	交通事故幸存者人群中急性应激障碍对后期创伤后应激障碍的预测研究
其他题名	The predictive role of acute stress disorder symptoms in subsequent posttraumatic stress disorder among survivors of road traffic Accidents
	李秀丽
	2011
摘要	摘要中国是一个自然灾害和突发性创伤性事件频发的国家，这些创伤性事件会给事件亲历者带来重大的心理影响，导致一系列严重的心理疾患，创伤后应激障碍（Postraumatic stress disorder, PTSD）是其中最为特异性的一种心理疾患。然而，中国相关的研究起步较晚，虽然积累了一些资料，但对建构有效的防治体系还是远远不够的，需要开展系统而深入的研究。本研究主要以206名公路交通事故幸存者为研究对象，采用纵向追踪的研究设计。目的：考察交通事故幸存者人群中急性应激障碍（Acute stress Disorder, ASD）与PTSD的流行情况、预测因素以及早期ASD不同症状簇对后续PTSD的预测作用。方法：被试为206名交通事故幸存者，其中男性168人，女性38人，年龄为39.8±12.5岁。在被试经历事故2-23天内，采用ASD量表（Acute Stress Disorder Scale，ASDS）进行评估；在被试经历事故4-12个月，采用17项PTSD检测表--特定事件版（PTSD Checklist-Specific Stressor Version，PCL-S）进行评估。结果：（1）206名中国交通事故幸存者中共有61人为可能的ASD患者，发生率为29.6%；女性较男性ASD症状严重（男：ASD=36.70±11.42；女：ASD=41.18±12.58；t=-2.14, p<0.05），已婚者较单身者ASD症状严重(已婚：ASD=38.37±11.94；未婚/丧偶/离异：ASD=30.86±8.37；t=5.22, p<0.001)，文化程度低者较文化程度高者ASD症状严重（初中及以下：ASD=38.74±11.73；高中及以上：ASD=34.76±11.64；t=2.18, P<0.05）；年龄（r=0.43，p<0.01）、车祸时是否有害怕/无助/惊恐经历(r=0.21，p<0.01)与ASD的症状表现严重程度显著相关；年龄能正向预测ASD严重程度(β=0.29)，且显著性水平达到p<0.001。（2）206名中国交通事故幸存者中共有51人为可能的PTSD患者，发生率为24.8%；女性较男性PTSD症状严重（男：PTSD=26.9±7.7；女：PTSD=31.46±8.87；p<0.05），已婚者较单身者PTSD症状严重(已婚：PTSD=28.72±8.07；未婚或丧偶/离异：PTSD=23.00±5.47；p<0.001)；年龄（r=0.34，p<0.001）、评估距离创伤时间间隔（r=0.14，p<0.05）、躯体康复状况（r=-0.72，p<0.001）与PTSD的症状严重程度显著相关；性别(β=0.15)、躯体康复状况(β=-0.66)能够预测PTSD严重程度，显著性水平达到p<0.001。（3）206名中国交通事故幸存者中，ASD严重程度能够预测PTSD严重程度(β=0.37, p<0.001)；ASD再体验症状(β=0.22, p<0.001)、高唤醒症状（β=0.16, p<0.05）能够预测PTSD严重程度；ASD再体验症状能够预测PTSD再体验症状(β=0.46)，ASD回避症状能够预测PTSD回避症状(β=0.19)，ASD高唤醒症状能够预测PTSD高唤醒症状(β=0.43)，且显著性水平达到p<0.001。结论：（1）ASD在我国交通事故幸存者中是一种常见的心理疾患，其主要的预测因素包括：性别、年龄、婚姻状况、文化程度、车祸时害怕/无助/惊恐的程度。（2）PTSD在我国交通事故幸存者中是一种常见的心理疾患，其主要的预测因素包括：性别、年龄、婚姻状况；评估距离创伤时间间隔、躯体康复状况。（3）创伤事件早期的ASD症状严重程度能很好地预测后续的PTSD症状，其中ASD的再体验与高唤醒症状能更好的预测后续的PTSD症状。
其他摘要	ABSTRACT Natural disasters and unexpected traumatic events have a high frequency in China, and they can cause serious mental health problems. The posttraumatic stress disorder (PTSD) is one of the most specific and serious mental health problems. However, research of this area began lately in China. Some information has been accumulated, but it’s far from enough for building a effective prevention and control system, and the systematic and thorough research is warranted. Objective : To investigate the prevalence and risk factors of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) among Chinese survivors of road traffic accident , and to analyze the predictive role of ASD symptoms in subsequent PTSD symptoms. Methods: A total of 206 participants (168 men, 38 women; mean age=39.8, SD=12.5 years) were recruited to this survey. The participants were administrated with the Acute Stress Disorder Scale（ASDS）2 to 23 days after the traffic accident and the 17-items PTSD Checklist (PCL-S) 4 to 12 months after the traffic accident. Results (1) There was a total of 61(29.6%) possible ASD patients among all participants. Women had more serious ASD symptoms than men (male: ASD=36.70±11.42; female: ASD=41.18±12.58; p <0.05), the married’s ASD symptom severity was higher than the single’s(married: ASD=38.37±11.94; single/widowed/divorced: ASD=30.86±8.37; p<0.001), people with low degree of education had more severe ASD symptoms than the people who had high degree of education (p <0.05); being elder（r=0.43，p<0.01）, having fear / helpless / horror experience of accident (r=0.21，p<0.01) were significantly correlated with the severity of ASD symptoms. According to Linear regression analysis, age could positively predicted ASD symptoms (β=0.29, p <0.001) . (2) There was a total of 51(24.5%) possible PTSD patients among all participants. Women had more serious PTSD symptoms than man (male: PTSD=26.9±7.7; female: PTSD=31.46±8.87; p<0.05), the married’ PTSD symptom severity was higher than the single’s(married: PTSD=28.72±8.07; single/widowed/divorced: PTSD=23.00±5.47; p<0.001); being elder（r=0.34，p<0.001）, time elapsed between assessment and trauma（r=0.14，p<0.05）, rehabilitation status(r=-0.72，p<0.001) were significantly correlated with the severity of PTSD symptoms; According to Linear regression analysis, gender(β=0.15) and rehabilitation status(β=-0.66) could predict for the severity of ASD symptoms(p <0.001). (3) In 206 Chinese survivors of road traffic accident, the severity of ASD symptom could predicte PTSD’s(β=0.37, p<0.001); The ASD’s cluster of reexperience and hyperarousal could predicte the severity of PTSD symptoms (β=0.22, p<0.001; β=0.16, p<0.05); The ASD’s cluster of reexperience could predicte the PTSD’s cluster of intrusion(β=0.46), the ASD’s cluster of avoidance could predicte the PTSD’s cluster of avoidance(β=0.19), the ASD’s cluster of hyperarousal could predicte the PTSD’s cluster of hyperarousal(β=0.43), and all of them had the significant ability of prediction(p<0.001). Conclusion： (1) ASD was a common mental problems among Chinese survivors of road traffic accident, and the main predictive factors of ASD included gender, age, marital status, the degree of education, whether there was fear / helpless / horror experience of accident. (2) PTSD was a common mental problems among Chinese survivors of road traffic accident, and the main predictive factors of PTSD included gender, age, marital status, time elapsed between assessment and trauma, rehabilitation status. (3) The severity of ASD symptoms early traumatic event could positively predict the subsequent severity of PTSD symptoms, reexperience and hyperarousal among the ASD’s cluster had the more effective role of prediction to the subsequent severity of PTSD symptoms.
学科领域	医学心理学
关键词	急性应激障碍创伤后应激障碍预测交通事故
学位类型	同等学力硕士
语种	中文
学位专业	心理学
学位授予单位	中国科学院研究生院
学位授予地点	北京
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/20671
专题	社会与工程心理学研究室
作者单位	中国科学院心理研究所
推荐引用方式 GB/T 7714	李秀丽. 交通事故幸存者人群中急性应激障碍对后期创伤后应激障碍的预测研究[D]. 北京. 中国科学院研究生院,2011.

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