災難與創傷後壓力症候群

本文以九二一集集大地震與精神醫學相關為主題，而發表於國際期刊的文章，配合回顧其他國內外的文獻，闡述創傷後壓力症候群的歷史源由、診斷標準、可能致因假說以及不同研究方法學對創傷後壓力症候群(PTSD)的盛行率、相關（危險）因素的影響，以進行差異性比較與提出改進的建議。許多學者從生物、心理與社會環境的不同層面提出影響創傷後壓力症候群發生的相關因子，因此，本文依精神醫學的生物－心理－社會致病因，配合公共衛生對疾病發生的網狀致因模式，提出影響PTSD發生的可能致因假說。另一方面，創傷後壓力症候群的盛行率視調查的方法、對象，研究工具的選擇，診斷系統，調查時間的切入點與災難定義而有所不同，約有1.5%-74%不等的差異；因此，未來對災難研究時需要依據目的，選擇能快速篩檢又具有信效度的工具，並事先規劃做有系統的介入；此外，為與倖存者建立良好關係，並獲得合作，在兼顧醫學倫理的前提下，提供醫療與服務是必須的；未來可進行的研究方向則包括創傷後壓力症候群的生物學致病因、復原因素及療效評估與針對災難倖存者PTSD盛行率、發生率及危險因素等流行病學進行長期追蹤研究。

關鍵字

九二一集集大地震；創傷後壓力症候群

並列摘要

This paper reviews the background of posttraumatic stress disorder (PTSD) and its diagnostic criteria and etiology by reviewing literature identified by a search of the MEDLINE(r) database. Emphasized is placed on studies of PTSD in survivors of the Chi-Chi earthquake, a major recent disaster in Taiwan, as well as other studies of PTSD outside of Taiwan. Previous research in PTSD has used a variety of methods which may explain the many inconsistent results related to prevalence and risk factors. Risk factors of PTSD may have a close relationship to biology, psychology, and social environments. Based on the biopsychosocial model of psychiatry and disease causation model as it applies to public health, we propose a model of the causation of PTSD. The disparity in post-earthquake PTSD prevalence (1.5%-74%) in previous studies from Taiwan can be attributed to differences in research methods, study populations, research tools, diagnostic criteria, time intervals, and case definition. Such wide discrepancies in prevalence in studies from Taiwan and elsewhere stress the importance of ensuring the reliability and validity of selected tools prior to the performance of research studies in post-disaster psychological impairment and that a systemic approach be applied to treatment and intervention. Furthermore, data from these studies illustrate that providing medical services for survivors is crucial to gaining adequate cooperation and follow-up cooperation. Issues related to PTSD that are most in need of further study include biological causation, psychosocial recovery and long-term evaluation of psychological rehabilitation.

並列關鍵字

Chi-Chi Earthquake ； Posttraumatic Stress Disorder

參考文獻

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