2015年八仙樂園派對粉塵爆炸事故之燒傷倖存者的創傷後壓力症狀與創傷後成長預測因子探討

目的：歷經創傷事件的個體，身心時常經驗到壓力反應，相關反應如持續出現一段時間並影響功能，則可能形成創傷後壓力症（Posttraumatic Stress Disorder；PTSD）。無論在研究上或臨床上，創傷後壓力症皆是重要議題，不過這並非創傷個體僅有的單一面向，過去已有研究指出正向成長也是另一種可能性。創傷後成長（Posttraumatic Growth；PTG），是指個體歷經高壓挑戰事件後所經驗到的正向改變。面對上述兩種臨床現象，過去曾有學者以認知觀點解構之，核心信念被違反（Core Belief Violation）被認為與PTSD具正相關，同時也被認為是邁向PTG的起始點，而刻意反芻（Deliberate Rumination）則被認為是導向PTG的關鍵因素，此一論述被過去許多實徵研究所驗證。在各式創傷事件當中，燒燙傷被認為是高衝擊、高挑戰之事件；燒燙傷的受傷樣態與後續復原的特殊性，使之成為創傷領域中獨特的議題，不過截至目前仍未有實徵研究以燒傷族群為例，探討認知因素於PTSD及PTG之預測效果。據此，本研究將探討兩大問題，其一為核心信念被違反對PTSD之預測效果，其二為核心信念被違反與刻意反芻對PTG之預測效果。方法與結果：為檢驗上述問題，本研究以116位2015年八仙樂園粉塵燃燒事件之燒傷倖存者為研究對象，透過晤談與自陳量表蒐集資料，主要以相關法與階層迴歸進行統計分析。控制變項方面，本研究納入人口學變項、燒傷總體面積、燒傷前憂鬱史、燒傷前創傷史，預測變項為核心信念被違反、刻意反芻，結果變項為PTSD與PTG。結果發現，相關分析指出，燒傷前憂鬱史、燒傷前創傷史、核心信念被違反、刻意反芻與PTSD呈正相關；燒傷前憂鬱史與PTG呈負相關，刻意反芻與PTG呈正相關。階層迴歸分析指出，在控制燒傷前憂鬱史及燒傷前創傷史之後，核心信念被違反對PTSD有正向預測效果；在控制燒傷前憂鬱史及核心信念被違反之後，刻意反芻對PTG有正向預測效果。討論：本研究結果說明了先前身心狀態與認知因素對創傷後壓力症狀的影響力，應有助於病理機制的描繪與理解。另外在創傷後成長的方面，驗證了創傷後成長模型當中的部分假設，亦即刻意反芻對創傷後成長的正向預測效果。另外，本研究參與者之得分表現有助於理解大型災難創傷脈絡下之倖存者其災後心理適應，提供後續研者究不同思考面向。本研究結果期能為燒傷心理領域提供更豐富之知識累積，也能盼能為相關工作者作為實務操作上的參考，更貼近燒傷倖存者的內在心理世界。

關鍵字

核心信念；刻意反芻；燒燙傷；創傷後成長；創傷後壓力症；燒傷倖存者；八仙塵燃事件

並列摘要

OBJECTIVE:It is well known that traumatized individuals are easily to experience trauma related stress symptoms from time to time. Meanwhile, posttraumatic stress symptoms attract much attention in trauma research. However, posttraumatic stress symptoms are not the only pattern that traumatized individuals may display. Previous studies have shown that individuals have the potential to bounce forward after the adversity. Posttraumatic growth (PTG) refers to positive change experienced as a result of struggle with highly challenging life circumstances. A few scholars had been interpreted these two psychological phenomenon with a cognitive perspective. Based on shattered assumption theory and Posttraumatic growth model, core beliefs violation caused by traumatic event will lead to more severe PTSD symptoms and deliberate rumination is considered to be the key factors leading to posttraumatic growth. Previous empirical studies have verified these statement. Among various types of traumatic events, burn injury is seen as a high challenging event. Unlike other traumatic survivors, burn survivors have to deal with additional challenges such as unbearable pain and appearance change while they recovering such as unbearable pain and itch as well as visible appearance change. Burn injury involves so many psychological issues, making it a unique topic in trauma research field. Until now, there is no research specifically exploring the impact of cognitive factors on PTSD and PTG in burn survivors. Based on this, this study thus aimed to investigate the predictive effect of cognitive factors to posttraumatic stress symptoms and posttraumatic growth in burn survivors. METHODS: A total of 116 burn survivors of the 2015 New Taipei Water Park Explosionparticipated in this study. A brief interview with the participants was conducted followed by that all participants completed self-report scales. Pearson correlation, biserial correlation and hierarchical regression were conducted for data analyses. Demographic variables, Total Body Surface Area, Pre-burn mental status were used as control variables. Predictor variables were theory-derived cognitive factors, i.e., core belief challenge and deliberate rumination. Outcome variables are posttraumatic symptoms and posttraumatic growth. Assessments were conducted individually at the hospital setting. RESULTS: Pearson’s correlation analyses indicate that, pre-burn depression, pre-burn trauma, core belief violation were positively correlated with posttraumatic stress symptoms. Pre-burn depression was negatively correlated with posttraumatic growth, and deliberate rumination was positively correlated with posttraumatic growth. Hierarchical regression indicate that core belief violation significantly predicted PTSD under taking pre-burn depression and pre-burn trauma as control variables. Deliberate rumination significantly and uniquely predicted PTG under taking pre-burn depression and core belief violation as control variables. DISCUSSIONS: This study emphasize the importance of cognitive factors to the psychological adaptation in burn survivors. It help us to know more about PTSD pathological mechanisms.As for PTG, a part of PTG model assumption were verified via this study. More specifically, deliberate rumination had positive predictive effect on PTG. Besides, this study may contribute to the understanding of psychological adaptation of survivors under severe major disaster. In general, we are looking forward to providing a richer knowledge and clinical implications in this field.

並列關鍵字

core beliefs ； deliberate rumination ； burn trauma ； posttraumatic growth ； posttraumatic stress symptoms ； burn survivors ； new taipei water park burn disaster

參考文獻

Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic Stress Disorder in The National Comorbidity Survey. Arch Gen Psychiatry, 52, 1048-1060. doi: 10.1001/archpsyc.1995.03950240066012

參考文獻