臺灣中部地區地震創傷後壓力相關精神疾病罹病盛行率與危險因子- 兩年追蹤研究

The Prevalence and Risk Factors of Posttraumatic Stress Related Morbidities among the Victims of Earthquake in Central Taiwan: Two-year Follow-up Study

張家銘(Chia-Ming Chang)

指導教授 ： 賴德仁

中山醫學大學/醫學院/醫學研究所/博士(2008年)

https://doi.org/10.6834/CSMU.2008.00100

摘要

研究背景及目的
過去對於地震造成心理衝擊的研究多為橫切面立意取樣，缺乏長期縱貫性的研究。本研究針對中台灣921地震災區隨機取樣的居民，在地震發生後第一年與第二年進行調查。
本研究的目的有三：(一) 探討第一年不同創傷後壓力疾患（Posttraumatic Stress Disorder，簡稱PTSD）診斷群的盛行率及其特徵差異；(二) 探討第一年PTSD、創傷後壓力罹病嚴重度，與整體精神罹病嚴重度的預測因子；(三)探討兩年精神診斷、創傷後壓力罹病嚴重度與整體精神罹病嚴重度的差異及與地震暴露程度的關係。

研究材料與方法
本研究選取中寮鄉兩個村，兩村各隨機取樣150戶，每戶選出一位居民接受兩階段的訪問。第一階段由受過訓練的醫學生做訪員，利用結構性問卷評估受訪居民，例如：社會人口變項、自覺壓力程度、社會支持及失能程度、地震暴露程度、自殺危險性、大衛生創傷後壓力量表(評估創傷後壓力罹病嚴重度)、中國人健康問卷(評估整體精神罹病嚴重度)、過去創傷經驗、醫療利用與身心健康狀態。第二階段由資深精神醫療人員作MINI 神經精神診斷會談。
分析上我們首先比較第一年不同創傷後壓力疾患(full PTSD、partial PTSD (簡稱PTSS)及non-PTSD三組)的盛行率及特徵差異。其次將第一年創傷後壓力症候群(PTSD/PTSS)、創傷後壓力罹病嚴重度(大衛生創傷後壓力量表的總分)及整體精神罹病嚴重度(中國人健康問卷的總分)共三種當作地震後的預後指標，比較三種預後指標的預測因子。最後合併第一年與第二年的資料，比較第一年與第二年個案的精神診斷與相關罹病的差異，並檢定地震創傷暴露嚴重度與創傷後罹病嚴重度，及整體精神罹病嚴重度的相關。

研究結果
第一年完成兩階段受訪共252人。PTSD的盛行率10.3%、PTSS盛行率19.0%、non-PTSD 的盛行率70.7%。校正性別、年齡與教育程度後，可發現PTSD 及PTSS兩組非常相似，皆顯著較non-PTSD組容易有:女性、創傷暴露、自殺危險、合併廣泛性焦慮疾患、合併其他精神疾病、整體精神病理、失能、身心健康缺損。而PTSD組較PTSS組有較多的現在重鬱症、生命損失、壓力脆弱度缺損。
女性與合併現在重鬱症，是創傷後壓力症候群的預測因子。現在憂鬱症及身心健康受損，是創傷後壓力嚴重度的預測因子。女性、現在憂鬱症、過去創傷事件數與身心健康受損，則是整體精神罹病嚴重度的預測因子。
第二年剩下199位民眾受訪。PTSD盛行率由第一年9.5%降為第二年的7.5%，PTSS盛行率由第一年的13.1%降為第二年的12.1%。地震暴露程度與第一年與第二年的整體精神罹病嚴重度，與創傷罹病嚴重度皆有顯著相關。

結論
地震災後的各種創傷後壓力相關疾患像是PTSD及PTSS都是常見的，並且PTSS仍有類似PTSD的心理社會功能受損，同樣需要重視。女性、現在重鬱症及身心健康受損，在評估地震造成的身心影響時尤其要注意。追蹤發現，有相當的PTSD個案會慢性化，地震暴露程度是預測身心影響重要的指標。

關鍵字

地震 ； 創傷後壓力疾患 ； 部分創傷後壓力疾患

並列摘要

Background and subjective
Most of the past research to study the psychological impact of earthquake were cross-sectional design with convenient sampling, and long-term studies were rare. This study was carried in the first and second year after 1999 ChiChi earthquake in central Taiwan to a random sample of earthquake survivors with structural interview.
The aims of this study were (1) to investigate the prevalence and characteristic differences of post-traumatic stress diagnostic groups in the 1st year after earthquake; (2) to investigate the predictors of post-traumatic stress syndrome, post-traumatic morbidities, and general psychiatric morbidities in the 1st year after earthquake; (3) to investigate the psychiatric diagnoses, post-traumatic morbidities, and general psychiatric morbidities in the 1st and 2nd year after earthquake and their associations with the severity of earthquake exposure.

Material and methods
Two villages in Chung-Liao county were choose and 150 households were randomly selected from each village. Each household will select one subject to receive two-stage interviews. First stage structural interview were conducted by trained medical students to measure their sociodemographic data, perceived stress and social support, disability, traumatic exposures in earthquake, suicide risk, Davidson Trauma Scale (DTS, to assess posttraumatic morbidities), Chinese Health Questionnaires (CHQ, to assess general psychiatric morbidities), questionnaires to rate traumatic experiences, health care utilizations, and wellbeing. Second stage interviews were conducted by senior psychiatrists or psychologists for the MINI neuropsychiatric interview schedules. Two surveys were conducted in the 10 months and 22 months post earthquake.
We firstly defined the three post-traumatic stress diagnostic groups (full PTSD, partial PTSD (PTSS), and non-PTSD) to investigate their prevalences and characteristics. We secondly investigated the predictors of three post-traumatic outcomes (PTSD/PTSS, posttraumatic morbidities (from DTS), and general psychiatric morbidities (from CHQ). Lastly, we pooled the data from the first and second year surveys to compare the psychiatric diagnoses and related morbidities between first year and second year after earthquake. We also examined the association between earthquake exposure severities and posttraumatic morbidities, and general psychiatric morbidities in the two years.

Results
252 subjects completed the two stage interview in the first year. The prevalence rate for PTSD was 10.3% (n=26) and 19.0% for PTSS (n=48). The PTSD and PTSS groups were very similar and differed significantly from non-PTSD on most variables, with greater likelihood of the following: female gender; total trauma exposure; generalized anxiety disorder; suicidality; any other axis I disorder; general psychopathology, disability (work, social, leisure); and impaired wellbeing. Few differences were observed between the PTSD and PTSS groups, although greater likelihood for major depression, trauma- related loss of life, and impaired stress vulnerability were noted in the PTSD group.
Variables predictive of PTSD/PTSS included female gender and current depression. Current depression and impaired well-being were predicted by greater PTSD severity. Greater psychiatric morbidity was predicted by female gender, current depression, number of traumatic experiences, and impaired well-being.
199 subjects completed the survey of the second year. The prevalence of PTSD decreased from 9.5% in the first year to 7.5% in the second year; and the prevalence of PTSS decreased from 13.1% in the first year to 12.1% in the second year. The earthquake exposure severity were significantly associated with the posttraumatic morbidities and general psychiatric morbidities in the first and second year.

Conclusions
PTSD and PTSS are commonly observed following earthquake and are associated with similarly high levels of psychosocial impairment. Female gender, current depression, and impaired well-being should be considered in assessing earthquake survivors who are at increased risk for developing posttraumatic outcomes. Most of the PTSD will be chronic and earthquake exposure severity were significantly associated with post-disaster outcomes.

並列關鍵字

earthquake ； PTSD ； partial PTSD

參考文獻

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