汶川地震8.5年后青少年身心状况研究

汶川地震8.5年后,对地震极重灾区的2291名青少年进行问卷调查,考察其创伤后应激障碍(PTSD)、抑郁、创伤后成长(PTG)和生活满意度等身心反应的现状及其共存形态。结果发现:(1)地震发生8.5年后4.75%的青少年有明显的PTSD症状,29.98%的青少年有明显的抑郁症状,其中女生、少数民族学生、高年级学生的症状水平更高;46.13%的青少年报告其出现了明显的PTG,其中女生和少数民族学生的PTG水平更高;青少年的生活满意度较低,其中初一年级显著高于其他年级,但性别和民族差异不显著;(2)青少年的PTSD与抑郁呈显著正相关、与生活满意度呈显著负相关、与PTG相关不显著,抑郁与PTG和生活满意度呈显著负相关,PTG与生活满意度呈显著正相关;(3)青少年的PTSD、抑郁、PTG和生活满意度之间具有共存的形态,具体表现为成长组(32.6%)、低症状组(39.4%)、症状-成长共存组(5.8%)、中等症状共病组(17.8%)和高度症状共病组(4.4%)等5种类别。     

突发灾难事件引发创伤后应激障碍特点的研究

目的:探讨新疆地区突发灾难事件后医学院大学生创伤后应激障碍发生的特点,为高校学生心理健康指导及民族团结教育提供科学依据。方法:采用PTSD筛查问卷及开放式访谈调查方法对750名医学本科生进行研究。结果:在7.5暴力事件突发后,医学生PTSD的发生率达到12.8%。总体来看,以学生的PTSD症状中,回避维度平均分高于警觉维度的平均分。在性别、民族、学院、年级以及被试的性质上,被试的PTSD存在显著差异。医学生在7.5事件中充当的角色性质、所处学院、所处年级三个变量能联合预测PTSD症状2.7%的变异量。结论:高校学生工作者及高校教师应该根据医学生的特点,及时有效地采取危机干预措施,减少和避免创伤后应激障碍的发生,促进学生心理健康,引导学生建立积极的民族团结意识。     

失独父母创伤后应激障碍症状的潜在类别及其相关因素

摘 要 研究旨在探讨失独父母创伤后应激障碍（PTSD）症状的潜在类别及相关因素,分析不同类别失独父母心理韧性的差异。采用创伤后应激障碍量表（PCL-5）、心理韧性量表对385名失独父母进行测查。结果发现：（1）失独父母PTSD症状存在三种潜在类别：PTSD高症状组（30%）、PTSD中度症状组（38%）、PTSD低症状组（32%）。（2）相比PTSD低症状组而言,PTSD高或中度症状组有显著的年龄和失独年限效应,PTSD高症状组中年龄≤60岁、失独年限<10年的人群所占比例较高;PTSD中度症状组的年龄≤60岁的人群所占比例更高。（3）PTSD高症状组心理韧性得分显著低于其他两组。应及时关注和干预小于60岁、失独年限<10年和低心理韧性的失独群体。     

失独父母创伤后应激障碍症状的潜在类别及其相关因素

摘 要 研究旨在探讨失独父母创伤后应激障碍（PTSD）症状的潜在类别及相关因素,分析不同类别失独父母心理韧性的差异。采用创伤后应激障碍量表（PCL-5）、心理韧性量表对385名失独父母进行测查。结果发现：（1）失独父母PTSD症状存在三种潜在类别：PTSD高症状组（30%）、PTSD中度症状组（38%）、PTSD低症状组（32%）。（2）相比PTSD低症状组而言,PTSD高或中度症状组有显著的年龄和失独年限效应,PTSD高症状组中年龄≤60岁、失独年限<10年的人群所占比例较高;PTSD中度症状组的年龄≤60岁的人群所占比例更高。（3）PTSD高症状组心理韧性得分显著低于其他两组。应及时关注和干预小于60岁、失独年限<10年和低心理韧性的失独群体。     

震后儿童创伤后应激障碍的症状网络演化

本研究借助网络分析方法,探讨儿童创伤后应激障碍(PTSD)症状的演化规律。以经历汶川地震的197名儿童为研究对象,在灾后4、29、40和52个月对其PTSD症状进行了历时4年的追踪测量。网络分析结果显示,闪回的中心性一直较高,而其他高中心性的症状随时间的推移发生了变化：侵入性想法和创伤线索引发生理性反应的中心性随时间推移呈上升趋势,线索引发情感反应和未来无望的中心性随时间推移呈下降趋势。本研究拓宽了学界对儿童PTSD症状学的认识, 并为建立灾后阶段性干预模式提供启示。     

价值观对蓄意创伤受害者创伤后应激障碍症状的影响

探讨价值观对蓄意创伤受害者创伤后应激障碍（Posttraumatic Stress Disorder ,简称PTSD）症状的影响方式。方法：采用事件冲击量表、受害人认可评价量表、施瓦兹价值观量表作为测查工具,测查了163 名蓄意创伤受害者。结果：（1）蓄意创伤受害者的PTSD三大症状表现有显著差异,闯入症状水平最高,回避症状水平次之,高警觉症状水平最低。（2）蓄意创伤受害者所持的价值观和对外界接纳的评价能较好地预测PTSD三大症状。（3）内敛价值类型通过诸如社会接纳等反映外在标准的因素影响PTSD的闯入症状。结论：蓄意创伤受害者PTSD症状表现有其自身的特点,对外界接纳的评价和自身所持的价值观对其PTSD症状有直接或间接的影响     

蓄意创伤受害者的创伤后应激障碍症状及影响因素分析

目的:研究蓄意创伤受害者的PTSD症状及影响因素。方法:采用事件冲击问卷、创伤经历揭露问卷、受害人认可问卷和攻击描述问卷等测查工具对163名蓄意创伤受害者进行调查。结果:(1)蓄意创伤受害者的PTSD三大症状之间相关显著,且方差分析结果差异显著,闯入性症状>回避症状>高警觉症状;(2)创伤严重程度与PTSD三大症状的相关显著;(3)创伤揭露中情绪反应对PTSD三大症状都有显著的预测作用;(4)社会认可度中的一般性排斥对PTSD三大症状都有显著的预测作用。结论:蓄意创伤受害者有着较强的PTSD症状,且以闯入性症状最为严重,回避和高警觉症状次之;创伤的严重程度、揭露时的情绪反应和社会认可度中的一般性排斥等都对蓄意创伤受害者的PTSD症状有影响作用。     

创伤后应激障碍中的非适应性泛化现象

过度泛化现象是区分普通心理问题和严重心理问题的重要指标。创伤后应激障碍(posttraumatic stress disorder, PTSD)患者在创伤事件后会出现非适应性的泛化。现有研究结果表明非适应性泛化(maladaptive generalization)可能是PTSD发生发展的一个重要因素, 但也有研究支持PTSD是导致了泛化从适应性向非适应性化转变的原因。虽然泛化现象的变化与PTSD症状的发展有相同趋势, 且具有共同的生理基础：记忆相关神经结构, 但二者之间的关系尚无明确定论。阐明PTSD与非适应性泛化之间的关系对PTSD的预测、诊断和治疗均有推进作用。     

内源性大麻素与创伤后应激障碍:可能的作用机制与治疗应用

近年来,内源性大麻素系统已被视为创伤后应激障碍(PTSD)未来药物治疗的新靶标。实证研究提示,内源性大麻素系统可能通过影响个体的恐惧记忆加工、焦虑与抑郁表型以及奖励与动机调控而参与了PTSD的发生发展。应用适量的大麻素类物质可缓解PTSD症状,尤其可以改善患者的睡眠问题。未来的研究应进一步明确内源性大麻素系统在PTSD病因学中的作用机制,提高现有药用大麻素类物质的临床安全性,并发展新型大麻素受体调节剂。另外,探讨遗传因素和反应异质性在内源性大麻素治疗PTSD中的作用,也将促进治疗人群的早期识别和精准医疗的发展。     

创伤后应激障碍对震后青少年自杀意念的影响：安全感的调节作用

为探讨创伤后应激障碍（PTSD）及其各个症状簇对震后青少年自杀意念的影响,并检验安全感在其中的调节作用,研究采用创伤暴露程度问卷、流调中心抑郁量表儿童版、DSM-5的PTSD症状核查表、安全感量表和儿童行为问题核查表对汶川地震8.5年后的1136名中学生进行调查。结果发现：PTSD、负性认知和情绪改变症状、警觉性增高症状分别正向预测自杀意念,侵入性症状和回避性症状对自杀意念的预测作用不显著;安全感在侵入性症状、负性认知和情绪改变症状、警觉性增高症状、PTSD与自杀意念之间起负向调节作用,在回避性症状与自杀意念之间不起调节作用。这表明PTSD各症状簇对震后青少年自杀意念的预测作用不同,且安全感在其中发挥的调节作用也不同。     

REM Sleep Bout Duration and Frequency in PTSD

The few pharmacological treatments shown to be effective in reducing sleep disturbance in posttraumatic stress disorder (PTSD) might work through normalization of rapid eye movement (REM). However, evidence of REM sleep disturbance in PTSD has been inconsistent and the definition of REM bout has varied as well. In this study, we compared polysomnographic findings in adults with PTSD to both normal sleepers and insomniacs. We found no differences between those with and without PTSD on REM bout frequency or duration. We did, however, find gender differences within our PTSD sample as consistent with a previous review suggesting that males with PTSD are more likely to demonstrate REM sleep disturbance. Consensus on REM bout definition is needed, in addition to studies powered to detect gender differences.     

Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants.     

Subtypes of clinical presentations in malingerers of posttraumatic stress disorder: an MMPI-2 cluster analysis

This paper investigated subtypes of individuals trained and instructed to malinger Posttraumatic Stress Disorder (PTSD) through a cluster analysis of their Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and validity scales. Participants were 84 men and women college students at a community college in the southeastern United States. Two well fitting MMPI-2 cluster solutions were evaluated with discriminant analyses and multivariate analyses of variance (MANOVAs); a 2-cluster solution was deemed optimal. Significant between-cluster differences emerged in follow-up analyses on most of the content scales of the MMPI-2. Most demographic variables did not account for differences in cluster membership. Clusters differed in their reported clarity of the materials used to educate them about PTSD. Discriminant analyses yielded better correct classification rates than those from previous studies, when the more severely symptomatic cluster was compared with a sample of clinical combat-related PTSD veterans. Implications are considered in conducting future malingered PTSD investigations.     

Systematic Review and Meta-Analysis of Stepped Care Psychological Prevention and Treatment Approaches for Posttraumatic Stress Disorder

Stepped care approaches have been developed to increase treatment accessibility for individuals with posttraumatic stress disorder (PTSD). However, despite guidelines recommending stepped care, it is currently unclear how the approach compares to other treatments for PTSD in terms of symptom reduction, cost, and client-rated acceptability. We conducted a systematic review and meta-analysis of randomized controlled and open trials evaluating stepped care prevention (i.e., targeting those with recent trauma exposure at risk of developing PTSD) and treatment approaches for adults and adolescents/children with PTSD. Eight prevention and four treatment studies were included. There was considerable variation in the sample types, stepped approaches, and control conditions. Most studies found no significant differences between stepped care (both prevention and treatment) and control (active and usual care) in terms of PTSD severity, loss of PTSD diagnosis, depression severity, and quality of life at the final follow-up. There was some evidence to suggest that stepped care was more cost-effective, and as acceptable or more acceptable compared to controls. Interpretations were tempered by high statistical heterogeneity, risk of bias, and lack of recommended evidence-based treatments. Stepped care can make PTSD treatment more accessible; however, more high-quality research is needed comparing stepped care to active controls.     

Young Children’s Physiological Reactivity during Memory Recall: Associations with Posttraumatic Stress and Parent Physiological Synchrony

Autonomic reactivity is implicated in stress response and social engagement – both key components of posttraumatic stress disorder (PTSD) – but few studies have examined autonomic reactivity in pediatric samples, and no known studies have examined physiological synchrony among children with PTSD and caregivers. In a sample of 247 young children (94 girls, 153 boys), most (85%) of whom had exposure to trauma and 40% who met criteria for PTSD, we examined children’s patterns of respiratory sinus arrhythmia (RSA) at baseline and in response to a memory recall task, as well as correspondence between parents’ and children’s RSA. Children with PTSD demonstrated significantly higher reactivity than other groups during their recollection of a traumatic memory, but not during other memory tasks. Regarding synchrony, caregivers’ and children’s RSA were more significantly and positively correlated during the trauma recall task among children who had had exposure to a potentially traumatic event but did not meet PTSD criteria, suggesting physiological synchrony may be protective in contexts of trauma. Overall, findings demonstrate physiological reactivity differences among young children with PTSD. While more work is needed to understand the meaning of parent-child physiological synchrony, these data suggest that children’s psychopathology is associated with physiological synchrony processes among young children with exposure to trauma.     

Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Attention training improves aberrant neural dynamics during working memory processing in veterans with PTSD

Posttraumatic stress disorder (PTSD) is associated with executive functioning deficits, including disruptions in working memory (WM). Recent studies suggest that attention training reduces PTSD symptomatology, but the underlying neural mechanisms are unknown. We used high-density magnetoencephalography (MEG) to evaluate whether attention training modulates brain regions serving WM processing in PTSD. Fourteen veterans with PTSD completed a WM task during a 306-sensor MEG recording before and after 8 sessions of attention training treatment. A matched comparison sample of 12 combat-exposed veterans without PTSD completed the same WM task during a single MEG session. To identify the spatiotemporal dynamics, each group’s data were transformed into the time-frequency domain, and significant oscillatory brain responses were imaged using a beamforming approach. All participants exhibited activity in left hemispheric language areas consistent with a verbal WM task. Additionally, veterans with PTSD and combat-exposed healthy controls each exhibited oscillatory responses in right hemispheric homologue regions (e.g., right Broca’s area); however, these responses were in opposite directions. Group differences in oscillatory activity emerged in the theta band (4–8 Hz) during encoding and in the alpha band (9–12 Hz) during maintenance and were significant in right prefrontal and right supramarginal and inferior parietal regions. Importantly, following attention training, these significant group differences were reduced or eliminated. This study provides initial evidence that attention training improves aberrant neural activity in brain networks serving WM processing.     

Similarities and differences between MMPI and MMPI-2 applications to the assessment of posttraumatic stress disorder

The purpose of this study was to address the question: Is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) comparable to the original MMPI in its applicability to the assessment of posttraumatic stress disorder (PTSD) among Vietnam combat veterans? The question was addressed by administering both the original MMPI and MMPI-2 to 29 subjects classified as meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria for PTSD and comparing MMPI and MMPI-2 scores in terms of: degree of association, code-type congruence, diagnostic hit rates (when compared to two other clinical samples, and one normal sample), and congruence of the Keane PTSD Scale (PK). Results reveal highly significant correlations between MMPI and MMPI-2 basic scales for the PTSD sample as well as congruence in 2-point codes comparable to previous studies. The MMPI-2 was found to identify effectively PTSD subjects from the other groups. Results also showed a high degree of association between the MMPI and MMPI-2 in regard to PK scores, although minor differences were found in PK raw scores between the two tests. Overall, the findings suggest a high degree of comparability between the MMPI and MMPI-2 in the assessment of PTSD.     

A Cross-Lagged Panel Approach to Understanding Social Support and Chronic Posttraumatic Stress Disorder Symptoms in Veterans: Assessment Modality Matters

Although there is a strong and consistent association between social support and posttraumatic stress disorder (PTSD), the directionality of this association has been debated, with some research indicating that social support protects against PTSD symptoms, whereas other research suggests that PTSD symptoms erode social support. The majority of studies in the literature have been cross-sectional, rendering directionality impossible to determine. Cross-lagged panel models overcome many previous limitations; however, findings from the few studies employing these designs have been mixed, possibly due to methodological differences including self-report versus clinician-administered assessment. The current study used a cross-lagged panel structural equation model to explore the relationship between social support and chronic PTSD symptoms over a 1-year period in a sample of 264 Iraq and Afghanistan veterans assessed several years after trauma exposure. Approximately a third of the sample met criteria for PTSD at the baseline assessment, with veterans’ trauma occurring an average of 6 years prior to baseline. Two separate models were run, with one using PTSD symptoms assessed via self-report and the other using clinician-assessed PTSD symptoms. Excellent model fit was found for both models. Results indicated that the relationship between social support and PTSD symptoms was affected by assessment modality. Whereas the self-report model indicated a bidirectional relationship between social support and PTSD symptoms over time, the clinician-assessed model indicated only that baseline PTSD symptoms predicted social support 1 year later. Results highlight that assessment modality is one factor that likely impacts disparate findings across previous studies. Theoretical and clinical implications of these findings are discussed, with suggestions for the growing body of literature utilizing these designs to dismantle this complex association.     

A meta-analytic investigation of the structure of posttraumatic stress disorder symptoms

Converging lines of evidence have called into question the validity of conceptualizations of posttraumatic stress disorder (PTSD) based on the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) and suggested alternative structural models of PTSD symptomatology. We conducted a meta-analysis of 40 PTSD studies (N = 14,827 participants across studies) that used a DSM-based measure to assess PTSD severity. We aggregated correlation matrices across studies and then applied confirmatory factor analysis to the aggregated matrices to test the fit of competing models of PTSD symptomatology that have gained support in the literature. Results indicated that both prominent 4-factor models of PTSD symptomatology yielded good model fit across subsamples of studies; however, the model comprising Intrusions, Avoidance, Hyperarousal, and Dysphoria factors appeared to fit better across studies. Results also indicated that the best fitting models were not moderated by measure or sample type. Results are discussed in the context of structural models of PTSD and implications for the diagnostic nosology.