地震后青少年创伤后应激障碍的潜在结构分析

为考察地震后青少年创伤后应激障碍（PTSD）的潜在症状结构,本研究采用儿童创伤后应激障碍症状量表和儿童抑郁量表,对汶川地震一年后的746名中学生进行调查。利用验证性因素分析对竞争模型进行比较,结果发现包括侵入性、回避性、麻木性、精神痛苦性唤起和焦虑性唤起等5个症状的PTSD精神痛苦性唤起模型显著优于DSM-IV的PTSD模型、4维情感麻木模型和4维精神痛苦模型。效度分析的结果发现,PTSD精神痛苦性唤起模型具有良好的外部区分效度。所有结果均表明PTSD精神痛苦性唤起模型在汶川地震后青少年群体中具有良好的适用性,可以作为判定震后青少年PTSD症状的有效标准。     

小学生创伤后应激障碍对睡眠问题的影响:积极认知的调节作用

本研究采用创伤暴露程度问卷、儿童创伤后应激障碍症状量表、应对方式问卷和儿童行为问题核查表对汶川地震30个月后844名小学生进行调查,探讨汶川地震后小学生的创伤后应激障碍(PTSD)、积极认知与睡眠问题之间的关系。结果表明,PTSD对睡眠问题具有正向预测作用,积极认知对睡眠问题的预测作用不显著。调节效应的检验结果发现,积极认知调节着PTSD及其回避性症状对睡眠问题的影响,具体表现为PTSD及其回避性症状对睡眠问题的预测作用随着积极认知水平的增加而降低,但是积极认知分别在PTSD的闯入性症状和警觉性增高症状与睡眠问题的关系之间不起调节作用。     

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。     

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。     

创伤后应激障碍对青少年生活满意度的影响：社会支持的调节作用

采用问卷法对雅安地震2.5年后的397名中学生进行测试,考察创伤后应激障碍及其各维度对生活满意度的影响,并检验社会支持在其中的调节作用。结果发现,侵入性症状、负性认知和情绪改变症状、警觉性增高症状和PTSD总分负向预测生活满意度,回避性症状对生活满意度预测作用不显著;社会支持在警觉性增高症状、回避性症状、PTSD总分与生活满意度之间起调节作用,社会支持在侵入性症状、负性认知和情绪改变症状与生活满意度之间不起调节作用。     

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。     

失独父母创伤后应激障碍的症状结构、特征及预测因素

为考察我国失独父母创伤后应激障碍(PTSD)的症状特征及预测因素, 采用失独父母自身和孩子有关的基本信息问卷, 创伤后应激检查量表平民版(PCL-C), 对中国的463名失独父母进行调查。结果表明: (1)采用验证性因素分析验证了包括闯入、回避性、麻木性、精神痛苦性唤起和焦虑性唤起等5个因子的PTSD精神痛苦性唤起模型在中国失独父母中的适用性。(2)根据DSM-IV的诊断标准进行筛查, 71.92%的失独父母为PTSD阳性, 其中PTSD的回避、闯入、精神痛苦性唤起、情感麻木、焦虑性唤起因子阳性率依次增高。(3)失独父母的年龄、孩子的离世时长与PTSD症状具有显著的相关性; 失独父母的PTSD症状得分在自身性别、家庭所在地及家庭收入状况上存在显著差异; 将所有因素纳入回归方程后发现: 最能预测失独父母PTSD症状的因素包括: 性别、家庭所在地、年龄。     

创伤后应激障碍患者情绪记忆优势研究述评

创伤后应激障碍(PTSD)是由高情绪刺激引起延迟出现和长期持续的精神障碍。闯入、闪回、病理性重复体验、持续性警觉性增高和回避等症状严重损害其认知功能。PTSD患者记忆形成了情绪网络。情绪记忆具有强烈、持久的特点, 在记忆中具有优势地位。回顾PTSD患者情绪记忆优势的行为及脑成像研究发现, PTSD患者情绪记忆优势研究结果并不完全一致, 受到诸多因素的影响, 这些影响因素需进一步探讨。     

术后乳腺癌患者体象对创伤后应激障碍和创伤后成长的影响：反刍的中介作用

为探讨乳腺癌患者反刍这一认知情绪调节方式在体象和创伤后应激障碍（PTSD）、创伤后成长（PTG）之间的中介作用,采用体象量表（BIS）、认知情绪调节问卷中文版（CERQ-C）、创伤后应激障碍量表（PSS）和创伤后成长问卷（PTGI）对150名乳腺癌术后患者进行研究。结果发现：（1）乳腺癌患者的体象可以正向预测PTSD和PTG;（2）乳腺癌患者的反刍在体象和PTSD的闯入性症状、回避性症状中起中介作用,在体象与PTG中的中介作用不显著。结果表明,体象既可以正向预测乳腺癌患者的PTSD和PTG,也可以通过反刍的中介作用影响PTSD。     

青少年创伤后应激障碍症状与网络成瘾症状的关系：惩罚敏感性和孤独感的中介及性别的调节

汶川地震9.5年后,对汶川县和都江堰市767名中学生进行调查,考察惩罚敏感性和孤独感在创伤后应激障碍症状和网络成瘾症状之间的多重中介作用及性别差异。结果发现：（1）PTSD症状正向预测网络成瘾症状,并分别通过惩罚敏感性、孤独感的单独中介作用及两者的链式中介作用显著预测网络成瘾症状;（2）女性的PTSD症状显著正向预测网络成瘾症状,并分别通过惩罚敏感性和孤独感间接影响网络成瘾症状;男性的网络成瘾症状仅被PTSD症状正向预测。     

Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash

We assessed the psychiatric co-morbidity associated with chronic posttraumatic stress disorder (PTSD) (1-2 years) secondary to personal injury motor vehicle accidents (MVAs) in two studies. In Study 1, we compared the results of SCID assessments for 75 treatment-seeking MVA survivors (51 with PTSD and 24 with symptoms but no PTSD). In Study 2, we compared similar results among 132 MVA survivors who had been followed prospectively for 12+ months after their accidents (19 with PTSD, 32 who had PTSD but who had remitted, and 81 who never met criteria for PTSD). We found comparable levels of current co-morbid major depression (53%), any mood disorder (62-68%), generalized anxiety disorder (26%) and any anxiety disorder (42%) for both groups of participants with chronic PTSD. These rates of co-morbidity were higher than those found in non-PTSD comparison groups with similar MVA histories.     

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.     

Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans

Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up.Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.     

Posttraumatic Stress Disorder and Associated Functional Impairments During Pregnancy: Some Consequences of Violence Against Women

Despite the high prevalence of violence in the lives of women of reproductive age, and the adverse consequences posed to pregnant women suffering from PTSD, few studies have examined violence-related trauma and PTSD among pregnant women. A structured research interview was administered to a convenience sample of 85 prenatal care women to collect information regarding their experiences of violence victimization, PTSD symptoms related to violence-related traumatic events, and whether these symptoms impaired various aspects of the women's daily functioning. Results indicated that 69% of the women experienced a violent traumatic event, with the majority of events occurring before the current pregnancy and being perpetrated by the women's intimate partners. The traumatized women evidenced high levels of PTSD symptoms during pregnancy, with 58% of the women meeting criteria for a PTSD diagnosis. Moreover, many of the women with PTSD symptoms reported that the symptoms adversely affected aspects of their daily functioning.     

Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic

The Institute of Medicine has stressed the need for evaluations of evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) among active duty service members (AD) using a variety of evaluation approaches (Institute of Medicine, 2012). The current study examined the clinical files of 134 service members who completed treatment for PTSD using either prolonged exposure (PE) or cognitive processing therapy at an outpatient clinic. At the completion of each session, therapists made a clinical rating as to whether or not the session was protocol adherent. The total number of treatment sessions and the proportion of sessions rated as being protocol adherent were calculated. Multi-level models estimated the change in patient PTSD and other psychological symptoms over time as a function of clinician-rated protocol adherence and total number of sessions. Approximately 65% of clinic encounters were rated by therapists as being protocol adherent. Significant reductions in PTSD and psychological symptoms were associated with protocol adherence, and this was particularly true for patients who began treatment above clinical thresholds for both PTSD and other psychological symptoms. However, as the number of sessions increased, the impact of protocol adherence was attenuated. Patient characteristics, including gender, ethnicity, and co-morbidity for other psychiatric disorders were not related to symptom change trajectories over time. These findings suggest that protocol adherence and efficiency in delivery of EBTs for the treatment of PTSD with AD is critical.     

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。     

Suicide Ideation in Female Survivors of Military Sexual Trauma: The Trauma Source Matters

Female veterans who have experienced military sexual trauma (MST) are at elevated suicide risk, yet knowledge is limited regarding correlates of suicide ideation (SI) in this population. MST is associated with a higher risk of posttraumatic stress disorder (PTSD) relative to other trauma types; however, no studies have examined whether experiencing SI differs based on the source of PTSD symptoms (MST‐related, non–MST‐related). Female service members/veterans (SM/Vs; n = 311) who screened positive for MST and reported exposure to a Criterion A event completed an online survey assessing self‐reported demographics, PTSD, depression, the source of their PTSD symptoms, and SI. Ninety‐one (29.3%) reported experiencing current SI, and 223 (71.7%) identified MST as the source of their current PTSD symptoms. Participants who identified MST as the source of their PTSD symptoms were over two times more likely to report SI, compared to those who described non–MST‐related events as the source of their PTSD symptoms. Compared to those who reported the source of their PTSD symptoms as combat‐/deployment‐related, those who identified MST as the source were at least three times as likely to report current SI. Results underscore the importance of efforts to address MST‐related PTSD symptoms when working with female SM/Vs.     

The cycle of violence as a function of PTSD and appetitive aggression: A longitudinal study with Burundian soldiers

During deployment, soldiers face situations in which they are not only exposed to violence but also have to perpetrate it themselves. This study investigates the role of soldiers' levels of posttraumatic stress disorder (PTSD) symptoms and appetitive aggression, that is, a lust for violence, for their engaging in violence during deployment. Furthermore, factors during deployment influencing the level of PTSD symptoms and appetitive aggression after deployment were examined for a better comprehension of the maintenance of violence. Semi-structured interviews were conducted with 468 Burundian soldiers before and after a 1-year deployment to Somalia. To predict violent acts during deployment (perideployment) as well as appetitive aggression and PTSD symptom severity after deployment (postdeployment), structural equation modeling was utilized. Results showed that the number of violent acts perideployment was predicted by the level of appetitive aggression and by the severity of PTSD hyperarousal symptoms predeployment. In addition to its association with the predeployment level, appetitive aggression postdeployment was predicted by violent acts and trauma exposure perideployment as well as positively associated with unit support. PTSD symptom severity postdeployment was predicted by the severity of PTSD avoidance symptoms predeployment and trauma exposure perideployment, and negatively associated with unit support. This prospective study reveals the importance of appetitive aggression and PTSD hyperarousal symptoms for the engagement in violent acts during deployment, while simultaneously demonstrating how these phenomena may develop in mutually reinforcing cycles in a war setting.     

Examining the relation between PTSD and insomnia on aggression

Posttraumatic stress disorder (PTSD) symptoms and poor sleep have been identified as potential causals factor in aggression, violence, and impulsive behavior. Given the high cost of aggression to society and public health, identifying modifiable factors related to aggression, such as insomnia, may guide treatment strategies to help decrease aggression. Participants were 143 Veterans seeking treatment for PTSD at a VA outpatient PTSD clinic. Linear and logistic regression analyses were used to examine the relation between PTSD and insomnia on aggression. Results from bivariate analyses indicated that while both PTSD and insomnia severity were associated with higher aggression scores independently, when PTSD and insomnia were examined together, PTSD severity was the only significant predictor of aggression. Interaction effects yielded nonsignificant results suggesting that poor sleep did not moderate the PTSD and aggression relation. Results suggest that addressing PTSD symptoms as a first treatment target may be more important for decreasing risk for aggression than targeting insomnia. More research is needed to understand whether treating PTSD and insomnia reduces aggression in Veterans.     

Emotion Dysregulation in Comorbid Posttraumatic Stress Disorder and Substance Use Disorders: A Narrative Review

Co-occurrence of substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) is extremely common and is associated with elevated dropout and relapse rates. Given that PTSD/SUD co-occurrence rates among veterans have been found to be as high as 55?75%, it is important to identify mechanisms that may affect the interplay of both disorders. Emotion dysregulation (ED) presents a candidate mechanism that may underlie poor treatment response in co-occurring PTSD/SUD. This article proposes a transdiagnostic emotion regulation framework that considers ED conceptualized as a combination of low ability to tolerate emotional distress (low distress tolerance) and difficulties in the goal-directed use of emotion regulation strategies as a key risk factor in co-occurring PTSD/SUD. The authors review empirical findings from self-report and laboratory-based studies of ED in PTSD. They describe psychological explanations of the emotion-substance relationship and review studies documenting ED in SUDs and in co-occurring PTSD/SUD. The literature on ED in PTSD/SUD suggests that (a) patients with PTSD may resort to substances to cope with trauma-related symptoms due to ED, and (b) ED may maintain SUD symptoms and interfere with psychological treatment. Longitudinal studies on bidirectional relationships between ED and substance use in PTSD are needed, particularly research examining the course of ED in PTSD patients who use substances versus those who do not.