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。

Latent Classes of Posttraumatic Stress Disorder Symptoms and Their Resilience Difference of Parents Who Lost Their Only Child

Abstract There has been a remarkable number of families who have lost their only child known as Shidu family, partially because of the one-child policy in China. The Shidu family means that the couple have only one child who has died because of disasters, accidents, homicide or suicide, and the mother is over 49 years that has passed her reproductive age so that the couple have no ability to regenerate another child. At present, there are more than one million Shidu families in China, and about 76,000 Shidu families occur each year according to official statistics. As a unique and vulnerable group, they not only were trapped in financial and pension predicament, but also suffered serious physical and mental health problems, such as post-traumatic stress disorder (PTSD), depression, grief symptoms and so forth. Shidu parents is a unique vulnerable group in Chinese society deserving attention. This study aims to (a) determine whether there are distinct PTSD symptom subgroups or classes in Shidu parents in China, (b) examine whether social-demographic and loss-related variables are associated with classes membership, and (c) compare the resilience difference among each latent classes. Participants were 385 parents who lost their only child were recruited from ten cities of five provinces in China during November 2016 to July 2017. The mean age of participants was 61.46 (SD=7.98), with females being 48% of the sample. Participants were asked to complete the PTSD Checklist for DSM-5 (PCL-5) and a short Chinese version of Connor-Davidson Resilience Scale (CD-RISC-10). Latent class analyses was used to identify different symptom classes of PTSD.We explored 1-5 latent class model, the values of the Log-likelihood, AIC，BIC and aBIC decreased with the number of classes. The three classes solution had the highest entropy and the p-value of LMR was significant. Based on fit-indices and interpretability of the outcomes, the three-classes solution was selected as the optimal solution, were named high-symptom class (30%), intermediate-symptom class (38%) and low-symptom class (32%), respectively. Further analysis indicated that classes differed in terms of age and time since loss (χ2=8.19-12.16, p<0.01); no significant differences were found among the classes in terms of gender, degree of education or religious belief (p>0.05). When age, time since loss were included in multinomial regression analyses predicting class membership, it was found that compared to those in the low-symptom class: (1) individuals in the high-symptom class were predicted by under 60 years old (OR=2.72) and the time since loss less than 10 years (OR=0.46). (2) individuals in the intermediate-symptom class were predicted by under 60 years old (OR=2.52). One-way ANOVA showed that the resilience score of high-symptom class was significantly lower than the other two classes (F=33.63, p<0.001), while the resilience score between the intermediate-symptom class and low-symptom class was not significant. There were three latent classes of PTSD symptoms among parents who lost their only child. PTSD symptoms were more serious in parents under 60 years old and lost child in the preceding 10 years, and resilience was a protective factor for parents’ PTSD symptoms after loss the only child. Attention and effective intervention should be given to those who were less than 60 years, and child died less than 10 years, helping them improve their resilience level to reduce the risk of PTSD or even other negative events.