负性生活事件、社会支持和创伤后应激障碍症状：对汶川地震后青少年的追踪研究

创伤后应激障碍是灾难后常见的心理病理问题, 灾后继发负性生活事件和社会支持是影响创伤后应激障碍症状的重要因素。该研究采用追踪设计, 历时2年对汶川地震后都江堰地区1573名青少年进行3次测查, 考察震后继发负性生活事件、不同类型社会支持与创伤后应激障碍症状之间的相互作用关系。研究发现：不同类型的社会支持与震后继发负性生活事件、创伤后应激障碍症状存在不同的作用关系; 震后继发负性生活事件不仅直接影响个体的心理健康还对个体的社会支持系统有损害; 震后负性生活事件、主观支持与创伤后应激障碍症状存在联动效应, 即三者中任一方面的变化都可能引起其他方面的变化。

Posttraumatic Stress Symptoms, Negative Life Events and Social Supports: A Longitudinal Study of Survival Adolescents following the 2008 Wenchuan Earthquake

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder following natural disasters. A growing number of studies have reported elevated prevalence and risk factors of PTSD among adolescent survivors of earthquake, flood and hurricane. Social supports and negative life events have been identified as important influence factors of adolescents’ posttraumatic stress disorder. Studies have documented that there are complex interplays among negative life events, social supports and mental health problems. The leading theoretical models of their relations include stress prevention model, support deterioration model, reciprocity of stress and perceived support model. The present study explored and compared these models of negative life events, social supports and posttraumatic stress symptoms in a large, prospective non-clinical sample of adolescents after the 2008 Wenchuan earthquake. This study is a part of the longitudinal study of adolescents in Dujiangyan district after the 2008 Wenchuan earthquake in China. A total of 1573 adolescents were sampled from Dujiangyan district, 20 kilometer away from the epicenter. At the time of 6, 18, 24 months after the earthquake, participants were asked to complete questionnaires including Self-Rating Scale for Posttraumatic Stress Disorder, Adolescent Self-Rating Life Events Checklist, Social Support Rating Scale for Children and Adolescents, and demographics including sex, age, sibling, location, and earthquake exposure factors. One thousand and seventy-four adolescents were followed up all of the three waves. The mean age of the participants was 14.9 years (SD = 1.3) at wave 1, 42.4% were female, 30.9% resided in rural areas, and 83.2% were only child. Structural equation model was used to explore the causations of posttraumatic stress symptoms, social support and negative life events following the earthquake. The results showed a moderate continuity of posttraumatic stress symptoms, negative life events, subjective social supports, objective social supports and utilization of social supports across the three waves (b = 0.39-0.57). Reciprocal relations were founded between posttraumatic stress symptoms and negative life events. To be specific, wave 1 posttraumatic stress symptoms positively predicted wave 2 negative life events (β = 0.16), wave 2 negative life events positively predicted wave 3 posttraumatic stress symptoms (β = 0.07); wave 1 negative life events positively predicted wave 2 posttraumatic stress symptoms (β = 0.07), wave 2 posttraumatic stress symptoms positively predicted wave 3 negative life events (β = 0.10). Subjective social supports and negative life events, objective social supports and negative life events also longitudinal predicted each other across waves. Specifically, wave 1 subjective social supports predicted wave 2 negative life events negatively (β = -0.11), wave 2 subjective social supports negatively predicted wave 3 negative life events (ß = -0.07), wave 1 negative life events predicted wave 2 subjective social supports negatively (β = -0.08), wave 2 negative life events negatively predicted wave 3 subjective social supports (β = -0.11); wave 1 negative life events predicted wave 2 objective social supports (β = -0.08) negatively, wave 1 objective social supports negatively predicted wave 2 negative life events (β = -0.06). In addition, wave 1 subjective social supports predicted wave 2 posttraumatic stress symptoms significantly (β = -0.07). Posttraumatic stress symptoms, negative life events and social supports influence each other. Subjective social supports, objective social supports and utilization of social supports have characteristic relations with posttraumatic stress symptoms and negative life events. Posttraumatic stress symptoms and negative life events should be assessed and prevented timely. It would be effective and meaningful to guide the survival adolescents to perceive, construct, maintain, seek and utilize their social supports.