芦山地震后儿童急性应激障碍症状、创伤后应激障碍症状与抑郁症状的交叉滞后分析

摘要

目的:考察芦山地震后儿童的急性应激障碍(ASD)症状、创伤后应激障碍(PTSD)症状和抑郁症状的关系,并探讨地震后2周儿童ASD症状和抑郁症状对地震后6周PTSD症状和抑郁症状是否存在预测作用.方法:选取经历芦山地震的10～14岁儿童197例(男生93例,女生104例),使用急性应激障碍量表(ASDS)、加州大学创伤后应激障碍反应指数修改版(UCLAPTSD-RI)和简版抑郁-焦虑-压力量表(DASS)分别于地震后2周和6周进行测查.采用交叉滞后分析方法对数据进行分析.结果:地震后2周儿童在ASDS上得分为(36.5±10.9),检出率为28.6％,在DASS抑郁维度上得分为(3.3±2.8);6周儿童在UCLAPTSD-RI上得分为(18.5 ±12.6),检出率为8.2％,在DASS的抑郁维度上得分为(3.3±3.5).交叉滞后分析结果显示,2周儿童ASDS得分对6周UCLAPTSD-RI得分(β=0.59,P＜0.001)和DASS抑郁维度得分(β=0.29,P＜0.001)的预测作用具有统计学意义,而2周儿童DASS抑郁维度得分对6周儿童UCLAPTSD-RI得分的预测作用无统计学意义.结论:地震后儿童ASD症状对随后PTSD症状和抑郁症状具有正向的预测作用,地震后6周内的抑郁症状可能相对稳定.%Objective:To examine the relationships between acute stress disorder (ASD) symptoms,posttraumatic stress disorder (PTSD) symptoms and depressive symptoms in children survivors following the Lushan earthquake in China.Methods:One hundred ninety-seven children aged 1 to 14years (93 male and 104 female) were followed up at two and six weeks after Lushan earthquake.The ASDS,UCLA PTSD Reaction Index and DASS were used to measure the ASD,PTSD and depressive symptoms.Results:The average scores of ASDS and the depression subscale of DASS at two weeks after earthquake were(36.5 ± 10.9) and (3.3 ± 2.8),respectively.The average scores of UCLA PTSD Reaction Index and the depression subscale of DASS-21 at six weeks after earthquake were (18.5 ± 12.6) and (3.3 ± 3.5),respectively.The rates of ASD and PTSD were 28.6％ and 8.2％,respectively.The cross-lagged structural equation analysis with latent variables indicated that the ASD symptoms at two weeks after earthquake positively predicted PTSD symptoms (β =0.59,p ＜ 0.001) and depressive symptoms (β =0.29,p ＜0.001) at six weeks after earthquake.But there was no significant association between depressive symptoms at two weeks and PTSD symptoms at six weeks after earthquake.Conclusion:ASD symptoms in the early time postearthquake could predict subsequent PTSD and depressive symptoms,while depressive symptoms tend to remain stable within six weeks after earthquake.