天津市社区人群创伤性事件的暴露率及其与重性抑郁障碍的关系

摘要

目的 调查天津市社区人群创伤性事件的暴露情况,探讨创伤性事件与重性抑郁障碍(MDD)患病的关系.方法 采用多阶段整群随机抽样的方法,对2011年天津市18个区县的15538个家庭中18岁以上人群进行一般健康问卷(12项,GHQ-12)调查,在完成调查的11748例对象中,根据罹患精神障碍的危险等级,按照高危100%、中危40%和低危10%的比例抽取调查对象.最终选取4438名社区居民采用美国精神障碍诊断及统计手册第4版(DSM-Ⅳ)轴Ⅰ诊断临床定式检查患者版(SCID-Ⅰ/P)进行定式访谈,了解受调查者创伤性事件的暴露情况和MDD的患病率.Logistic回归分析罹患MDD的影响因素.结果 4438例受调查者中469例经历过创伤性事件,调整后的总暴露率为10.3%.469例创伤性事件的暴露者中76例罹患MDD,调整后的患病率为6.7%.而无创伤性事件暴露的人群中MDD患病率为3.3%.Logistic回归分析显示女性(OR=1.77,95%CI:1.27~2.46)、丧偶/离异、经历创伤性事件(OR=2.21,95%CI:1.46~3.34)是罹患MDD的危险因素.结论 天津市社区人群创伤性事件的总暴露率为10.3%,MDD的患病与是否有过创伤性事件经历有关;建议全社会广泛动员参与,更加关注高危人群的心理健康问题.%Objective To investigate the prevalence of traumatic event exposure and its relationship with major depressive disorder (MDD) in community population in Tianjin. Methods A multi-stage cluster random sampling method was used for the general health questionnaire (GHQ-12) in the population aged above 18 in 15538 families of 18 counties in Tianjin city. Among the 11748 subjects who completed the survey, they were divided into the high-risk group (100%), medium risk group (40%) and low risk group (10%) according to the risk level of mental disorders. Finally, 4438 residents were interviewed with the diagnostic and statistical manual of mental disorders Fourth Edition (DSM-Ⅳ) axisⅠdiagnostic clinical interview version (SCID-Ⅰ/P). The prevalence of respondents exposed to traumatic events and MDD was calculated. Logistic regression analysis was applied to obtain the risk factors of MDD. Results A total of 469 people experienced traumatic events in 4438 subjects, and the adjusted total exposure rate was 10.3%. Seventy-six people suffered from MDD in 469 cases with traumatic events, and the adjusted total exposure rate was 6.7%. The prevalence of MDD was 3.3% in people with no traumatic events. Logistic regression analysis showed that female (OR=1.77,95%CI:1.27-2.46), widowed/divorced and experienced a traumatic event (OR=2.21,95%CI:1.46-3.34) were the risk factors of MDD. Conclusion The total exposure rate of traumatic events is 10.3% in community residents in Tianjin, and the prevalence of MDD is related with the traumatic event exposure. It is suggested that the whole society should mobilize and participate extensively, and pay more attention to the psychological health problems of high risk population.