PSYCH OpenIR  > 健康与遗传心理学研究室
灾后儿童创伤后应激反应类型与阶段的追踪研究
其他题名The trajectories and courses of posttraumatic stress among children survive from the earthquake: a four years longitudinal study
程锦
学位类型博士
导师刘正奎
2018-06
学位授予单位中国科学院大学
学位授予地点中国科学院心理研究所
学位名称理学博士
关键词儿童 创伤后应激反应 轨迹类别 阶段特征 质性分析 影响因素
摘要

    我国是自然灾害多发的国家。经历重大自然灾害后,创伤后应激反应是个体典型的心理反应。但并不是所有的个体都会发展出创伤后应激障碍而需要心理干预,而且心理干预资源有限,此外我国灾后心理救援仍在发展阶段,因此,辨别哪些个体需要干预以及了解群体的创伤反应阶段特点具有重要意义。本研究以经历芦山地震的儿童为研究对象,试图探索儿童创伤后应激反应的轨迹类别和阶段特征以及儿童创伤后应激反应的影响因素。

    本研究共分为三个部分。首先,本研究考察了儿童创伤后应激反应随时间变化的趋势。第一部分研究通过追踪设计,对芦山县某校学生进行追踪调查,在芦LlJ地震后2周收集了333份数据测量了急性应激障碍(acute stress disorder, ASD ),随后地震后1._5个月,6个月,12个月,24个月和48个月分别收集了331份,272份,306份,2_53份和190份测量儿童创伤后应激障碍(posttraumatic stress disorder, PTSD)症状的数据。第一部分旨在探讨ASD和PTSD症状的检出率和得分随时间的变化趋势,以及PTSD症状与时间的函数关系。结果发现:震后2周ASD症状的检出率为30.0070, 1.5个月,6个月,12个月,24个月和48个月时PTSD症状的检出率分别为8.1 070 , 6.3 070 , 6.1 070 , 4.4%和4.7 070;即随时间呈现一定的下降趋势,其中ASD到PTSD症状检出率的下降最快,2年后PTSD症状检出率几乎不变;PTSD症状与时间呈对数函数关系(y=-1.25534 In x +19.38737,且在4个月以前PTSD症状下降速率最快,4个月以后PTSD症状下降速率减缓。 

第二部分研究探讨了儿童创伤后应激反应的轨迹类别及影响因素。利用至少完成两次追踪测试的304名被试的数据进行潜变量增长模型分析。结果发现:儿童创伤后应激反应的轨迹类别有4类,心理韧性占_53.8070,低症状占32.6070,心理恢复占7.0 070,高症状占6.6070;地震前双留守,与妈妈的感情不好,地震时受伤与地震后2周ASD症状的检出是儿童PTSD症状轨迹类别为高症状,心理恢复或低症状的风险因素。

    第三部分研究探讨了儿童创伤后应激反应的时程与阶段特征。采用访谈法,在地震后4年对追踪被试中的22名儿童进行了深入访谈,收集他们地震时的经历,创伤后应激反应及其转折点,创伤后应激反应的影响因素。结果发现:根据儿童所报告的时程特征,儿童创伤后应激反应的时程可以分为4个阶段;第一阶段在1周内,儿童处于高度应激状态,第二阶段在1周至1个月内,儿童急性应激反应迅速减少,并逐步稳定,第三阶段在1个月至2年内,儿童创伤后应激反应逐渐减少,但容易被其他应激事件诱发,第四阶段在2年后,儿童只是偶尔会再想起地震,但很少害怕,逐渐摆脱了地震的影响;儿童创伤后应激反应的风险因素是亲近的人去世和创伤暴露,良好的社会支持是儿童最主要的保护因素。

    综上所述,本研究发现:

   (1)质性分析将儿童创伤后应激反应划分为4个阶段,结合数据分析4个月内是PTSD症状降低速率最快的阶段,恰好将第三个阶段划分为1至4个月和4个月至2年。因此,最终儿童创伤后应激障碍反应时程被划分为五个阶段并依据阶段特征依次命名为,应激阶段(1周内),逐步稳定阶段(1周一1个月),快速恢复阶段(1个月一4个月),缓慢复原阶段(4个月一2年),新生活阶段(2年以后)。

   (2)芦山地震后儿童创伤后应激反应轨迹类别有四类,以心理韧性(53.800为主,低症状组(32.6070)次之,心理恢复(7.0 070)和高症状组(6.6070)都占有相对低的比例。质性分析表明,在时程上,心理韧性组儿童表现出创伤后应激反应爆发早恢复快,部分高症状组和低症状组儿童表现出创伤后应激反应爆发晚恢复慢。

    (3)创伤暴露程度直接影响儿童的急性应激反应,例如目睹大量惨状,亲近人去世,身体受伤,但不一定预测儿童PTSD轨迹类别。而良好的社会支持对儿童PTSD轨迹类别起到重要的预测作用,主要表现在地震前是否双留守,与妈妈的关系,地震时和谁一起逃生,地震后社会力量和同伴支持。特别是双留守儿童具有高风险创伤后应激反应轨迹类别的主要原因是地震时缺乏父母及时有效的情感支持。

    总之,本研究具有一定的临床意义和理论意义。首先,在灾后心理干预方面,儿童创伤后反应的轨迹类别和阶段结果均提示,灾后儿童心理援助至少持续2年或直到当地完成灾后重建;影响因素分析结果提示灾后儿童心理干预的重点对象是创伤暴露水平高以及缺乏社会支持的儿童;此外,社会网络破坏的消极影响也提示可以采用以促进儿童社会网络重建为目的的干预手段。其次,本研究首次采用方程拟合的方法揭示了儿童PTSD症状与时间的函数关系;结合量化研究和质性研究首次明确提出儿童创伤后反应的五个阶段特征,丰富了群体创伤后反应的阶段理论;质性分析对儿童创伤后应激反应的影响因素的作用机制进行更深入的分析;本研究还提供了发展心理学的视角理解儿童创伤后应激反应。

其他摘要

    Nature disasters occurred frequently in China. Posttraumatic stress symptoms are widespread among the individuals experienced nature disasters. But not all of them would be onset of posttraumatic stress disorder (PTSD). In addition, the resource of psychological treatment is limited after nature disaster and the work of psychological assistance post-disaster is still on development in our country. Therefore, to identify the high-risk groups and understand the features of posttraumatic stress symptoms development among people after nature disaster are important. This study took children survived from the Lushan earthquake as subjects to explore the trajectories, the phase features and the risk and protective factors of children posttraumatic stress symptoms.
    This study consists of three parts. Study 1 aims at exploring the tendency of posttraumatic stress symptoms among children over time. The longitudinal study was used. The students from a school located Lushan county were accessed at 2 weeks after the earthquake by the Acute Stress Disorder Scale(ASDS), followed at 1.5, 6, 12,24 and 48 months after the earthquake by the University of California at Los Angeles PTSD Reaction Index for DSM-IV (UCLA PTSD-RI). Finally, 333, 331,272, 306, 253 and 190 students completed the questionnaire at 2 weeks, 1.5, 6, 12, 24 and 48 months, respectively. The results showed that the prevalence of ASD symptoms was 30.0070,  the prevalence  of PTSD  symptoms  at  1._5,  6,  12,  24  and  48  months respectively was 8.1%,6.3 070, 6.1%,4.4070 and 4.7070. The relationship between PTSD symptoms and time present as a logarithmic function (y=一1.25534 In x+19.3 8737).Though the logarithmic function, the decline speed of PTSD symptoms was the most fast before 4 months after the earthquake.
    Study 2 aims at investigating the trajectories of posttraumatic stress symptoms among children and the risk and protective factors. The latent class growth analysis was used to analyze the data from 304 students who completed the UCLA PTSD-RI at least twice. The results showed 4 trajectories of PTSD symptoms, namely resilience (53.8070), low symptoms (32.6070), recovery (7.0070), high symptoms (6.6070). We also found that double left-behind before the earthquake, bad relationship with mother, injured during the earthquake, and the detection of ASD at 2 weeks were the risk factors of high symptoms, recovery or low symptoms for children.
    Study 3 aims at exploring the phase and features of children PTSD symptoms. In total, 22 students from the original subjects were in-depth interviewed at 48 months after the earthquake. Four phases of posttraumatic stress symptoms among children were identified. The first stage was in lweek after the earthquake, and children were experiencing highly acute stress response. The second stage was from 1 week to 1 month after the earthquake, and posttraumatic stress symptoms sharply decrease among children. The third stage was from 1 month to 2 years, PTSD symptoms remit little by little. But in the third stage, children were vulnerable by other stress events.
The fourth stage was 2 years after the earthquake, children almost were not affected by the earthquake and they rarely thought of the earthquake. Close person death and trauma exposure was the risk factors and good social support was the most important protective factors of PTSD symptoms among children.
    In conclusion, the main findings of this study as follows.
    (1)Four stages of posttraumatic stress were found by qualitative analysis. However, 4 months was a time point of the decrease speed of PTSD symptoms by quantitive analysis and 4 months exactly divided the third stage into two stages, including 1 month to 4 months and 4 months to 2 years. Finally, the time line of posttraumatic stress symptoms among children was divided into _5 stages and was named as acute stress stage (1 week), generally stable stage (1 week}l month), quick recovery stage (1 month}4 months), slow recovery stage (4 months}2 years) and new life stage (2 years).
    (2) Four trajectories of PTSD symptoms among children were found, resilience (53.8070), low symptoms (32.6070), recovery (7.0070) and high symptoms (6.6070). By qualitive analysis, the results showed that at the aspect of time line, resilience group recover sooner than some of low symptoms group and high symptoms group.
    (3) Trauma exposure had directly affects on the acute stress reaction but did not predicted the trajectories of PTSD symptoms among children. Good social supports predicted resilience trajectory of PTSD symptoms among children. Good social supports include not double left-behind children, escaped with parents during the earthquake, the peer support and the non-governmental organizations (NGOs) and the government support. Especially lack of emotional support from parents was the risk of PTSD symptoms among double left-behind children.
    In conclusion, this study has important implications in practice and theory. In the practice, first, the results about trajectories and stages of children's PTSD symptoms suggested that the project of children psychological treatment post-disaster should last at least 2 years or until the post-disaster reconstruction completed; second, the children with high trauma exposure and low social support were high risk of continuous high PTSD symptoms which need the psychological treatment most; third,social network reconstruction may be good means to treatment. In the theory, the study first revealed the logarithmic function relationship between PTSD symptoms and time; this study first put forward five stages of children PTSD symptoms which enriched the theory of PTSD; the qualitative analysis revealed the mechanism of the influence factors; the study also provided a development psychology perspective to understand children posttraumatic stress reaction.

学科领域应用心理学
页数116
语种中文
文献类型学位论文
条目标识符http://ir.psych.ac.cn/handle/311026/26295
专题健康与遗传心理学研究室
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程锦. 灾后儿童创伤后应激反应类型与阶段的追踪研究[D]. 中国科学院心理研究所. 中国科学院大学,2018.
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