健康与遗传心理学研究室知识库

心身疾病患者是一个创伤经历复杂且高创伤暴露的庞大群体，创伤后应激障碍（Posttraumatic stress disorder, PTSD）对该群体的心身健康造成了严重危害。2013年美国精神病学会（American Psychiatric Association, APA）提出了《精神疾病诊断与统计手册第五版》（Diagnostic And Statistical Manual of Mental Disorders Fifth Edition, DSM-5; APA, 2013）并对PTSD诊断标准进行了一系列修订，其中新加入的歪曲责备症状引发了后续大量争议和研究。本研究关注了歪曲责备症状在中国心身疾病患者群体中的症状学表现。

本研究采集了中国综合医院心身医学科门诊病人994人，平均年龄37.2岁，女性占70.5%。我们首先采用PDS创伤筛查量表调查了该群体的创伤暴露情况，采用PCL-5量表进一步评估了其中608名具有创伤经历的被试的PTSD症状筛查阳性率、PTSD各症状阳性率，并对包括歪曲责备症状在内的认知与情绪负性改变症状进行了项目反应理论分析，其次我们比较了歪曲责备症状阳性组和阴性组PTSD症状筛查阳性情况和总体症状严重程度的影响，并检测了控制人口统计学变量后歪曲责备症状对PTSD症状筛查阳性和总体严重程度的预测作用及该症状的诊断效能；最后我们采用SF-36评估了创伤暴露被试的健康相关生活质量，比较了歪曲责备症状阳性组和阴性组的健康相关生活质量得分，并检测了控制人口统计学变量后歪曲责备症状对躯体和心理社会健康相关生活质量的预测作用。

研究一发现该群体创伤暴露率约为61.2%，50.3%的创伤暴露者经历过2种及以上的创伤事件，其中自然灾害是该群体中最常见的创伤事件；创伤暴露群体PTSD症状筛查阳性率约为34.9%，歪曲责备症状的症状阳性率约为37.8%；IRT结果显示歪曲责备症状难度为0.352，区分度为1.850。研究二发现歪曲责备症状阳性组的PTSD筛查阳性率（z=16.039，p<0.001）和总体症状严重程度（t=-24.61，p<0.001）都显著高于阴性组；该症状在PTSD症状筛查阳性中的灵敏度为0.807，特异度为0.851，准确度为0.836；歪曲责备症状能够显著预测PTSD筛查阳性情况（OR=20.09，p<0.001）和总体症状严重程度（β=0.68，p<0.001）。研究三发现歪曲责备症状阳性组的躯体和心理社会健康相关生活质量得分显著高于阴性组（all ps<0.001），同时在控制人口统计学变量后仍可显著预测躯体和心理社会健康相关生活质量（all ps<0.001）。

本研究的结果说明歪曲责备症状具有良好的症状学特征，为DSM-5 PTSD诊断标准在心身疾病群体中的适用性提供了证据。

Psychosomatic patients have high trauma exposure and experience complex traumatic events, and post-traumatic stress disorder (PTSD) has severe impacts on their psychological and physical health. American Psychiatric Association (APA) proposed the fifth edition of the Diagnostic And Statistical Manual of Mental Disorders (DSM-5) in 2013 and revised the PTSD diagnostic criteria, of which the newly-added distorted blame (D3) symptom has caused much debate. The present study investigated the symptomatic characteristics of the distorted blame symptom in a sample of Chinese psychosomatic patients.

The sample included 994 outpatients from Psychosomatic Medicine department of a Chinese general hospital (mean age 37.2 years, female 70.2%). First, we assessed traumatic exposure of this sample with the PDS trauma screening questions. Second, among 608 people had traumatic experience, we investigated the prevalence of PTSD symptoms measured by PCL-5, and did Item Response theory (IRT) analysis for all symptoms reflecting the D (Negative alterations in cognitions and mood) cluster. Third, we compared PTSD prevalence and severity between groups differing on their endorsement of the D3 criteria, investigated associations between endorsing D3 symptom with PTSD possibility and severity after controlling demographic confounding factors, and tested diagnosis efficiency of the D3 symptom. Fourth, We assessed Health-related quality of life of the trauma exposers with SF-36, compared scores of health-related quality of life between groups differ on their endorsement of the D3 criteria, and investigated associations between endorsing D3 symptom with physical and psychosocial health-related quality of life after controlling demographic confounding factors.

Study 1 found that 61.2% of this sample have experienced trauma, 50.3% of trauma-exposers have experienced two or more types of trauma events, and natural disasters were the most common trauma which trauma-exposers experienced; the prevalence of PTSD in trauma-exposed group was 34.9%, and the prevalence of D3 symptom was 37.8%; the difficulty of the D3 criteria was 0.352, while the discrimination of this criteria was 1.850 within D cluster. Study 2 found that PTSD prevalence (z=16.039，p<0.001) and severity (t=-24.61，p<0.001) of the group endorsed D3 criteria were significantly higher than the group did not endorse; the sensitive of the D3 symptom was 0.807, the specificity of this symptom was 0.851, and the accuracy of this symptom was 0.836; endorsing D3 criteria was a significant predictor for possibility (OR=20.09，p<0.001) and severity of PTSD (β=0.68，p<0.001) after controlling demographic confounding factors. Study 3 found that scores of physical and psychosocial health-related quality of life were significantly lower in the group endorsed D3 criteria than the group did not endorse (all ps<0.001); endorsing D3 criteria was a significant predictor for physical and psychosocial health-related quality of life after controlling demographic confounding factors (all ps<0.001).

The results of this study indicated that the D3 symptom has good symptomatic characteristics, and provided more empirical supports for the applicability of the DSM-5 PTSD diagnostic criteria in psychosomatic patients.