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灾后儿童创伤后应激障碍和抑郁共病关系的演化及核心症状
Alternative TitleEvolution and core symptoms of the relationship between post-traumatic stress disorder and depressive symptoms among children after disasters
梁一鸣
Contributor刘正奎
2021-06
Abstract创伤后应激障碍(posttraumatic stress disorder, PTSD)和抑郁是创伤后最常见的心理障碍。由于二者共病的高发生率及其带来的不良临床后果,探究二者共病的病因学机制和寻找关键性干预靶点具有重要的理论和临床意义。关于PTSD和抑郁的病因学假设仍存在争议,且现有关于二者共病的研究存在缺乏长时程纵向研究、缺乏系统性症状层面的分析及缺乏对儿童青少年群体关注的重要局限。本研究采用长时程纵向设计,从宏观层面的整体探讨入手,进而探究微观层面的症状作用。 研究的第一节从整体层面探讨儿童青少年PTSD 和抑郁症状的发展轨迹和相互影响模式。被试为301 名经历过“512”汶川地震的北川县学生(M 年龄 = 12.5岁, 52.2%为男性)。调查持续了4 年,分别于震后4、16、29、40 和52 个月进行了调查。测量工具为UCLA-PTSD 反应指数量表和儿童抑郁量表,统计方法为混合增长模型和交叉滞后模型。研究结果显示:(1)PTSD 存在3 种轨迹——韧性组(74.9%)、恢复组(7.5%)和故态复发组(17.7%);(2)抑郁存在2 种轨迹——韧性组(66.2%)和持续组(33.8%);(3)PTSD 和抑郁在灾后早期阶段呈相互预测的模式,而在后期阶段仅抑郁预测PTSD。 研究的第二节从症状网络的视角出发,探讨儿童青少年PTSD 和抑郁症状的共病网络结构的演变。被试为1460 名经历过舟曲特大泥石流的舟曲县学生(M 年 龄 = 12.9 岁,47.7%为男性)。调查从灾后3个月开始持续了2年,分别于3、15和27个月进行了调查。测量工具同第一节,统计方法为正则化偏相关网络。研究结果显示:(1)相比于PTSD 症状网络的结构,抑郁症状网络的结构发展更稳定;(2)线索引发的生理反应、睡眠问题和哭泣在早期的共病网络中具有高预期影响水平,线索引发的生理反应、与他人疏离、注意力问题、悲伤、自我贬低、自我讨厌和孤独在后期的共病网络中具有高预期影响水平;(3)与他人疏离、睡眠问题(睡眠障碍)、自我讨厌和孤独是共病网络中持续具有高中介性的症状。 研究的第三节在第二节的基础上引入时间维度,探讨儿童青少年PTSD 和抑郁症状的共病网络中的症状作用路径。被试和测量工具同第二节,统计方法采用多水平向量自回归模型(mlVAR)。研究结果显示:PTSD 和抑郁重叠的症状之一睡眠障碍是共病时间网络中最具有预测力的核心症状。 本论文在宏观层面上发现,PTSD 和抑郁症状在灾后早期阶段可以相互预测,而后期仅抑郁症状预测PTSD 症状,部分支持了共病假说中的交互作用假说。对于PTSD 和抑郁症状的轨迹分析和二者网络结构演变分析均显示抑郁的发展比PTSD 稳定,这可能是后期抑郁占主导作用的重要原因。症状网络视角下,PTSD与抑郁的重叠症状和抑郁内与广泛性情感痛苦相关的症状维系着两个疾病的联结。时间网络的分析识别出灾后3 个月的睡眠障碍对共病网络中的症状具有重要的预测性,提示了创伤性睡眠问题对长期抑郁和PTSD 形成的关键作用。本文具有重要的临床启示:在儿童青少年的灾后心理干预中,早期应当同时关注PTSD和抑郁,后期应当重点关注持续的抑郁症状。同时,在早期的临床诊断中应当高度关注创伤后睡眠问题,以期提高诊断的敏感性,从而切断PTSD 和抑郁症状的长期发展。
Other AbstractPosttraumatic stress disorder and depression are the most common psychological disorders to occur after people exploring a traumatic event. Due to the high incidence of comorbidity and its adverse clinical consequences, it is important to explore the etiological mechanism of the comorbidity of PTSD and depression and to find the key intervention targets. There are still controversies over the etiological hypothesis of PTSD and depression while the existing research on their comorbidity lacks studies of long-term longitudinal analysis or systematic symptom level analysis, without having the attention on children and adolescents. The current study adopted a long-term longitudinal design, starting the discussion from an overall perspective and then discussing in further details. The first section of the study explores the developmental trajectory and mutual influence mode of PTSD and depressive symptoms among children and adolescents. The participants were 301 students from Beichuan County who had experienced the “512” Wenchuan earthquake (Mage = 12.5 years old, 52.2% were males). The whole investigation lasted for 4 years and were carried out at 4, 16, 29, 40 and 52 months after the earthquake. The study used UCLA-PTSD Reaction Index for DSM-Ⅳ and Children’s Depression Inventory for measurement, and used Latent Growth Mixture Modeling and Cross-Lagged Model as the tools of data analysis. The results showed that: (1) There were three trajectories of PTSD: resilience group (74.9%), recovery group (7.5%) and relapse group (17.7%); (2) depression had two trajectories resilience group (66.2%) and chronic group (33.8%); (3) PTSD and depression showed a mutually predictive pattern in the early stage after the disaster, while in the later stage, only depression predicted PTSD. The second section of the study explored the evolution of the comorbid network structure of PTSD and depressive symptoms in children and adolescents from the perspective of the symptom network. Participants were 1,460 Zhouqu County students who had experienced Zhouqu debris flow (Mage = 12.9 years old, 47.7% were males). The investigation lasted for 2 years from 3 months after the disaster, and the investigation was carried out at 3, 15 and 27 months. The measurements were the same as those in the first section, and the regularized partial correlation network was used as statistical method in this section. The results showed that: (1) Compared with the structure of the PTSD symptom network, the structure of the depressive symptom network was more stable. (2) Physiological cue reactivity, sleep problems and crying had a high level of expected influence in the comorbid network at the early stage. Physiological cue reactivity, detachments, concentration problems, sadness, self-depreciation, self-hatred and loneliness had high levels of expected influence in the comorbid network at the later stage. (3) Detachments, sleep problems, self-hate and loneliness had persistently high levels of betweenness in the comorbid network. The third section of the study introduced the time dimension on the basis of the second section to explore the symptom action path in the comorbid network of PTSD and depression symptoms in children and adolescents. The participants and measurements were the same as in section 2, and the statistical method used a multilevel vector autoregressive model (mlVAR). The results showed that sleep problems, one of the overlapping symptoms of PTSD and depression, were the most predictive symptoms in the comorbid temporal network. To summarize the findings of this paper, from an overall perspective, posttraumatic stress symptoms and depressive symptoms predicted each other in the early postdisaster stage, while only depressive symptoms predicted posttraumatic stress symptoms in the later stage. These results partially supported the interaction hypothesis in the comorbidity hypothesis. The trajectory analysis and the analysis of the evolution of the network structure of PTSD and depressive symptoms showed that the development of depression was more stable than the one of PTSD. This might be an important reason for the dominant role of depression in the later stage. From the perspective of the symptom network, the overlapping symptoms of PTSD and depression and the symptoms related to generalized emotional pain in depression maintain the connection between the two diseases. The analysis of the time network identified that sleep problems 3 months after the disaster have an important predictive effect on the symptoms in the comorbid network, suggesting the key role of traumatic sleep problems in the formation of long-term depression and PTSD. This article has important clinical implication. In the psychological intervention of children and adolescents after a disaster, PTSD and depression should be considered at the same time at the early stage, and persistent depressive symptoms should continue to be considered at the later stage. Meanwhile, attention should be paid to posttraumatic sleep problems in early clinical diagnosis to improve the sensitivity of diagnosis, thereby cutting off the long-term development of PTSD and depressive symptoms.
Keyword创伤后应激障碍(PTSD) 抑郁 共病 症状网络 儿童青少年
Subtype博士
Language中文
Degree Name理学博士
Degree Discipline应用心理学
Degree Grantor中国科学院心理研究所
Place of Conferral中国科学院心理研究所
Document Type学位论文
Identifierhttp://ir.psych.ac.cn/handle/311026/39614
Collection健康与遗传心理学研究室
Recommended Citation
GB/T 7714
梁一鸣. 灾后儿童创伤后应激障碍和抑郁共病关系的演化及核心症状[D]. 中国科学院心理研究所. 中国科学院心理研究所,2021.
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