本帖最後由 lsc0019 於 2009-5-4 22:57 編輯
作者：Caroline Cassels
出處：WebMD醫學新聞
April 20, 2009 — 新研究認為，軍人戰鬥前的生理或心理健康狀態不佳，會使他們在退役後新發生創傷後壓力症候群(posttraumatic stress disorder，PTSD)的風險增加。
一篇包括了5,410 名退伍軍人的大型前溯研究顯示，一開始的生理心理健康測量最低者，發生PTSD症候群或診斷的風險達2至3倍。
主要作者、Cynthia LeardMann向Medscape Psychiatry表示，就我們所知，這是首次前溯探討與新發生之PTSD症候群或診斷有關的身、心理健康研究。本研究認為，派駐戰場前的生理或心理健康狀態不佳，與退役後PTSD風險增加有強烈關聯。
研究者也指出，研究發現提供生理和心理健康狀態對預防戰鬥後多數PTSD之重要性的強力證據。
這項研究線上登載於4月16日的BMJ期刊。
【開始時的心理健康是最強的預測因子】
PTSD與不佳的健康狀態和生活品質有關。不過，多數之前的研究是根據橫斷面或回溯資料，因此，作者指出，使得難以確認不佳的生理或心理健康對新發生或持續的PTSD症候群的影響。
為了研究此一問題，研究者使用Millennium Cohort Study這個有關軍人長期健康的21年縱向研究資料，其中包括了在2000年10月時對美國各軍種軍人隨機篩選的研究世代。
在2001年7月至2003年間，使用醫療結果研究SF-36健康調查，評估開始時的心理和生理健康，這些研究對象在伊拉克和阿富汗進行第一次戰爭之後，在2004至2006年間獲得追蹤資料。
符合的5,410名參與者中(在開始後與追蹤期間有派駐且進行戰鬥者)， 397人 (7.3%) 在追蹤期間有新發生的PTSD症候群或診斷；校正其他變項之後，研究者發現，開始時自我報告心理健康低於15百分位者，佔了戰鬥退役後PTSD的35%。
再者，作者報告指出，新發生PTSD者有58%生理或心理健康狀態在開始時都低於15百分位。
整體來說，研究者發現，心理健康低於15百分位者，新發生PTSD症候群或診斷風險增加3倍，生理健康低於15百分位者，新發生PTSD症候群或診斷風險增加2倍。
【確認有風險的族群】
根據LeardMann小姐表示，之前的研究指出，創傷或經歷壓力時的生理過程可以被許多整合因素如對創傷事件的認知、解釋與評估，以及所用的因應策略和其他個人與社會因素而改變。
她表示，因此，創傷經驗前心理健康不佳者對於壓力事件的反應較差，會有負面反應和反社會經驗。
她指出，經歷事件前心理健康不佳，不只會影響創傷發生時的反應，也可能影響事件後運用的因應策略。
作者寫道，我們辨識出有風險的族群，其健康狀態似乎可以預測戰鬥退役後的PTSD可能性。理論上，這類族群應是PTSD預防計畫的對象，在暴露於壓力之後早期介入，或者甚至避免曝露於壓力事件。
美國國防部資助本研究。作者報告並無相關宣告。
BMJ. 線上發表於2009年4月17日。
Poor Physical, Mental Health Status May Increase PTSD Risk
By Caroline Cassels
Medscape Medical News
April 20, 2009 — Poor physical or mental health prior to combat exposure may predispose military personnel to an increased risk for new-onsetposttraumatic stress disorder (PTSD) after deployment, new research suggests.
A large prospective study that included 5410 veterans showed deployed military personnel with the lowest baseline measures of physical or mental health had 2 to 3 times the risk of having PTSD symptoms or diagnosis.
"To our knowledge, this is the first study to prospectively investigate diminished physical and mental health in relation to new-onset symptoms or diagnosis of PTSD. This study suggests diminished mental or physical health status before combat deployment is strongly associated with an increased risk of PTSD after deployment," lead author Cynthia LeardMann, told Medscape Psychiatry.
The investigators also note that the findings provide "strong evidence that physical and mental health is essential for prevention of a large portion of PTSD after combat."
The study is published online April 16 in BMJ.
Baseline Mental Health Strongest Predictor
PTSD has been linked to diminished health status and quality of life. However, most previous studies have been based on cross-sectional or retrospective data, and therefore, the authors note, this has made it difficult to determine the effects of substandard physical or mental health on new-onset or persistent symptoms of PTSD.
To investigate this question, investigators used data from the Millennium Cohort Study, a 21-year longitudinal study designed to determine the long-term effects of military service on health. It includes an invited cohort randomly selected from all US military personnel serving in October 2000.
Using the medical outcomes study SF-36 health survey for veterans, mental and physical health was assessed at baseline between July 2001 and 2003. Follow-up data were obtained between 2004 and 2006, after study subjects had their first combat deployment in Iraq and Afghanistan.
Of 5410 eligible participants (deployed between baseline and follow-up and reporting combat exposures), 397 (7.3%) had new-onset symptoms or diagnosis of PTSD at follow-up. After adjustment for all other variables, the researchers found military service members who were below the 15th percentile for self-reported baseline mental health accounted for 35% of the incidence of PTSD after combat deployment.
Furthermore, the authors that reported 58% of those with new-onset PTSD fell below the 15th percentile for mental or physical health at baseline.
Overall, investigators found a 3-fold increase in new-onset symptoms or diagnosis of PTSD among those below the 15th percentile of mental health and a 2-fold increase of new-onset PTSD symptoms or diagnosis of PTSD among those below the 15th percentile of physical health.
At-Risk Population Identified
According to Ms. LeardMann, previous research indicates that psychological processes during traumatic or stressful experience may be shaped by a multitude of integrated factors, including perception, interpretation, and evaluation of the traumatic event, as well as coping strategies used and other personal and social factors.
"Therefore," she said, "individuals with diminished mental health prior to a traumatic experience might be more likely to react poorly to the stressful event, including having a negative response and dissociative experience."
She added that having diminished mental health prior to the event may not only affect the reaction while the trauma is occurring butpossibly the coping strategies used after the event.
"We have identified an at-risk population whose functional health seems to predict vulnerability to PTSD after combat deployment. In theory, such a population could be targeted for PTSD prevention programs, early intervention after exposure to stress, or even protection from stressful exposures, when possible," the authors write.
The study was funded by the US Department of Defense. The authors report no disclosures.
BMJ. Published online April 17, 2009. |
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