失独父母创伤后应激障碍的症状结构、特征及预测因素

doi:10.3724/SP.J.1041.2018.01400

摘要/Abstract

摘要：

为考察我国失独父母创伤后应激障碍(PTSD)的症状特征及预测因素, 采用失独父母自身和孩子有关的基本信息问卷, 创伤后应激检查量表平民版(PCL-C), 对中国的463名失独父母进行调查。结果表明: (1)采用验证性因素分析验证了包括闯入、回避性、麻木性、精神痛苦性唤起和焦虑性唤起等5个因子的PTSD精神痛苦性唤起模型在中国失独父母中的适用性。(2)根据DSM-IV的诊断标准进行筛查, 71.92%的失独父母为PTSD阳性, 其中PTSD的回避、闯入、精神痛苦性唤起、情感麻木、焦虑性唤起因子阳性率依次增高。(3)失独父母的年龄、孩子的离世时长与PTSD症状具有显著的相关性; 失独父母的PTSD症状得分在自身性别、家庭所在地及家庭收入状况上存在显著差异; 将所有因素纳入回归方程后发现: 最能预测失独父母PTSD症状的因素包括: 性别、家庭所在地、年龄。

关键词: 失独父母, 创伤后应激障碍, 症状特征, 预测因素

Abstract:

The Chinese culture regards death as a taboo subject that is often avoided in daily conversations. Moreover, the death of a family member is a family affair that is inappropriate to share with others. Thus, the bereavement experience of the Chinese is a particularly mysterious territory that provides limited information. Among all types of bereavement, the death of a child is the most significant stressor that a parent could experience. In particular, an only child’s death is the ultimate trauma that any parent could ever encounter. However, China’s one-child policy, which has been implemented since the late 1970s, has the number of bereft parents who lost their only child to illness, accident, and other causes reaching millions. For shidu parents, the death of their only child may be the most significant source of traumatic stress, coupled with financial difficulties, thereby possibly leading to a state of stress and even severe post-traumatic stress disorder (PTSD). Therefore, research on PTSD symptoms in shidu parents is critical. This study attempts to analyze the symptom characteristics and predictive factors of PTSD in shidu parents

The study investigated 463 shidu parents (mean age = 60.20 years, SD = 7.58) from March 2017 to December 2017 by using convenience sampling. The subjects completed the Parents Themselves and Their Children’s Basic Information Questionnaire and PTSD Checklist—Civilian Version (PCL-C). The survey results indicated that (1) the five-factor dysphoric arousal model entailing intrusion, avoidance, emotional numbing, dysphoric arousal, and anxious arousal was verified in the sample group of shidu parents. (2) The PTSD prevalence in the sample group was 71.9%. Among them, the incidence of PTSD, intrusion, avoidance, dysphoric arousal, emotional numbing, and anxious arousal increased. Repeated stress events; memory of past events (children), ideas, and the pain; and attempt to avoid stress factor (children’s death events) memory are the symptoms with the highest positive rates. (3) PTSD symptoms are significantly correlated with the duration of the loss and age of the shidu parents. Significant differences in PTSD symptoms were demonstrated in terms gender, home location, and family income status. The variables were incorporated into a regression equation and the three factors (i.e., gender, home location, and age) can be used to predict the PTSD symptoms

This research has theoretical and practical significance. First, this research enriched the study of PTSD symptom structure by verifying Elhai’s five-factor dysphoric arousal model. Second, this study determined that the three main factors, namely, gender, home location, and age, can be used to predict PTSD symptoms. This finding is beneficial for scholars to study the mechanism for PTSD emergence and development. Lastly, this research will enable the development of effective intervention methods for Chinese shidu PTSD. In the process of psychosocially assisting shidu parents, patients with high risk of PTSD should be screened in five aspects: intrusion, avoidance, emotional numbing, dysphoric arousal, and anxious arousal, particularly intrusion and avoidance. Furthermore, shidu patients should be distinguished in terms of age, home location, and gender to be able to implement effective approaches to alleviate the symptoms of PTSD.

Key words: Shidu parents, posttraumatic stress disorder, symptom characteristics, predictive factors

中图分类号:

R395

宋潮, 李婉君, 蒙晓晖, 邢怡伦, 符仲芳, 王建平. (2018). 失独父母创伤后应激障碍的症状结构、特征及预测因素. 心理学报, 50(12), 1400-1412.

SONG Chao, LI Wanjun, MENG Xiaohui, XING Yilun, FU Zhongfang, WANG Jianping. (2018). Assessing the symptom structure, characteristics, and predictive factors of posttraumatic stress disorder among Shidu parents. Acta Psychologica Sinica, 50(12), 1400-1412.

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项目	PTSD临床症状	DSM-IV模型	情感麻木模型	精神痛苦模型	精神痛苦性唤起模型
B1	闯入性思维	I	I	I	I
B2	噩梦	I	I	I	I
B3	记忆闪回	I	I	I	I
B4	情绪反应	I	I	I	I
B5	生理反应	I	I	I	I
C1	回避创伤相关想法	A/N	A	A	A
C2	回避提示创伤的线索	A/N	A	A	A
C3	创伤有关的遗忘	A/N	N	D	N
C4	丧失兴趣	A/N	N	D	N
C5	疏远他人	A/N	N	D	N
C6	情感麻木	A/N	N	D	N
C7	无希望感	A/N	N	D	N
D1	睡眠问题	H	H	D	DA
D2	易激惹	H	H	D	DA
D3	注意力问题	H	H	D	DA
D4	过度警觉	H	H	H	AA
D5	过分的惊跳反应	H	H	H	AA

项目	PTSD临床症状	DSM-IV模型	情感麻木模型	精神痛苦模型	精神痛苦性唤起模型
B1	闯入性思维	I	I	I	I
B2	噩梦	I	I	I	I
B3	记忆闪回	I	I	I	I
B4	情绪反应	I	I	I	I
B5	生理反应	I	I	I	I
C1	回避创伤相关想法	A/N	A	A	A
C2	回避提示创伤的线索	A/N	A	A	A
C3	创伤有关的遗忘	A/N	N	D	N
C4	丧失兴趣	A/N	N	D	N
C5	疏远他人	A/N	N	D	N
C6	情感麻木	A/N	N	D	N
C7	无希望感	A/N	N	D	N
D1	睡眠问题	H	H	D	DA
D2	易激惹	H	H	D	DA
D3	注意力问题	H	H	D	DA
D4	过度警觉	H	H	H	AA
D5	过分的惊跳反应	H	H	H	AA

变量	人数(百分比)	变量	人数(百分比)	变量	人数(百分比)
与逝者关系		逝者性别		是否预料孩子去世
父子	161 (34.77%)	男	332 (71.71%)	是	74 (15.98%)
母子	299 (64.57%)	女	130 (28.08%)	否	382 (82.50%)
缺失	3 (0.65%)	缺失	1 (0.22%)	缺失	7 (1.51%)
家庭所在地		教育程度		家庭人均收入
农村	215 (46.44%)	小学及以下	120 (25.92%)	0~999	134 (28.94%)
城市	243 (52.48%)	中学	293 (63.28%)	1000~1999	97 (20.95%)
缺失	5 (0.11%)	本科/大专及以上	35 (7.59%)	2000~2999	149 (32.18%)
		缺失	15 (3.20%)	3000及以上	83 (17.93%)
婚姻关系		是否有宗教信仰		是否有孙辈
有伴侣	317 (68.47%)	是	401 (86.61%)	是	117 (25.27%)
离异或丧偶	139 (30.02%)	否	54 (11.66%)	否	333 (71.92%)
缺失	7 (1.51%)	缺失	8 (1.73%)	缺失	13 (2.81%)

变量	人数(百分比)	变量	人数(百分比)	变量	人数(百分比)
与逝者关系		逝者性别		是否预料孩子去世
父子	161 (34.77%)	男	332 (71.71%)	是	74 (15.98%)
母子	299 (64.57%)	女	130 (28.08%)	否	382 (82.50%)
缺失	3 (0.65%)	缺失	1 (0.22%)	缺失	7 (1.51%)
家庭所在地		教育程度		家庭人均收入
农村	215 (46.44%)	小学及以下	120 (25.92%)	0~999	134 (28.94%)
城市	243 (52.48%)	中学	293 (63.28%)	1000~1999	97 (20.95%)
缺失	5 (0.11%)	本科/大专及以上	35 (7.59%)	2000~2999	149 (32.18%)
		缺失	15 (3.20%)	3000及以上	83 (17.93%)
婚姻关系		是否有宗教信仰		是否有孙辈
有伴侣	317 (68.47%)	是	401 (86.61%)	是	117 (25.27%)
离异或丧偶	139 (30.02%)	否	54 (11.66%)	否	333 (71.92%)
缺失	7 (1.51%)	缺失	8 (1.73%)	缺失	13 (2.81%)

模型	χ²	df	χ²/df	CFI	TLI	SRMR	RMSEA	RMSEA (90% CI)	BIC
M1	261.517	99	2.642	0.952	0.934	0.052	0.060	0.051~0.068	20912.782
M2	283.645	99	2.865	0.945	0.925	0.054	0.063	0.055~0.072	20934.910
M3	258.369	98	2.636	0.952	0.934	0.052	0.059	0.051~0.068	20915.772
M4	249.972	94	2.659	0.954	0.933	0.051	0.060	0.051~0.069	20931.926