灾后中小学生创伤后应激障碍和抑郁症状的共存模式

doi:10.3724/SP.J.1041.2022.01503

摘要/Abstract

摘要：

为揭示灾后中小学生创伤后应激障碍(PTSD)和抑郁在症状层面的共存模式, 本研究分别在汶川地震和雅安地震1年后, 对灾区的中小学生进行问卷调查, 并基于高斯图形模型和贝叶斯爬山算法构建了二者的共存症状网络。结果发现, 在DSM-IV的框架下, PTSD和抑郁的重叠症状以及情绪麻木症状在二者的共存网络中起到了桥接作用; 子网络探测结果与DSM-IV划分的症状边界不同, PTSD中的闯入性症状和回避性症状是其区别于抑郁的特异性症状, 且多为闯入性症状激发回避性症状; 在二者的共存模式中, 多为抑郁症状激发PTSD症状。上述结果在汶川和雅安两个样本中均得到了交叉验证, 具有一定的可推广性。

关键词: 创伤后应激障碍(PTSD), 抑郁, 网络分析, 中小学生

Abstract:

Post-traumatic stress disorder (PTSD) and depression have high rates of co-morbidity among primary and secondary school students who have experienced a major natural disaster. Some researchers have suggested that overlapping symptoms and dysphoria symptoms of PTSD contribute to co-morbidity, while others have attempted to explain the co-morbidity through a causal relationship between them. However, most of these studies have been based on the hypothesis of common causes, explaining co-morbidity at level of disorders or dimensions, while few studies have investigated patterns of the co-morbidity from the perspective of symptoms.

The Child PTSD Symptoms Scale (CPSS) and Center for Epidemiologic Studies Depression Scale for Children (CES-DC) were administered to two samples of primary and secondary school students one year after the earthquake (Wenchuan earthquake, N = 2530, 47.0% males, M_age = 12.86, SD = 1.96; Ya'an earthquake, N = 723, 47.7% males, M_age = 13.40, SD = 2.29). Gaussian graphical models (GGM) and Bayesian hill climbing algorithms were used to describe patterns of the co-morbidity between PTSD and depression.

Overlapping symptoms and emotional numbness were the bridging symptoms. Detachment and future- limited symptoms were bridge symptoms in DSM-IV, were not bridge symptoms in the absence of DSM-IV, and fear, startle response and hypervigilance symptom were bridge symptoms. DSM-IV inaccurately defines the boundaries of PTSD, while intrusion and avoidance symptoms are core symptoms of PTSD. Depressive symptoms were more likely to trigger PTSD symptoms, while intrusive symptoms triggered avoidance symptoms.

The above findings were cross-validated in both Wenchuan and Ya'an samples, enhancing the generalizability of the findings and responding to the reproducibility crisis of psychological research. This enlightens clinical practitioners to prioritize the identification of bridging symptoms in the early assessment of clients who have suffered from traumatic events, in order to screen out clients at high-risk of co-morbid with depression. Secondly, the bridge symptoms should also be used as a breakthrough in the intervention process to develop intervention strategies. Finally, during the prognostic process, special attention should be paid to the recurrence of bridging symptoms to prevent the re-emergence of co-morbidity.

Key words: PTSD, depression, network analysis, primary and secondary school students

中图分类号:

B844
R395

王文超, 原昊, 伍新春. (2022). 灾后中小学生创伤后应激障碍和抑郁症状的共存模式. 心理学报, 54(12), 1503-1516.

WANG Wenchao, YUAN Hao, WU Xinchun. (2022). Co-morbidity patterns of posttraumatic stress disorder and depressive symptoms: A network analysis of post-earthquake primary and secondary school students. Acta Psychologica Sinica, 54(12), 1503-1516.

图/表 19

参考文献 65

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变量	汶川		雅安
变量	频数	百分比	频数	百分比
民族
汉族	405	16.0%	717	99.2%
藏族	628	24.8%	6	0.8%
羌族	1434	56.7%
彝族	2	0.1%
其他	57	2.3%
年级(T1)
四年级	451	17.8%	130	18.0%
五年级	505	20.0%	150	20.7%
六年级	450	17.8%
初一	461	18.2%	128	17.7%
初二	431	17.0%	174	24.1%
高一	99	3.9%	112	15.5%
高二	127	5.0%	29	4.0%
创伤暴露
被困	500	19.8%	61	8.4%
受伤	155	6.1%	83	11.5%
父/母死亡	76	3.0%	2	0.3%
老师死亡	105	4.2%	2	0.3%
同学死亡	327	12.9%	82	11.3%
亲戚/朋友死亡	906	35.8%	79	10.9%
房屋严重或完全损毁	1607	63.5%	497	68.6%
害怕受伤	1609	63.6%	425	58.7%
害怕死亡	1510	59.7%	420	58.0%

变量	汶川		雅安
变量	频数	百分比	频数	百分比
民族
汉族	405	16.0%	717	99.2%
藏族	628	24.8%	6	0.8%
羌族	1434	56.7%
彝族	2	0.1%
其他	57	2.3%
年级(T1)
四年级	451	17.8%	130	18.0%
五年级	505	20.0%	150	20.7%
六年级	450	17.8%
初一	461	18.2%	128	17.7%
初二	431	17.0%	174	24.1%
高一	99	3.9%	112	15.5%
高二	127	5.0%	29	4.0%
创伤暴露
被困	500	19.8%	61	8.4%
受伤	155	6.1%	83	11.5%
父/母死亡	76	3.0%	2	0.3%
老师死亡	105	4.2%	2	0.3%
同学死亡	327	12.9%	82	11.3%
亲戚/朋友死亡	906	35.8%	79	10.9%
房屋严重或完全损毁	1607	63.5%	497	68.6%
害怕受伤	1609	63.6%	425	58.7%
害怕死亡	1510	59.7%	420	58.0%

所属网络	汶川网络1	雅安网络1	汶川网络2	雅安网络2
所有被估计的边
整个网络	666	666	465	465
PTSD子网络	136	136	45	45
抑郁子网络	120	120	136	136
PTSD与抑郁的直连边	272	272	170	170
权重不为0的边
整个网络	465	437	345	315
PTSD子网络	111	104	43	42
抑郁子网络	99	98	115	114
PTSD与抑郁的直连边	172	161	111	96
网络密度
整个网络	0.70	0.66	0.74	0.68
PTSD子网络	0.82	0.76	0.96	0.93
抑郁子网络	0.83	0.82	0.85	0.84
PTSD与抑郁的直连边	0.63	0.59	0.65	0.56
网络强度
整个网络	18.53	17.95	15.11	14.52
PTSD子网络	5.28	5.04	3.29	3.39
抑郁子网络	5.13	5.16	6.39	6.41
PTSD与抑郁的直连边	5.33	5.19	2.73	2.30
平均权重
整个网络	0.04	0.04	0.04	0.05
PTSD子网络	0.05	0.05	0.08	0.08
抑郁子网络	0.05	0.05	0.06	0.06
PTSD与抑郁的直连边	0.03	0.03	0.02	0.02

所属网络	汶川网络1	雅安网络1	汶川网络2	雅安网络2
所有被估计的边
整个网络	666	666	465	465
PTSD子网络	136	136	45	45
抑郁子网络	120	120	136	136
PTSD与抑郁的直连边	272	272	170	170
权重不为0的边
整个网络	465	437	345	315
PTSD子网络	111	104	43	42
抑郁子网络	99	98	115	114
PTSD与抑郁的直连边	172	161	111	96
网络密度
整个网络	0.70	0.66	0.74	0.68
PTSD子网络	0.82	0.76	0.96	0.93
抑郁子网络	0.83	0.82	0.85	0.84
PTSD与抑郁的直连边	0.63	0.59	0.65	0.56
网络强度
整个网络	18.53	17.95	15.11	14.52
PTSD子网络	5.28	5.04	3.29	3.39
抑郁子网络	5.13	5.16	6.39	6.41
PTSD与抑郁的直连边	5.33	5.19	2.73	2.30
平均权重
整个网络	0.04	0.04	0.04	0.05
PTSD子网络	0.05	0.05	0.08	0.08
抑郁子网络	0.05	0.05	0.06	0.06
PTSD与抑郁的直连边	0.03	0.03	0.02	0.02

标签	缩写	题项	量表
B1	噩梦	会做噩梦	CPSS
B2	想法侵入	和地震有关的令人难过的想法或画面, 会突然闯进我的脑海中	CPSS
B3	情感反应	当我想起或听别人说到地震的时候, 会感到难过	CPSS
B4	闪回	我的行为或情绪反应好像不断经历地震一样	CPSS
B5	生理反应	当我想起或听别人说到地震的时候, 会有一些身体上的反应	CPSS
C1	兴趣减退	对过去经常做的事明显失去兴趣	CPSS
C2	未来受限	感觉我未来的计划或希望不会实现	CPSS
C3	回避线索	试图躲避那些会让我想起地震的活动、人物或地点	CPSS
C4	情绪麻木	情绪麻木(比如, 哭不出来, 或高兴不起来)	CPSS
C5	失忆	无法记起这次地震的一些重要经历	CPSS
C6	疏离	感觉与周围的人亲近不起来	CPSS
C7	回避想法	试图不去回忆、谈论或感受地震这件事	CPSS
D1	注意力问题_D	很难集中注意力	CPSS
D2	睡眠问题_D	很难入睡或容易惊醒	CPSS
D3	惊跳反应	感觉紧张或很容易受到惊吓	CPSS
D4	高警觉	过分警觉	CPSS
D5	烦躁易怒	感觉焦躁不安或容易发火	CPSS
A1	感到困扰	我为一些以前并没有困扰我的事而觉得困扰	CES-DC
A2	食欲不振	我不想吃东西, 也不怎么觉得饿	CES-DC
A3	外部支持无用	即使家人和朋友努力使我好受点, 我也无法快乐起来	CES-DC
A4	自我认可	我觉得我和其他孩子一样好	CES-DC
A5	注意力问题_A	我觉得我无法集中精力做事	CES-DC
A6	情绪低落	我觉得情绪低落不开心	CES-DC
A7	精疲力竭	我觉得太累了, 不能做事情了	CES-DC
A8	乐观	我觉得有好事要发生	CES-DC
A9	挫败无用	我觉得自己以前做的事没有起作用	CES-DC
A10	恐惧	我觉得恐惧	CES-DC
A11	睡眠问题_A	我睡得没有以前好	CES-DC
A12	开心	我觉得开心	CES-DC
A13	活力降低	我比以前安静多了	CES-DC
A14	孤独	我觉得孤独, 好像我没有任何朋友似的	CES-DC
A15	被排斥	我觉得我认识的小孩对我不友好, 他们不想和我在一起	CES-DC
A16	享受生活	我过得很好	CES-DC
A17	哭泣	我想哭	CES-DC
A18	悲伤	我觉得悲伤	CES-DC
A19	不被喜爱	我觉得人们不喜欢我	CES-DC
A20	难以开始	对我来说, 很难开始着手做一些事情	CES-DC