【作者】 朱宏博；

【导师】 张丽；

【作者基本信息】 吉林大学 ， 临床医学， 2011， 硕士

【摘要】 目的:在汶川地震两周年时,调查长春市某中学震区异地复学青少年创伤后应激障碍(PTSD)症状检出率,应对方式特点和心理健康状况,分析并探讨地震和异地复学对震区青少年的心理健康影响及危险因素;为今后心理干预和震后安置提供依据。方法:采取整群抽样法,抽取在长春市某中学异地复学的190名来自地震极重灾区四川省茂县羌族初中二年级学生作为研究样本,予以问卷调查。共计190名学生接受了调查并填写了问卷,收回有效问卷180份,有效回收率为94.74%。其中男性85人,女性95人。被试年龄13-17岁,平均年龄为15.08±0.967岁。调查问卷包括自编地震基本情况调查表,创伤后应激障碍自评量表,症状自评量表,简易应对方式问卷等。心理测查过程严格质量控制。所有数据录入Excel2000建立数据库并整理编码。采用SPSS14.0统计软件对资料统计学分析。统计方法包括:统计描述,t检验,方差分析,Pearson相关及Spearman相关分析。结果:1.创伤后应激症状(PTSS)检出率为65.6%,其中轻度PTSS占16.7%;中重度占48.9%。2. 92.8%的震区异地复学青少年感到有学习压力;女性被试比男性被试体验到更多的分离症状; 167人(94.4%)使用积极应对方式;10人(5.7%)采取消极应对方式。3.在地震中是否有被困经历、是否有恐怖经历、是否目睹/接触遇难遗体等因素对PTSD-SS总分及三个因子分(重现/回避症状、心理障碍/功能受损、情感麻木/紧张敏感)有显著影响(p<0.001);有被困经历、恐怖经历、目睹/接触过遇难遗体的被试要比没有此类经历的被试在PTSS总分及三个因子上的得分高,且差异显著(p<0.05)。4.不同年龄、不同性别的被试PTSS总分及因子得分上有差异。13～14岁年龄组比15、16～17岁年龄组在PTSS总分[F(2,177)=4.048, p<0.05]及重现/回避症状[F(2,177)=3.361, p<0.05]、心理障碍/功能受损[F(2,177)=3.420, p<0.05]、情感麻木/紧张敏感[F(2,177)=3.419, p<0.05]等三个因子的得分低,差异显著;女性在PTSS总分及三个因子的得分比男性高,差异显著(p<0.05)。5.震区异地复学青少年中有61.1%的人存在不同程度心理问题。被试群体在躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性等各因子得分均显著高于中国青少年常模水平(p<0.001);有过被困经历、恐怖经历以及目睹/接触过遇难遗体的被试比没有此类经历的被试SCL-90总分及各因子分高,存在统计学差异(p<0.05)。在躯体化、强迫、人际敏感、抑郁、焦虑、恐怖、偏执、精神病性八个因子上女性被试的得分均高于男性;特别是在在强迫、抑郁、恐怖这三个因子上,女性被试得分显著高于男性被试,但在敌对因子上男性得分高于女性,但差异不显著。6.震区异地复学青少年心理健康状况与PTSD-SS总分和因子分的相关分析:结果显示SCL-90总分以及躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执、精神病性各因子得分和PTSD-SS总分以及重现/回避症状、心理障碍/功能受损、情感麻木/紧张敏感这三个因子分都呈显著正相关(p<0.05);7.震区异地复学青少年经历地震后有28.3%的人感到中、重度痛苦,65%的人感到轻度痛苦;地震痛苦程度与PTSD-SS总分及因子分呈显著正相关(p<0.05)。结论:1.地震极重灾区异地复学青少年在地震两年后存在较高创伤后应激反应和心理健康问题,其中创伤后应激症状检出率为65.6%;有61.1%的青少年存在心理健康问题。异地复学青少年心理健康水平低于中国青少年平均水平。女性比男性更易出现创伤后应激症状和心理问题,女性心理问题主要症状为强迫、抑郁、恐怖;心理问题越重,创伤后应激症状会越明显。2.在地震中有过被困经历、有恐怖经历、有目睹/接触过遇难者遗体以及地震痛苦程度是创伤后应激症状和心理问题的重要相关因素。3.震区异地复学青少年心理健康需要特别关注;有必要对这一群体进行有效的心理干预;提供社会和家庭支持。更多还原

【Abstract】 Purpose:The aim of the study is to investigate the relevance ratio of PTSD, evaluate the psychologic status and the defense mechanism as well as the coping style in teenagers survived in the earthquake who had returned to school in different places and a psychological service had been provided for them. We analyzed the psychologic influence and risk factor to the adolescents suffered from the demographic factors,, the earthquake exposure levels, coping styles and had been back to school in different places. We hope this study can provide a guidance for the psychological intervention and treatment for future.Methods:By using the cluster sampling method, The psychological measurements were made in 190 junior middle school students of Qiang Nationality, who were from disaster area, Mao county, Sichuan, and had returned to school in Changchun. One hundred ninety questionnaires were sent out and there were 180 valid questionnaires, availability is 94.74% , The students screened included 85 boys, 95 , age range, 13–17 years; mean age, 15.08±0.967 years. The measuring scales used were as follows: self-designed basic questionnaire for earthquake traumatic exposure, post-traumatic stress disorder self-rating scale(PTSD-SS), symptom checklist 90(SCL-90), simplified coping style questionnaire, etc. All data were logged in Excel 2000 and a database was established. All analyses were performed using SPSS for Windows, version 14.0. Statistical methods included as follows: statistical description, t test, ANOVA, Pearson correlation and Spearman correlation analysis. Results:1. The detection rate of post -traumatic stress symptoms(PTSS)is 65.6%. including 16.7% with mildly abnormal PTSS and 48.9% with moderate to severe.2. Teenagers felt progressive study pressures; Women who had experience separation symptoms gain more feeling than that of men in this test. 167 people (94.4%) use positive coping styles; 10 people (5.7%) take negative coping styles.3. Whether trapped experience in the quake, whether have the experience of fear and terror, Whether or not witnessed or contacted corpse have significantly effect(p<0.001)(reappear/avoidance symptoms, psychological barrier/dysfunction score, emotional numbing/nervous sensitive symptoms). One who has the experience of been trapped and fear, witnessed or contacted corpse gets a higher score in total score and three factors of PTSD-SS than who has no these experiences, and have a significantly differences(p<0.05).4. People of different ages have different scores in PTSS and the three factors. 13 to 14 age group get lower score than 15 and 16 ~ 17 years old age group in PTSS total cent [F(2,177)=4.048, p<0.05]and recreate/withdrawal symptoms[F(2,177)=3.361, p<0.05], psychological obstacles/function is impaired[F(2,177)=3.420, p<0.05], emotional numbing/nervous sensitive[F(2,177)=3.419, p<0.05] and have significant differences; Girls get higher score ,significant differences, than boys in total cent and three factors of PTSS(p<0.05).5. 61.1% of teens who had returned to school in different places have lots of different psychological problems, including somzatization , force, interpersonal sensitive, depression, anxiety, hostile, terror, paranoid, psychoticism and so on , various factors score significantly higher level of the norm of Chinese teenagers (p < 0.001); Trapped experience, horror and see/contact corpses was trying to get higher score than others who has no experience and exist statistical differences in SCL - 90 (p < 0.05). Except in hostile factor on males gets higher than men; In force, depression, terror that three factors, there was a significant difference between women and men, women were trying to get higher score than men.6. Teenagers who had returned to school in different places, their mental health and PTSS total score and factors of correlation analysis: result points total score of SCL - 90, and somzatization, sensitive interpersonal relation, depression, anxiety, hostile, terror, paranoid, psychoticism factor score respectively with total score of PTSD - SS/ar symptoms, and reproduce psychological barrier/function damaged and emotional numbing/nervous sensitive these three factors points are positively correlated (p<0.05).7. 28.3% of teenagers who had returned to school in different places felt medium or heavy pain after the earthquake, 65 percent of people felt mild pain; Pain degree of degree and total cent of PTSD - SS and factor points is a significant positive correlation.Conclusion:1. Teenagers who had returned to school in different places to study from the heavy earthquake area after two years ago, still existing the higher post-traumatic stress and psychological problems . The detection rate of post -traumatic stress symptoms(PTSS)is 65.6%; 61.1% of them have lots of different psychological problems. Back to school mental health of young people in different places lower than the average level of the China Youth. Women are more vulnerable than men to post-traumatic stress symptoms and psychological problems, The main symptoms of psychological problems of women is compulsion, depression, terror. The heavier psychological problem , the more obvious PTSS will be.2.Trapped in the earthquake, had experience with the horrors, witnessed/contact bodies and the degree of seismic suffering post-traumatic stress symptoms and psychological problems are important factors.3. All of these teenagers’mental health must pay attention; It is necessary to effectively this group psychological intervention; Provide social and family support to help them to alleviate post-traumatic stress symptoms and solve the psychological problems.更多还原