中国临床心理学杂志

艾滋病感染者中创伤后应激障碍的发病率及症状结构

作者：王倩¹ 高隽² 杨蕴萍¹

单位：1. 首都医科大学附属安定医院临床心理科北京100088
2. 复旦大学社会发展与公共政策学院心理学系上海200433

关键词：艾滋病感染者创伤后应激障碍(PTSD) 发病率创伤后应激障碍检核表因子结构

分类号：R395.2

出版年,卷(期):页码：2015,23(3):482-486

摘要：

目的:本研究考察我国艾滋病感染者中创伤后应激障碍的发病率及其症状结构。方法:样本1为云南省HIV感染者91名, 样本2为该省和北京HIV感染者366名, 施测自编创伤事件问卷及创伤后应激障碍检查表(PCLC), 用DSM-Ⅳ 轴Ⅰ障碍定式临床检查病人版(SCID-I)访谈对样本1被试进行诊断评估, 确定PCL-C区分PTSD的分界点;用验证性因素分析比较PTSD症状结构的3个竞争模型。结果:①再体验-回避-麻木-警觉一阶四因子模型拟合最优;②PCL-C区分HIV感染者罹患PTSD的最佳分界点为44分, 对应敏感度0.842, 特异度0.906, 诊断效能0.94, 样本1中PTSD发病率为41.80%。结论:PTSD在HIV感染者人群中发病率高, PCL-C在该人群中呈一阶四因子一阶相关结构, 提示该种症状分类具有跨样本一致性。

Objective: This research aimed to explore the prevalence of Post-traumatic Stress Disorder(PTSD) and its symptoms classification among Chinese HIV-positive patients. Methods: Ninety-one(sample 1) and 366 HIV-positive patients(sample 2) completed the Traumatic Events Questionnaire and PTSD Checklist-Civilian Version(PCL-C). The Structured Clinical Interview for DSM-IV AXIS I Disorders(SCID-I) was conducted in sample 1. In sample 2, confirmatory factor analysis was performed to test three competitive models. Results: ①The optimal cut-off point of PCL-C for PTSD in HIV sample was 44, with the sensitivity of 0.842, the specificity of 0.906 and the diagnostic efficiency of 0.94. The prevalence of PTSD was 41.80%. ②The inter-correlated four-factor model was the best fit for the data. Conclusion: The prevalence of PTSD in HIV-positive people was rather high and the PTSD symptoms classification was best described by the four-factor model, indicating a fairly good cross-sample validation of this model.

基金项目：

本研究获得北京市教育委员会科技计划面上项目(KM200810025011)支持

作者简介：

参考文献：

1 APA. Diagnostic and Statistical Mental Disorder, Fourth Edition( DSM-Ⅳ). Washington, DC, 1994. 393-445
2 Tedstone JE, Tarrier N. Posttraumatic stress disorder following medical illness and treatment. Clinical Psychology Review,2003, 23: 409-448
3 Schnurr PP, Friedman MJ. An overview of research findings on the nature of posttraumatic stress disorder. Department of Veterans Affairs National Center for PTSD Psychotherapy in Practice, 1997, 3(4): 11-25
4 Breslau N, Kessler RC, Chilcoat HD, et al. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Arch Gen Psychiatry, 1998, 55: 626-632
5 Schutzwoh M, Maercher A. Effects of varying diagnostic criteria for PTSD are endorsing the concept of partial PTSD. Journal of Trauma Stress 1999, 12: 155-165
6 Katz SR. Risk factors of post-traumatic stress disorder symptomatology in HIV-infected women. Dissertation, 2002
7 Kelly B, Raphael B, Judd F, et al. Posttraumatic stress disorder in response to HIV infection. General Hospital Psychiatry,1998, 20(6): 345-352
8 Shelby RA, Golden-Kreutz DM, Andersen BL. Mismatch of posttraumatic stress disorder(PTSD) symptoms and DSM-IV symptom clusters in a cancer sample: Exploratory factor analysis of the PTSD Checklist-Civilian version. Journal of Traumatic Stress, 2005, 18 (4): 347-357
9 King DW, Leskin GA, King LA, et al. Confirmatory factor analysis of the clinician-administered PTSD scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychological Assessment, 1998, 10: 90-96
10 Simms LJ, Watson D, Doebbeling BN. Confirmatory factor analysis of posttraumatic stress-symptoms in deployed and non-deployed veterans of the Gulf war. Journal of Abnormal Psychology, 2002, 111: 637-647
11 Howsepian AA. Post-traumatic stress disorder following needle-stick contaminated with suspected HIV positive blood. General Hospital Psychiatry, 1998, 20(2): 123-124
12 Campbell-Sills L, Cohan SL, Stein MB. Relationship of resilience to personality, coping, and psychiatric symptoms in young adults. Behavior Research and Therapy, 2006, 44:585-599
13 邱皓政, 林碧芳. 结构方程模型的原理与应用. 北京:中国轻工业出版社, 2009. 69-89
14 Yu XN, Zhang JX. Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale(CD-RISC) with Chinese people. Social Behavior and Personality, 2007,35(1): 19-30
15 Vedhara K, Nott KH. Psychosocial vulnerability to stress: a study of HIV-positive homosexual men. Journal of Psychosomatic Research, 1996, 41 (3): 255-267
16 Delahanty DL, Bogart LM, Figler JL. Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals. Aids Care,2004, 16(2): 247-260
17 WHO. HIV instrument users manual. Mental health: Evidence and research department of mental health and substance dependence. Geneva, 2002

服务与反馈：

【文章下载】【加入收藏】