一起重大道路交通事故受伤人员的心理危机评估  

Assessment of psychological crisis among the injured from a serious road traffic accident

作　　者：汤路瀚 王鹤秋[1] 张滢[1] 沈芳[1] 郭忠伟[1] 姜波 王萍[1] 魏红辉[1] 徐方忠[1] TANG Luhan;WANG Heqiu;ZHANG Ying;SHEN Fang;GUO Zhongwei;JIANG Bo;WANG Ping;WEI Honghui;XU Fangzhong(Department of Clinical Psychology,Tongde Hospital of Zhejiang Province,Hangzhou,Zhejiang 310012,China)

机构地区：[1]浙江省立同德医院临床心理科,浙江杭州310012

出　　处：《预防医学》2022年第10期973-977,共5页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：浙江省医药卫生平台重点资助计划(2012ZDA006);浙江省软科学研究计划(2021C35114)。

摘　　要：目的针对一起重大交通事故幸存者进行心理危机评估,了解其主要心理行为反应和急性应激障碍(ASD)发生情况。方法纳入一起重大交通事故中≥7岁受伤人员,排除重度伤患者。收集性别、年龄、文化程度、婚姻状况、受伤程度、亲人伤亡情况和心理行为反应等资料;由心理危机评估人员采用半结构化访谈和急性应激障碍量表(ASDS)评估ASD发生情况,并分析影响因素。结果纳入心理危机评估132人,男性82人,占62.12%;女性50人,占37.88%;年龄为(46.50±18.57)岁。无明显外伤6人,占4.54%;轻度伤113例,占85.61%;中度伤13例,占9.85%。6人在此次事故中有亲人死亡。心理行为反应以睡眠差、焦虑担忧、闪回和害怕为主,检出率分别为42.42%、35.58%、26.52%和23.48%。检出ASD阳性40例,阳性检出率为30.30%。女性ASD阳性检出率为52.00%,高于男性的17.07%(χ^(2)=17.940,P<0.001);事故中有亲人死亡者ASD阳性检出率为83.33%,高于无亲人死亡者的26.98%(χ^(2)=8.370,P=0.004);中度伤患者ASD阳性检出率较高,为61.54%(χ^(2)=6.786,P=0.034)。多因素logistic回归分析结果显示,女性(OR=7.764,95%CI:3.187~18.915)和文化程度高(高中/中专,OR=6.896,95%CI:1.030~46.152;大专及以上,OR=71.583,95%CI:4.145~1236.270)的受伤人员ASD风险较高。结论重大道路交通事故发生后的心理行为反应以睡眠差和焦虑担忧为主,女性和文化程度高者ASD发生风险较高,应及时进行心理危机干预。Objective To investigate psychological and behavioral responses and the prevalence of acute stress disorder(ASD)among the injured from a serious road traffic accident.Methods The injured persons at ages of 7 years and older from a serious road traffic accident were enrolled,and individuals with severe injury were exclude.Participants’gender,age,educational level,marital status,injury severity,family member’s injury and death during the accident and psychological and behavioral status were collected.The prevalence of ASD was estimated using a semi-structured interview and the ASD Scale,and the factors affecting the development of ASD were identified using a multivariable logistic regression model.Results A total of 132 survivors participated in psychological crisis assessment,including 82 men(62.12%)and 50 women(37.88%)and with a mean age of(46.50±18.57)years.There were 6 participants without obvious trauma(4.54%),113 with mild injury(85.61%)and 13 with moderate injury(9.85%),and there were 6 participants with death of their family members during this accident.Insomnia,anxiety,flashback and fear were predominant psychological and behavioral responses,with prevalence rates of 42.42%,35.58%,26.52% and 23.48%,respectively.The prevalence of ASD was 30.30%among participants,and a higher rate of ASD was detected among women than among men(52.00%vs.17.07%;χ^(2)=17.940,P<0.001).The detection of ASD was higher among participants with death of their family members than among those without death of their family members(83.33%vs.26.98%;χ^(2)=8.370,P=0.004),and a higher detection rate of ASD was seen among participants with moderate injury(61.54%;χ^(2)=6.786,P=0.034).Multivariable logistic regression analysis showed a higher risk of ASD among females(OR=7.764,95%CI:3.187-18.915)and those with a high educational level(high school/technical secondary school,OR=6.896,95%CI:1.030-46.152;diploma and above,OR=71.583,95%CI:4.145-1236.270).Conclusions Insomnia and anxiety are predominant psychological and behavioral responses

关 键 词：急性应激障碍 心理危机 心理行为反应 突发事故 

分 类 号：R395.6[哲学宗教—心理学]