创伤康复期患者应激障碍、心理弹性及大脑皮层厚度的研究
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摘要
目的:截至2006年4月,我国残疾人总数已达8296万,其中创伤致残占了相当大的比例。本研究的目的是针对创伤康复期患者这一特殊人群,研究他们的应激障碍、心理弹性及大脑皮层厚度的特点。为创伤康复期患者开展有针对性的心理康复提供理论依据。并进一步探讨应激障碍、心理弹性与大脑皮层厚度的联系,深入了解患者心理特点,为将来能从神经生物水平干预患者心理健康提供思路。
方法:采用创伤后应激障碍症状清单-平民版(Checklist-Civilian Version,PCL-C)、成人心理弹性量表(Resilience Scale for Adults,RSA)、症状自评量表(Symptom Checklist 90,SCL-90)、艾森克人格问卷(Eysenck Personality Questionnaire,EPQ)及应对方式五个心理量表,对179名三甲医院2008年12月到2010年3月的创伤康复期患者进行问卷调查。再从上述179名患者中选取身体状况较好,无手功能障碍的患者30人(其中PTSD组15人、非PTSD组15人),同时选取与创伤康复期患者相匹配的正常健康人15名进行大脑皮层厚度的研究。所有数据均采用SPSS11.5统计软件处理,主要方法有:t检验、相关分析、回归分析。
结果:
1.创伤康复期患者心理弹性总分为75.85±15.31,心理弹性较差。
2.创伤康复期患者PTSD总分≥38分比例为34.18%。PTSD组和非PTSD组,在心理弹性的6个因子及总均分上存在显著差异(t=-4.744,p=0.000)。
3.创伤康复期患者SCL-90量表中躯体化、抑郁、焦虑、恐惧、偏执、精神性因子分均高于全国常模(p<0.05或p<0.01)。SCL-90阳性组和阴性组在心理弹性、人格和应对方式上有显著差异。SCL-90得分与心理弹性中的自我认识、未来计划呈负相关,与神经质呈正相关,与应对方式中的自责、幻想、退避合理化呈正相关(p<0.05或p<0.01)。
4.患者心理弹性与各影响因素的相关分析发现,心理弹性与内外向、解决问题和求助有显著的正相关。
5.创伤康复期患者PTSD组的左侧大脑的眶额皮层厚度显著小于非PTSD组(p=0.018)。患者心理弹性因素与多个脑区的皮层厚度具有显著的相关性,其中包括额叶三角部、额上回、额缘、楔前叶、颞中回、扣带回等区域。
结论:创伤康复期患者心理弹性较差、心理健康水平低。患者的心理弹性水平越低,PTSD的发生率可能越大,低心理弹性、低心理健康水平可能是PTSD的重要预测因素。而内外向、解决问题和求助对心理弹性有显著的预测力。提示,可以通过干预患者的性格、改善心理健康水平等提高患者心理弹性,减少PTSD的发生。另外,发现PTSD组患者的左侧大脑的眶额皮层厚度显著小于非PTSD组,不同的心理弹性因素与多个脑区的皮层厚度分别具有显著的相关性,提示可进一步从神经生物水平干预患者心理健康。
Objective: As of April 2006 the total number of persons with disabilities has reached 8.296 million, which accounted for a considerable trauma disability percentage. The purpose of this study on rehabilitation patients after traumatic injury is to study their stress disorder, resilience and structural characteristics of the brains. It is also to provide a theoretical basis for developing targeted mental treatments for those patients, further explore the relationship between stress disorder, resilience and the volume of the cerebral cortex, understand the psychological characteristics, and provide future intervention ideas at a neurobiological level in those patients.
Methods: One hundred and seventy-nine rehabilitation patients after traumatic injury admitted in 3 high-grade hospitals from December 2008 to March 2010 were tested with PTSD Checklist-Civilian Version (PCL-C), Resilience Scale for Adult (RSA), Self-report Symptom Checklist 90 (SCL-90), Eysenck Personality Questionnaire (EPQ), and Copying Style Questionnaire. From the 179 patients, 30 people were selected with good health and without hand dysfunction (including 15 people from PTSD positive group, 15 from negative group) as well as 15 normal persons. Then we studied the volume of the cerebral cortex of those people.
Results: The average RSA total score of this cohort was 75.85±15.31. The average PTSD score of this cohort was 34.72±11.89. Significant difference was found in each factor and the total score of RSA between PTSD positive and negative groups (t=-4.744,p=0.000). Compared with the norms, evaluative indexes scores of SCL-90 including somatization, depression, anxiety, fear, crankiness and psychosis were higher (p<0.05). The scores on self-cognition and planning in RSA, nervousness in personality, self-blame, delusion, withdrawal and rationalization in copying style were significantly different between SCL-90 positive and negative groups (p<0.05 or p<0.01). Correlation analysis showed resilience was positively correlated with extraversion, settling problems and seeking for help. The volume of orbitofrontal cortex in the left brain of the PTSD positive group was significantly smaller than the negative group(p= 0.018). Correlation analysis showed several factor scores of RSA were correlated with different volume of the cortex separately.
Conclusion: The mental health and resilience level of rehabilitation patients after traumatic injury were low. When the resilience of patients is lower, PTSD is higher. Low resilience and mental health might be the main predictors for PTSD. Factors such as extraversion, settling problems and seeking for help can be of good prognostication ability. This suggests that patients can interfere with the character and improve the level of mental health patients to improve resilience and reduce the incidence of PTSD. In addition, it was shown that the PTSD positive group had a lower volume of orbitofrontal cortex in the left brain.
方法:采用创伤后应激障碍症状清单-平民版(Checklist-Civilian Version,PCL-C)、成人心理弹性量表(Resilience Scale for Adults,RSA)、症状自评量表(Symptom Checklist 90,SCL-90)、艾森克人格问卷(Eysenck Personality Questionnaire,EPQ)及应对方式五个心理量表,对179名三甲医院2008年12月到2010年3月的创伤康复期患者进行问卷调查。再从上述179名患者中选取身体状况较好,无手功能障碍的患者30人(其中PTSD组15人、非PTSD组15人),同时选取与创伤康复期患者相匹配的正常健康人15名进行大脑皮层厚度的研究。所有数据均采用SPSS11.5统计软件处理,主要方法有:t检验、相关分析、回归分析。
结果:
1.创伤康复期患者心理弹性总分为75.85±15.31,心理弹性较差。
2.创伤康复期患者PTSD总分≥38分比例为34.18%。PTSD组和非PTSD组,在心理弹性的6个因子及总均分上存在显著差异(t=-4.744,p=0.000)。
3.创伤康复期患者SCL-90量表中躯体化、抑郁、焦虑、恐惧、偏执、精神性因子分均高于全国常模(p<0.05或p<0.01)。SCL-90阳性组和阴性组在心理弹性、人格和应对方式上有显著差异。SCL-90得分与心理弹性中的自我认识、未来计划呈负相关,与神经质呈正相关,与应对方式中的自责、幻想、退避合理化呈正相关(p<0.05或p<0.01)。
4.患者心理弹性与各影响因素的相关分析发现,心理弹性与内外向、解决问题和求助有显著的正相关。
5.创伤康复期患者PTSD组的左侧大脑的眶额皮层厚度显著小于非PTSD组(p=0.018)。患者心理弹性因素与多个脑区的皮层厚度具有显著的相关性,其中包括额叶三角部、额上回、额缘、楔前叶、颞中回、扣带回等区域。
结论:创伤康复期患者心理弹性较差、心理健康水平低。患者的心理弹性水平越低,PTSD的发生率可能越大,低心理弹性、低心理健康水平可能是PTSD的重要预测因素。而内外向、解决问题和求助对心理弹性有显著的预测力。提示,可以通过干预患者的性格、改善心理健康水平等提高患者心理弹性,减少PTSD的发生。另外,发现PTSD组患者的左侧大脑的眶额皮层厚度显著小于非PTSD组,不同的心理弹性因素与多个脑区的皮层厚度分别具有显著的相关性,提示可进一步从神经生物水平干预患者心理健康。
Objective: As of April 2006 the total number of persons with disabilities has reached 8.296 million, which accounted for a considerable trauma disability percentage. The purpose of this study on rehabilitation patients after traumatic injury is to study their stress disorder, resilience and structural characteristics of the brains. It is also to provide a theoretical basis for developing targeted mental treatments for those patients, further explore the relationship between stress disorder, resilience and the volume of the cerebral cortex, understand the psychological characteristics, and provide future intervention ideas at a neurobiological level in those patients.
Methods: One hundred and seventy-nine rehabilitation patients after traumatic injury admitted in 3 high-grade hospitals from December 2008 to March 2010 were tested with PTSD Checklist-Civilian Version (PCL-C), Resilience Scale for Adult (RSA), Self-report Symptom Checklist 90 (SCL-90), Eysenck Personality Questionnaire (EPQ), and Copying Style Questionnaire. From the 179 patients, 30 people were selected with good health and without hand dysfunction (including 15 people from PTSD positive group, 15 from negative group) as well as 15 normal persons. Then we studied the volume of the cerebral cortex of those people.
Results: The average RSA total score of this cohort was 75.85±15.31. The average PTSD score of this cohort was 34.72±11.89. Significant difference was found in each factor and the total score of RSA between PTSD positive and negative groups (t=-4.744,p=0.000). Compared with the norms, evaluative indexes scores of SCL-90 including somatization, depression, anxiety, fear, crankiness and psychosis were higher (p<0.05). The scores on self-cognition and planning in RSA, nervousness in personality, self-blame, delusion, withdrawal and rationalization in copying style were significantly different between SCL-90 positive and negative groups (p<0.05 or p<0.01). Correlation analysis showed resilience was positively correlated with extraversion, settling problems and seeking for help. The volume of orbitofrontal cortex in the left brain of the PTSD positive group was significantly smaller than the negative group(p= 0.018). Correlation analysis showed several factor scores of RSA were correlated with different volume of the cortex separately.
Conclusion: The mental health and resilience level of rehabilitation patients after traumatic injury were low. When the resilience of patients is lower, PTSD is higher. Low resilience and mental health might be the main predictors for PTSD. Factors such as extraversion, settling problems and seeking for help can be of good prognostication ability. This suggests that patients can interfere with the character and improve the level of mental health patients to improve resilience and reduce the incidence of PTSD. In addition, it was shown that the PTSD positive group had a lower volume of orbitofrontal cortex in the left brain.
引文
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[2]苏慧,胡新爱,陈晓君.创伤骨折病人心理状态调查分析及护理对策.护理与康复,2003,2(2):81-82.
[3]李海垒,张文新.心理韧性研究综述.山东师范大学学报,2006, 51(3):149-152.
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