失独父母创伤后应激障碍的症状结构、特征及预测因素

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宋潮¹, 李婉君²^,³, 蒙晓晖¹, 邢怡伦¹, 符仲芳¹, 王建平¹(

)

1 北京师范大学心理学部, 应用实验心理北京市重点实验室, 心理学国家级实验教学示范中心<北京师范大学>, 北京 100875;
2 江苏食品药品职业技术学院, 江苏淮安223003
3 北京师范大学教育学部, 北京 100875

收稿日期:2018-04-04出版日期:2018-11-30发布日期:2018-10-30

基金资助:* 国家社科基金重大投标项目: 基于全国调研数据的中国失独人群心理健康援助体系研究资助(16ZDA233)

Assessing the symptom structure, characteristics, and predictive factors of posttraumatic stress disorder among Shidu parents

SONG Chao¹, LI Wanjun²^,³, MENG Xiaohui¹, XING Yilun¹, FU Zhongfang¹, WANG Jianping¹(

)

1 Beijing Key Laboratory of Applied Experimental Psychology; National Demonstration Center for Experimental Psychology Education <Beijing Normal University>; Faculty of Psychology, Beijing Normal University, Beijing 100875, China;
2 Jiangsu Food & Pharmaceutical Science College, Huai’an 223003, China;
3 Faculty of Education, Beijing Normal University, Beijing 100875, China

Received:2018-04-04Online:2018-11-30Published:2018-10-30

摘要/Abstract

摘要： 为考察我国失独父母创伤后应激障碍(PTSD)的症状特征及预测因素, 采用失独父母自身和孩子有关的基本信息问卷, 创伤后应激检查量表平民版(PCL-C), 对中国的463名失独父母进行调查。结果表明: (1)采用验证性因素分析验证了包括闯入、回避性、麻木性、精神痛苦性唤起和焦虑性唤起等5个因子的PTSD精神痛苦性唤起模型在中国失独父母中的适用性。(2)根据DSM-IV的诊断标准进行筛查, 71.92%的失独父母为PTSD阳性, 其中PTSD的回避、闯入、精神痛苦性唤起、情感麻木、焦虑性唤起因子阳性率依次增高。(3)失独父母的年龄、孩子的离世时长与PTSD症状具有显著的相关性; 失独父母的PTSD症状得分在自身性别、家庭所在地及家庭收入状况上存在显著差异; 将所有因素纳入回归方程后发现: 最能预测失独父母PTSD症状的因素包括: 性别、家庭所在地、年龄。

图/表 6

表1PTSD模型的项目分布表

项目	PTSD临床症状	DSM-IV模型	情感麻木模型	精神痛苦模型	精神痛苦性唤起模型
B1	闯入性思维	I	I	I	I
B2	噩梦	I	I	I	I
B3	记忆闪回	I	I	I	I
B4	情绪反应	I	I	I	I
B5	生理反应	I	I	I	I
C1	回避创伤相关想法	A/N	A	A	A
C2	回避提示创伤的线索	A/N	A	A	A
C3	创伤有关的遗忘	A/N	N	D	N
C4	丧失兴趣	A/N	N	D	N
C5	疏远他人	A/N	N	D	N
C6	情感麻木	A/N	N	D	N
C7	无希望感	A/N	N	D	N
D1	睡眠问题	H	H	D	DA
D2	易激惹	H	H	D	DA
D3	注意力问题	H	H	D	DA
D4	过度警觉	H	H	H	AA
D5	过分的惊跳反应	H	H	H	AA

表1PTSD模型的项目分布表

项目	PTSD临床症状	DSM-IV模型	情感麻木模型	精神痛苦模型	精神痛苦性唤起模型
B1	闯入性思维	I	I	I	I
B2	噩梦	I	I	I	I
B3	记忆闪回	I	I	I	I
B4	情绪反应	I	I	I	I
B5	生理反应	I	I	I	I
C1	回避创伤相关想法	A/N	A	A	A
C2	回避提示创伤的线索	A/N	A	A	A
C3	创伤有关的遗忘	A/N	N	D	N
C4	丧失兴趣	A/N	N	D	N
C5	疏远他人	A/N	N	D	N
C6	情感麻木	A/N	N	D	N
C7	无希望感	A/N	N	D	N
D1	睡眠问题	H	H	D	DA
D2	易激惹	H	H	D	DA
D3	注意力问题	H	H	D	DA
D4	过度警觉	H	H	H	AA
D5	过分的惊跳反应	H	H	H	AA

表2被试的基本信息表(N = 463)

变量	人数(百分比)	变量	人数(百分比)	变量	人数(百分比)
与逝者关系		逝者性别		是否预料孩子去世
父子	161 (34.77%)	男	332 (71.71%)	是	74 (15.98%)
母子	299 (64.57%)	女	130 (28.08%)	否	382 (82.50%)
缺失	3 (0.65%)	缺失	1 (0.22%)	缺失	7 (1.51%)
家庭所在地		教育程度		家庭人均收入
农村	215 (46.44%)	小学及以下	120 (25.92%)	0~999	134 (28.94%)
城市	243 (52.48%)	中学	293 (63.28%)	1000~1999	97 (20.95%)
缺失	5 (0.11%)	本科/大专及以上	35 (7.59%)	2000~2999	149 (32.18%)
		缺失	15 (3.20%)	3000及以上	83 (17.93%)
婚姻关系		是否有宗教信仰		是否有孙辈
有伴侣	317 (68.47%)	是	401 (86.61%)	是	117 (25.27%)
离异或丧偶	139 (30.02%)	否	54 (11.66%)	否	333 (71.92%)
缺失	7 (1.51%)	缺失	8 (1.73%)	缺失	13 (2.81%)

表2被试的基本信息表(N = 463)

变量	人数(百分比)	变量	人数(百分比)	变量	人数(百分比)
与逝者关系		逝者性别		是否预料孩子去世
父子	161 (34.77%)	男	332 (71.71%)	是	74 (15.98%)
母子	299 (64.57%)	女	130 (28.08%)	否	382 (82.50%)
缺失	3 (0.65%)	缺失	1 (0.22%)	缺失	7 (1.51%)
家庭所在地		教育程度		家庭人均收入
农村	215 (46.44%)	小学及以下	120 (25.92%)	0~999	134 (28.94%)
城市	243 (52.48%)	中学	293 (63.28%)	1000~1999	97 (20.95%)
缺失	5 (0.11%)	本科/大专及以上	35 (7.59%)	2000~2999	149 (32.18%)
		缺失	15 (3.20%)	3000及以上	83 (17.93%)
婚姻关系		是否有宗教信仰		是否有孙辈
有伴侣	317 (68.47%)	是	401 (86.61%)	是	117 (25.27%)
离异或丧偶	139 (30.02%)	否	54 (11.66%)	否	333 (71.92%)
缺失	7 (1.51%)	缺失	8 (1.73%)	缺失	13 (2.81%)

表3各竞争模型的拟合指数

模型	χ²	df	χ²/df	CFI	TLI	SRMR	RMSEA	RMSEA (90% CI)	BIC
M1	261.517	99	2.642	0.952	0.934	0.052	0.060	0.051~0.068	20912.782
M2	283.645	99	2.865	0.945	0.925	0.054	0.063	0.055~0.072	20934.910
M3	258.369	98	2.636	0.952	0.934	0.052	0.059	0.051~0.068	20915.772
M4	249.972	94	2.659	0.954	0.933	0.051	0.060	0.051~0.069	20931.926

表3各竞争模型的拟合指数

模型	χ²	df	χ²/df	CFI	TLI	SRMR	RMSEA	RMSEA (90% CI)	BIC
M1	261.517	99	2.642	0.952	0.934	0.052	0.060	0.051~0.068	20912.782
M2	283.645	99	2.865	0.945	0.925	0.054	0.063	0.055~0.072	20934.910
M3	258.369	98	2.636	0.952	0.934	0.052	0.059	0.051~0.068	20915.772
M4	249.972	94	2.659	0.954	0.933	0.051	0.060	0.051~0.069	20931.926

表4精神痛苦性唤起模型标准化的因子负荷和因子相关

题目	I	A	N	DA	AA
B1.反复发生令人不安的记忆、想法或形象	0.62
B2.反复发生令人不安的梦境	0.51
B3.压力性事件仿佛再一次发生	0.62
B4.想起压力性事件, 内心就非常痛苦	0.70
B5.想起压力性事件, 身体有反应(如呼吸困难、出汗)	0.59
C1.回避想起压力性事件的感觉或想法		0.60
C2.回避压力性事件的活动、谈话、地点或人物		0.67
C3.忘记了压力事件的重要部分			0.60
C4.对热衷的活动失去兴趣			0.55
C5.感觉与周围的人疏远或隔离			0.55
C6.感觉情感变得麻木			0.49
C7.对将来没有远大的设想			0.50
D1.难以入睡, 或睡眠很浅				0.34
D2.易被激怒或常发怒				0.62
D3.注意力难以集中				0.53
D4.过度警觉或小心					0.68
D5.容易被吓到					0.69
A	0.59^**
N	0.63^**	0.52^**
DA	0.63^**	0.53^**	0.59^**
AA	0.49^**	0.41^**	0.56^**	0.68^**

表4精神痛苦性唤起模型标准化的因子负荷和因子相关

题目	I	A	N	DA	AA
B1.反复发生令人不安的记忆、想法或形象	0.62
B2.反复发生令人不安的梦境	0.51
B3.压力性事件仿佛再一次发生	0.62
B4.想起压力性事件, 内心就非常痛苦	0.70
B5.想起压力性事件, 身体有反应(如呼吸困难、出汗)	0.59
C1.回避想起压力性事件的感觉或想法		0.60
C2.回避压力性事件的活动、谈话、地点或人物		0.67
C3.忘记了压力事件的重要部分			0.60
C4.对热衷的活动失去兴趣			0.55
C5.感觉与周围的人疏远或隔离			0.55
C6.感觉情感变得麻木			0.49
C7.对将来没有远大的设想			0.50
D1.难以入睡, 或睡眠很浅				0.34
D2.易被激怒或常发怒				0.62
D3.注意力难以集中				0.53
D4.过度警觉或小心					0.68
D5.容易被吓到					0.69
A	0.59^**
N	0.63^**	0.52^**
DA	0.63^**	0.53^**	0.59^**
AA	0.49^**	0.41^**	0.56^**	0.68^**

表5失独父母在PCL-C各项症状上得分超过3分的百分比(N = 463)

维度	症状	筛查阳性者(333)		筛查非阳性者(130)
维度	症状	症状百分比	维度百分比	症状百分比	维度百分比
闯入	B1.反复发生令人不安的记忆、想法或形象	94.6%	77.1%	61.5%	45.5%
	B2.反复发生令人不安的梦境	66.4%		26.2%
	B3.压力性事件仿佛再一次发生	82.3%		49.2%
	B4.想起压力性事件, 内心就非常痛苦	92.8%		77.7%
	B5.想起压力性事件, 身体有反应(如呼吸困难、出汗)	49.5%		13.1%
回避	C1.回避想起压力性事件的感觉或想法	87.1%	88.2%	56.2%	60.0%
回避	C2.回避压力性事件的活动、谈话、地点或人物	89.2%	88.2%	63.8%	60.0%
情感麻木	C3.忘记了压力事件的重要部分	67.3%	68.4%	43.8%	32.9%
	C4.对热衷的活动失去兴趣	69.7%		35.4%
	C5.感觉与周围的人疏远或隔离	70.9%		29.2%
	C6.感觉情感变得麻木	71.8%		36.9%
	C7.对将来没有远大的设想	62.5%		19.2%
精神痛苦性唤起	D1.难以入睡, 或睡眠很浅	83.8%	72.0%	33.8%	28.7%
	D2.易被激怒或常发怒	53.5%		20.8%
	D3.注意力难以集中	78.7%		31.5%
焦虑性唤起	D4.过度警觉或小心	58.3%	59.8%	10.8%	10.4%
焦虑性唤起	D5.容易被吓到	61.3%	59.8%	10.0%	10.4%

表5失独父母在PCL-C各项症状上得分超过3分的百分比(N = 463)

维度	症状	筛查阳性者(333)		筛查非阳性者(130)
维度	症状	症状百分比	维度百分比	症状百分比	维度百分比
闯入	B1.反复发生令人不安的记忆、想法或形象	94.6%	77.1%	61.5%	45.5%
	B2.反复发生令人不安的梦境	66.4%		26.2%
	B3.压力性事件仿佛再一次发生	82.3%		49.2%
	B4.想起压力性事件, 内心就非常痛苦	92.8%		77.7%
	B5.想起压力性事件, 身体有反应(如呼吸困难、出汗)	49.5%		13.1%
回避	C1.回避想起压力性事件的感觉或想法	87.1%	88.2%	56.2%	60.0%
回避	C2.回避压力性事件的活动、谈话、地点或人物	89.2%	88.2%	63.8%	60.0%
情感麻木	C3.忘记了压力事件的重要部分	67.3%	68.4%	43.8%	32.9%
	C4.对热衷的活动失去兴趣	69.7%		35.4%
	C5.感觉与周围的人疏远或隔离	70.9%		29.2%
	C6.感觉情感变得麻木	71.8%		36.9%
	C7.对将来没有远大的设想	62.5%		19.2%
精神痛苦性唤起	D1.难以入睡, 或睡眠很浅	83.8%	72.0%	33.8%	28.7%
	D2.易被激怒或常发怒	53.5%		20.8%
	D3.注意力难以集中	78.7%		31.5%
焦虑性唤起	D4.过度警觉或小心	58.3%	59.8%	10.8%	10.4%
焦虑性唤起	D5.容易被吓到	61.3%	59.8%	10.0%	10.4%

表6PTSD预测因素的回归分析分析结果(N = 463)

变量	β	t	r_partial
被试年龄	-0.11	-2.41*	-0.18
性别	0.23	5.35**	0.25
家庭所在地	-0.21	-4.09**	-0.20
孩子离世时长	-0.06	-1.32	-0.10
家庭收入	0.03	0.48	0.10

表6PTSD预测因素的回归分析分析结果(N = 463)

变量	β	t	r_partial
被试年龄	-0.11	-2.41*	-0.18
性别	0.23	5.35**	0.25
家庭所在地	-0.21	-4.09**	-0.20
孩子离世时长	-0.06	-1.32	-0.10
家庭收入	0.03	0.48	0.10

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