汶川地震后儿童和青少年心理危机和生命质量随访调查及相关对策研究

发布时间：2018-06-22 14:20

本文选题：地震 + 儿童和青少年　；参考：《第二军医大学》2013年博士论文

【摘要】：研究背景和意义2008年5月12日，四川省发生了里氏8.0级强烈地震。这次地震危害极大，遇难69227人，受伤374643人，失踪17923人，其中遇难和失踪的学生共计5335名，共造成四川省152万名城乡劳动者失业、失地，直接经济损失达8452亿元。如何从科学的角度帮助受灾群众重建家园，是灾区社会重归和谐的基础。心理重建，作为灾后重建的重要组成部分，得到了我国政府和各社会团体的高度关注。然而，目前大多数灾后心理援助的技术和方法都来自境外，对其是否符合中国人的特点，尚需要研究。加之，从国际范围来看，对灾难发生后儿童和青少年的心理学和社会流行病学研究还非常少。汶川地震中的儿童和青少年不但遭受身体上的严重损伤，在心理、精神以及社会关系上都受到巨大创伤，这使我国完全有条件在该领域做出独特的贡献，总结出一套切实可行、符合中国国情的心理援助模式。研究方法和内容本研究以中国汶川地震为背景，阐述了灾后儿童和青少年心理危机现状和发展趋势，剖析了我国灾后心理援助工作存在的问题，并在实证的基础上提出了完善灾区儿童和青少年心理援助工作的对策和建议。具体可分为理论研究、实证研究和对策研究等三个方面。首先，理论研究总结了地震后儿童和青少年心理危机的表现、发生机制、主要类型和诊断标准，以及地震后儿童和青少年心理危机干预的目标、模型和实践方法。其次，实证研究分析了汶川地震后儿童和青少年心理危机和生命质量随访研究结果，以及汶川地震后儿童和青少年心理卫生服务利用和社会支持状况。第三，对策研究论述了汶川地震后儿童和青少年心理危机高危人群的特点，并且就如何完善汶川地震后儿童和青少年心理卫生服务供给策略和个体心理危机干预策略做了深入讨论。主要研究结果心理危机方面，灾后第1年至第3年，灾区儿童创伤后应激障碍（PTSD）和抑郁的流行率未发生明显改变，分别维持在10%和13%以上，特别是遭遇严重受伤、丧失亲人或者其他对自己非常重要的人等创伤的群体PTSD和抑郁的患病率均高达20%以上。回归分析显示，丧失亲人的儿童最易患PTSD和抑郁，其患病可能性分别是未丧失亲人群体的6.6和4.1倍。以上研究结果表明汶川地震后灾区儿童和青少年PTSD和抑郁患病已相当普遍，平均每10人中就有1～2人患病。综合PTSD患者自杀危险性一般估计（13%），仅重灾县的340万受灾学生中，34万可能患PTSD，其中4.4万人有自杀的危险性。生命质量方面，灾区儿童和青少年生命质量总分以及各维度生命质量得分均低于国内儿童生命质量平均水平。灾后第1年至第3年，灾区儿童和青少年生命质量显著下降，其中生命质量总分下降2.0、学校功能得分下降4.6。PTSD患者、抑郁患者生命质量得分随时间分别降低6.4、6.7，而非PTSD患者、非抑郁患者生命质量得分并未表现出明显的随时间变化的趋势。PTSD和抑郁是影响灾区儿童和青少年生命质量的最重要因素，PTSD或抑郁每1分值的变化都会引起生命质量0.3～0.5的反向变动。心理卫生服务利用和社会支持方面，研究发现心理卫生服务利用率从初次调查的34.6%跌至随访调查的9.5%，更重要的是，PTSD患者、抑郁患者心理卫生服务利用率始终在低位徘徊（10%～25%），即大多数PTSD患者、抑郁患者没有利用任何形式的心理卫生服务。社会支持能有效降低灾区儿童心理危机发生概率和严重程度。卫生政策建议本研究建议，灾后心理重建工作在抚慰重要创伤经历人群的基础上，应逐渐关注间接暴露群体、少数民族、女性和茂县居民。同时，鉴于灾区儿童和青少年灾后心理健康状况严峻，波及范围和涉及人数规模巨大，且因客观因素制约，如灾区高度短缺心理援助资源、有关机构无力继续灾区心理援助计划等，建议参考部分国家自然灾害后成熟的心理援助模式，将此问题上升到国家层面来考虑和应对，建立由国家主导的可靠的灾区儿童和青少年心理援助长效机制，并使其成为今后常设的减灾救灾机制的一部分。具体包括建立国家主导的灾区多层次的儿童和青少年心理援助体系、培育专业的心理卫生服务队伍以及建立长期心理卫生档案随访制度等。在个体心理危机干预中，要克服单一心理治疗或者艺术治疗的缺陷，建立一个多学科和多层次合作的服务和研究团队，，采取“心理—社会—文化”的综合干预模式，建立灾后儿童和青少年心理评估和干预机制。
[Abstract]:Research background and significance in May 12, 2008, Sichuan province occurred a strong 8 magnitude earthquake. The earthquake was very dangerous, 69227 people were killed, 374643 people were injured and 17923 people were missing. Among them, there were 5335 students who were killed and missing. The total of 1 million 520 thousand workers in urban and rural areas of Sichuan province lost their jobs, lost their land, and the direct economic losses reached 845 billion 200 million yuan. How from science To help the affected people to rebuild their homes is the basis for the restoration of harmony in the disaster stricken areas. Psychological reconstruction, as an important part of the post disaster reconstruction, has been highly concerned by the government and the social groups. However, most of the technologies and methods of psychological assistance after the disaster are from abroad, and whether they are in accordance with the characteristics of the Chinese people. In addition, in addition, the psychological and social epidemiological studies of children and adolescents after the disaster have been very small. Children and adolescents in the Wenchuan earthquake suffered from serious physical injuries, psychological, spiritual and social relations, which made our country fully conditional on the situation. The region has made a unique contribution to summarize a set of practical psychological assistance models that are consistent with China's national conditions.
The research method and content based on the Wenchuan earthquake in China, expounded the status and development trend of the psychological crisis of children and adolescents after the disaster, analyzed the problems in the post disaster psychological assistance work in China, and put forward the countermeasures and suggestions on improving the psychological assistance work of children and adolescents in the disaster area. Three aspects such as theoretical research, empirical research and countermeasure research. First, the theoretical research summarizes the manifestations, mechanism, main types and diagnostic criteria of children and adolescents' psychological crisis after the earthquake, as well as the targets, models and practical methods of psychological crisis intervention for children and adolescents after the earthquake. Secondly, the empirical study analyses the Wenchuan earthquake. The results of follow-up study on psychological crisis and quality of life of children and adolescents, and the status of psychological health service and social support for children and adolescents after Wenchuan earthquake. Third, the countermeasures were made to discuss the characteristics of the high risk population of children and adolescents after the Wenchuan earthquake and how to improve children and youth after the Wenchuan earthquake. The supply strategy of mental health service and individual psychological crisis intervention strategy were discussed in depth.
The prevalence rates of post-traumatic stress disorder (PTSD) and depression in children in disaster areas were not significantly changed from first to third years after the disaster. The prevalence rates of PTSD and depression were both maintained at 10% and 13%, especially in severe injuries, loss of relatives or other groups of people who were very important to themselves. More than 20%. Regression analysis showed that children who lost loved ones were the most vulnerable to PTSD and depression, and the likelihood of their illness was 6.6 and 4.1 times as high as that of no relatives. The results showed that children and adolescents in the disaster area after the Wenchuan earthquake were quite common in PTSD and depression, with an average of 1~2 in every 10 people. A general estimate of risk (13%) is that only 340 thousand of the 3 million 400 thousand affected students in severe disaster counties may suffer from PTSD, and 44 thousand of them have the risk of suicide.
The quality of life of children and adolescents in disaster areas was lower than the average quality of life of the domestic children. First to third years after the disaster, the quality of life of children and adolescents in the disaster areas decreased significantly, the total score of life quality decreased by 2, the score of school function decreased by 4.6.PTSD patients and depressed patients. The quality of life scores decreased with time 6.4,6.7, but not PTSD patients. The life quality score of non depressed patients did not show a obvious trend of change with time.PTSD and depression were the most important factors affecting the quality of life of children and adolescents in the disaster area, and the changes of each 1 points of PTSD or depression could cause the reverse of the quality of life from 0.3 to 0.5. Change.
In the use of mental health service and social support, the study found that the utilization rate of mental health service fell from 34.6% of the first survey to 9.5% of the follow-up survey, and more importantly, the use rate of mental health service in the PTSD patients was always at the low level (10% to 25%), that is, most of the PTSD patients, and the depressive patients did not use any form of heart. Social support can effectively reduce the probability and severity of psychological crisis in children in the disaster area.
The health policy recommends that the post disaster psychological reconstruction work, on the basis of the relief of important traumas, should gradually pay attention to indirect exposure groups, ethnic minorities, women and Maoxian residents. At the same time, in view of the severe psychological health of children and adolescents in the disaster areas, the scope and number of people involved are large, and the objective factors are due to the objective factors. Constraints, such as the high shortage of psychological aid resources in the disaster area, the relevant institutions are unable to continue the psychological assistance program in the disaster area, and suggest that the psychological aid model of some state natural disasters should be referred to the state to consider and respond to the national level, and to establish a state led long-term mechanism for psychological assistance for children and adolescents in disaster areas. And make it a part of the permanent disaster reduction and disaster relief mechanism in the future, including the establishment of a multi-layered psychological assistance system for children and adolescents in the state led disaster areas, the cultivation of professional psychological health services and the establishment of a long-term follow-up system for mental health files. Or the defects of art treatment, establish a multi-disciplinary and multi-level cooperative service and research team, adopt a "Psycho socio culture" integrated intervention model, and establish psychological assessment and intervention mechanism for children and adolescents after disaster.
【学位授予单位】：第二军医大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R179

【参考文献】