本文選題：地震 + 兒童和青少年��； 參考：《第二軍醫(yī)大學(xué)》2013年博士論文

【摘要】：研究背景和意義2008年5月12日，四川省發(fā)生了里氏8.0級(jí)強(qiáng)烈地震。這次地震危害極大，遇難69227人，受傷374643人，失蹤17923人，其中遇難和失蹤的學(xué)生共計(jì)5335名，共造成四川省152萬(wàn)名城鄉(xiāng)勞動(dòng)者失業(yè)、失地，直接經(jīng)濟(jì)損失達(dá)8452億元。如何從科學(xué)的角度幫助受災(zāi)群眾重建家園，是災(zāi)區(qū)社會(huì)重歸和諧的基礎(chǔ)。心理重建，作為災(zāi)后重建的重要組成部分，得到了我國(guó)政府和各社會(huì)團(tuán)體的高度關(guān)注。然而，目前大多數(shù)災(zāi)后心理援助的技術(shù)和方法都來(lái)自境外，對(duì)其是否符合中國(guó)人的特點(diǎn)，尚需要研究。加之，從國(guó)際范圍來(lái)看，對(duì)災(zāi)難發(fā)生后兒童和青少年的心理學(xué)和社會(huì)流行病學(xué)研究還非常少。汶川地震中的兒童和青少年不但遭受身體上的嚴(yán)重?fù)p傷，在心理、精神以及社會(huì)關(guān)系上都受到巨大創(chuàng)傷，這使我國(guó)完全有條件在該領(lǐng)域做出獨(dú)特的貢獻(xiàn)，總結(jié)出一套切實(shí)可行、符合中國(guó)國(guó)情的心理援助模式。 研究方法和內(nèi)容本研究以中國(guó)汶川地震為背景，闡述了災(zāi)后兒童和青少年心理危機(jī)現(xiàn)狀和發(fā)展趨勢(shì)，剖析了我國(guó)災(zāi)后心理援助工作存在的問(wèn)題，并在實(shí)證的基礎(chǔ)上提出了完善災(zāi)區(qū)兒童和青少年心理援助工作的對(duì)策和建議。具體可分為理論研究、實(shí)證研究和對(duì)策研究等三個(gè)方面。首先，理論研究總結(jié)了地震后兒童和青少年心理危機(jī)的表現(xiàn)、發(fā)生機(jī)制、主要類(lèi)型和診斷標(biāo)準(zhǔn)，以及地震后兒童和青少年心理危機(jī)干預(yù)的目標(biāo)、模型和實(shí)踐方法。其次，實(shí)證研究分析了汶川地震后兒童和青少年心理危機(jī)和生命質(zhì)量隨訪研究結(jié)果，以及汶川地震后兒童和青少年心理衛(wèi)生服務(wù)利用和社會(huì)支持狀況。第三，對(duì)策研究論述了汶川地震后兒童和青少年心理危機(jī)高危人群的特點(diǎn)，并且就如何完善汶川地震后兒童和青少年心理衛(wèi)生服務(wù)供給策略和個(gè)體心理危機(jī)干預(yù)策略做了深入討論。 主要研究結(jié)果心理危機(jī)方面，災(zāi)后第1年至第3年，災(zāi)區(qū)兒童創(chuàng)傷后應(yīng)激障礙（PTSD）和抑郁的流行率未發(fā)生明顯改變，分別維持在10%和13%以上，特別是遭遇嚴(yán)重受傷、喪失親人或者其他對(duì)自己非常重要的人等創(chuàng)傷的群體PTSD和抑郁的患病率均高達(dá)20%以上�；貧w分析顯示，喪失親人的兒童最易患PTSD和抑郁，其患病可能性分別是未喪失親人群體的6.6和4.1倍。以上研究結(jié)果表明汶川地震后災(zāi)區(qū)兒童和青少年P(guān)TSD和抑郁患病已相當(dāng)普遍，平均每10人中就有1～2人患病。綜合PTSD患者自殺危險(xiǎn)性一般估計(jì)（13%），僅重災(zāi)縣的340萬(wàn)受災(zāi)學(xué)生中，34萬(wàn)可能患PTSD，其中4.4萬(wàn)人有自殺的危險(xiǎn)性。 生命質(zhì)量方面，災(zāi)區(qū)兒童和青少年生命質(zhì)量總分以及各維度生命質(zhì)量得分均低于國(guó)內(nèi)兒童生命質(zhì)量平均水平。災(zāi)后第1年至第3年，災(zāi)區(qū)兒童和青少年生命質(zhì)量顯著下降，其中生命質(zhì)量總分下降2.0、學(xué)校功能得分下降4.6。PTSD患者、抑郁患者生命質(zhì)量得分隨時(shí)間分別降低6.4、6.7，而非PTSD患者、非抑郁患者生命質(zhì)量得分并未表現(xiàn)出明顯的隨時(shí)間變化的趨勢(shì)。PTSD和抑郁是影響災(zāi)區(qū)兒童和青少年生命質(zhì)量的最重要因素，PTSD或抑郁每1分值的變化都會(huì)引起生命質(zhì)量0.3～0.5的反向變動(dòng)。 心理衛(wèi)生服務(wù)利用和社會(huì)支持方面，研究發(fā)現(xiàn)心理衛(wèi)生服務(wù)利用率從初次調(diào)查的34.6%跌至隨訪調(diào)查的9.5%，更重要的是，PTSD患者、抑郁患者心理衛(wèi)生服務(wù)利用率始終在低位徘徊（10%～25%），即大多數(shù)PTSD患者、抑郁患者沒(méi)有利用任何形式的心理衛(wèi)生服務(wù)。社會(huì)支持能有效降低災(zāi)區(qū)兒童心理危機(jī)發(fā)生概率和嚴(yán)重程度。 衛(wèi)生政策建議本研究建議，災(zāi)后心理重建工作在撫慰重要?jiǎng)?chuàng)傷經(jīng)歷人群的基礎(chǔ)上，應(yīng)逐漸關(guān)注間接暴露群體、少數(shù)民族、女性和茂縣居民。同時(shí)，鑒于災(zāi)區(qū)兒童和青少年災(zāi)后心理健康狀況嚴(yán)峻，波及范圍和涉及人數(shù)規(guī)模巨大，且因客觀因素制約，如災(zāi)區(qū)高度短缺心理援助資源、有關(guān)機(jī)構(gòu)無(wú)力繼續(xù)災(zāi)區(qū)心理援助計(jì)劃等，建議參考部分國(guó)家自然災(zāi)害后成熟的心理援助模式，將此問(wèn)題上升到國(guó)家層面來(lái)考慮和應(yīng)對(duì)，建立由國(guó)家主導(dǎo)的可靠的災(zāi)區(qū)兒童和青少年心理援助長(zhǎng)效機(jī)制，并使其成為今后常設(shè)的減災(zāi)救災(zāi)機(jī)制的一部分。具體包括建立國(guó)家主導(dǎo)的災(zāi)區(qū)多層次的兒童和青少年心理援助體系、培育專(zhuān)業(yè)的心理衛(wèi)生服務(wù)隊(duì)伍以及建立長(zhǎng)期心理衛(wèi)生檔案隨訪制度等。在個(gè)體心理危機(jī)干預(yù)中，要克服單一心理治療或者藝術(shù)治療的缺陷，建立一個(gè)多學(xué)科和多層次合作的服務(wù)和研究團(tuán)隊(duì)，，采取“心理—社會(huì)—文化”的綜合干預(yù)模式，建立災(zāi)后兒童和青少年心理評(píng)估和干預(yù)機(jī)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.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R179

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