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目的:评估高海拔地区(海拔3 400m)一起集体特大车祸事件中伤员及其家属的心理状况,为制定心理危机干预策略提供依据。方法:2013年5月5日车祸事件后的第3天,对青海果洛(海拔3 400m)发生的一起集体特大车祸事件中的25名伤员按照损伤严重度评分表(Injury severity scale,ISS)及8名急从低海拔地区赶来的伤员家属,采用WHO推荐的精神问题自评问卷(self-general questionnaire,SRQ-20)、创伤后应激障碍检查表(The PTSD Checklist,PTSD-7)等自评量表评估。对SRQ≥7或PTSD-7≥4分者,采用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)量表、MINI诊断量表等复核。结合伤员自身、家属的描述,由评估者经过个体晤谈后完成临床评估和定性访谈。结果:达到精神科疾病诊断标准1例(3.0%),需精神科随访并心理干预者4例(12.1%);存在明显情绪反应者16例(48.5%),14例为伤员,2例为伤员家属;其中有焦虑、抑郁情绪者占48.5%,有麻木回避情绪者占9.1%,伴有睡眠障碍者42.4%。伤员家属有明显情绪反应合并高原缺氧症状者占25.0%。伤情程度(r=2.271)和近半年重大生活事件(r=3.154)与SRQ得分呈正相关。结论:车祸后伤员及家属的心理应激反应均较高,在重视车祸伤患者的急救与治疗同时切不可忽略伤者及家属的心理状态。车祸后伤员及家属的心理应激反应以焦虑抑郁和睡眠障碍为主要症状。伤情严重、近半年有重大生活事件是需要重视的高危因素。伤员家属在接到车祸信息后,处于急性应激反应状态,从低海拔地区赶赴高海拔地区,容易发生高原反应,两者叠加可能会加重症状,也需关注。
Objectives: To assess the psychological status of the wounded and their relatives in a high-altitude area (elevation 3,400m) together with a large car accident, and provide a basis for the formulation of psychological crisis intervention strategies. METHODS: On the third day after the car accident on May 5, 2013, 25 casualties in a group car accident in Guoluo, Qinghai (elevation 3,400 m) were assessed according to the Injury severity scale (ISS) And 8 relatives of the wounded who were urgently required to come from a lower altitude area. The self-general questionnaire (SRQ-20), the PTSD Checklist (PTSD-7) Such as self-assessment scale assessment. For SRQ≥7 or PTSD-7≥4 points, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) scale and MINI diagnostic scale were used. Combined with the description of the wounded themselves and their families, the clinical evaluations and qualitative interviews were completed after the evaluators met through individual interviews. Results: One patient (3.0%) who met the diagnostic criteria of psychiatric disease, 4 patients (12.1%) required psychiatric follow-up and psychological intervention, 16 patients (48.5%) had obvious emotional reaction, 14 were injured and 2 Among them, 48.5% had anxiety and depression, 9.1% had numbness avoidance, and 42.4% had sleep disorders. Relatives of the wounded had obvious emotional reactions combined with hypoxia in the plateau accounted for 25.0%. The degree of injury (r = 2.271) and major life events in the past six months (r = 3.154) were positively correlated with SRQ scores. Conclusion: The psychological stress response of the injured and their relatives after the accident was high. The psychological state of the injured and their relatives should not be neglected while the first aid and treatment should be paid attention to. Psychological stress response to the injured and their relatives after the accident was mainly anxiety, depression and sleep disturbance. Severe injuries, nearly six months of major life events are high-risk factors that need attention. After receiving the information of a car accident, the injured relatives are in an acute state of stress response. They rushed to the high altitude area from low altitude areas and prone to altitude sickness. The superposition of the two may aggravate the symptoms and should be paid attention to.