震災後一個月內救難人員之急性壓力症候群

Acute Stress Syndromes of Rescue Workers within One Month after Major Earthquake

1999年9月21日凌晨1時47分所發生芮氏地震儀7.3級的集集大地震，是台灣近百年來最嚴重之自然災害，除了受災民眾外，救難人員在災害後之心理衛生問題之介入，亦是刻不容緩之工作。本研究於災後一個月之急性期實施，為探索處於高暴露狀態救災人員之急性壓力症候群與一般心身症狀，以及其與人口學因子、過去暴露經驗、以及災後之因應策略之關係。本研究之個案為參與本部與台北市消防局共同合作災後消防人員心理衛生輔導計劃之救難人員共95名。除基本資料外，症狀測量以結構式簡式症狀量表以及迷你國際神經精神會談工具實施之。在急性壓力症候群方面，以單一症狀而言逃避症狀出現頻率最高（31.6%）、其次為創傷經驗再體驗（20.0%）、以及回憶困難（20.0%）；就症狀向度而言，具有急性壓力症候群之亞症候群個案（subsyndromal cases）有26.3%，而具有PTSD之症候群個案有2.1%。一般心身症狀達到普通程度以上之單一症狀，以肌肉酸痛最多（19.1%），其次為擔心不夠整齊或小心（15.9%）、以及感覺憂鬱心情低落（10.6%），就達到臨床顯著程度綜合嚴重度指標（GSI）個案有3.2%，就症狀向度而言，敏感多疑最多（7.4%），其次為敵意（5.3%）、畏懼（3.2%）、人際敏感（3.2%）。在因應行為方面，以尋求社會支援之比率最高，有62名（65.3%），其次為自己一個人解決（32.6%）、請假（23.2%）、飲酒（17.9%）、尋求專業協助（2%）、離職或調職（1.1%）。在多變量分析中，過去曾處理過傷亡人體之經驗，與GSI呈負向相關（beta = -0.265；t =-2.341；p = 0.022），請假與否和GSI呈現正相關（beta = 0.290；t = 2.708；p = 0.008）。而在急性壓力症候群部分僅有請假一項，與個案具有亞症候群或症候群現象呈現正向相關（Exp（B）=5.25；95% confidence interval = 1.645-16.775；p = 0.005）。本研究顯示災後高暴露救難人員有相當之急性壓力症候群，且極少尋求醫療專業協助，災後心理衛生工作人員之主動積極介入有其必要性。此外，請假之因應行為與急性壓力症候群以及一般心身症狀皆呈現正相關，除了對於當值人員之身心狀況關照外，請假人員的追蹤與輔導，亦十分重要。

921 Earthquake was the most catastrophic event in Taiwan in this century. The requirement of mental health intervention was immediate just after the disaster, not only for victims but also the rescue workers. This study was aimed to explore the acute stress syndrome and general psychosomatic symptoms of highly stress exposure rescue workers within one month after this earthquake. A total of 95 rescue workers completed the structured assessments. In addition to basic data, the symptoms of acute stress syndrome were measured by using of the subscale of Mini International Neuropsychiatric Interview (MINI) and the general psychosomatic symptoms wee rated by using of Brief Symptom Rating Scale (BSRS). Besides, the coping behaviors, previous experience of handling corpus were also collected. The most frequent symptoms in acute stress syndrome were avoidance (31.6%), followed by re-experience (20.0%), and difficulty in recalling(20.0%). Subsyndromal presentations of acute stress syndrome were 26.3% and only 2.1% of subjects met the full criteria of PTSD, which defined in MINI. The frequencies of psychosomatic symptoms with moderate severity or above were muscle ache (19.1%), followed by over-worry and orderly (15.9%), and depression (10.6%). There were 3.2% of subjects with clinically significant scores in general severity index (GSI) of BSRS. On the coping behaviors, the subjects applied searching for social support (63.5%), work through alone (32.6%), taking a vacation (23.2%), drinking (17.9%), and search for professional aids (2%). Taking a vacation (positively) and previous experience of handling corpus (negatively) predicted GSI score and the subsyndromal or syndromal presentations of acute stress syndrome were only predicted by the coping behavior of taking a vacation (positive). Our study revealed some of the rescue workers with high stress exposure suffered from acute stress syndromes and few of them searching for medical expertise. Therefore, in the future, active engagement in the post-disaster mental health program of rescue workers was recommended. Besides, taking a vacation as coping behavior not only means physical restoration but also the indicator of psychological distress that must be paid attention (Full text in Chinese).