摘要：Objectives. Using a comprehensive disaster model, we examined predictors of posttraumatic stress disorder (PTSD) in combined data from 10 different disasters. Methods. The combined sample included data from 811 directly exposed survivors of 10 disasters between 1987 and 1995. We used consistent methods across all 10 disaster samples, including full diagnostic assessment. Results. In multivariate analyses, predictors of PTSD were female gender, younger age, Hispanic ethnicity, less education, ever-married status, predisaster psychopathology, disaster injury, and witnessing injury or death; exposure through death or injury to friends or family members and witnessing the disaster aftermath did not confer additional PTSD risk. Intentionally caused disasters associated with PTSD in bivariate analysis did not independently predict PTSD in multivariate analysis. Avoidance and numbing symptoms represented a PTSD marker. Conclusions. Despite confirming some previous research findings, we found no associations between PTSD and disaster typology. Prospective research is needed to determine whether early avoidance and numbing symptoms identify individuals likely to develop PTSD later. Our findings may help identify at-risk populations for treatment research. The frequency of major disasters in the United States alone is staggeringly high: once a week on average, a new disaster strikes somewhere in the United States. 1 Considering the frequency and devastation caused by such events in the United States and worldwide, understanding the psychiatric sequelae of major disasters is a public health issue of paramount importance. A comprehensive model, developed by this research team, of the mental health outcomes of disaster provides a framework for understanding factors associated with mental health sequelae of disasters. 2 This model includes domains of personal characteristics of survivors, characteristics of the disaster agent and individual exposures to it, characteristics of the disaster community, and secondary sequelae and other negative life events. Few studies, however, are designed to assess the relative contribution of these different factors, and comparison of the prevalence of psychiatric disorders among survivors of different disasters has been hampered by lack of diagnostic rigor and inconsistent methods across studies. A landmark review by Norris et al. 3,4 compiled mental health outcome data across the domains of the comprehensive model in a careful synthesis of 20 years of disaster research. This review included 250 published articles on the combined experience of 61 396 disaster survivors from 102 disasters. The body of original research reviewed was conducted in separate studies of numerous disasters by many research teams using “a variety of designs, time frames, assessment strategies, and sampling methods.” 3(p240) Although Norris’s group noted widely held assumptions that human-caused disasters result in more severe mental health sequelae compared with natural disasters, they urged further consideration of these relationships. 4 They also identified a continuing need for research that is prospective and longitudinal and examines diverse populations whose exposure is sufficient to yield adverse mental health consequences. The inherently emergent and chaotic nature of the postdisaster setting presents barriers to methodological rigor in disaster research. These conditions hamper timely access to highly exposed survivors, impede systematic sampling, restrict sample sizes, and limit time and resources that are critical to conducting full diagnostic assessments, and they undoubtedly contribute to contradictory findings in disaster research. Comparison of disaster research findings is limited by the variability in types and severity of disasters (e.g., large-scale vs more limited, local disasters; terrorism vs natural disasters), diversity of research samples (e.g., highly exposed survivors vs people who were distant from the incident; general population members vs treatment samples), and breadth of research methods (e.g., full diagnostic assessment vs questionnaires and symptom scales) inherent in this body of research. To overcome these limitations in understanding the psychosocial effects of disasters, comprehensive studies are needed that examine a breadth of disasters and exposed populations and use consistent methods. In the largest cross-disaster study conducted to date using consistent methods (uniform assessments and time frames) with full diagnostic evaluation, we merged data from 811 directly exposed survivors of 10 disasters of various types, conducted by 1 disaster team, to provide systematic data on the prevalence of posttraumatic stress disorder (PTSD) and its predictors.
