| BackgroundIn human society, various disasters are inevitable, such as 4.28 Jiaozhou-Jinan Railway Accident and 5.12 Wenchuan Earthquake. All the people who involved in these accidents would be left a traumatic experience more or less. The disaster victims can be divided into five levels, and the rescuers of level 2 are always be neglected. When disaster strikes, they would fling themselves into the rescue work. The special environment, the bitter pictures and overloaded works may result in mental changes, such as emotion, cognition and behavior, etc. Therefore, the rescuers are high-risk group. A mass of studies show that, if we don't give timely psychological crisis intervention, there will be a series of severe psychological problems. Therefore, timely psychological crisis intervention is very important.ObjectivesTo study the mental state of the rescuers in disasters and the effect evaluation of psychological crisis intervention, and to explore the influencing factors and intensity of mental health state in different time. In order to prevent, control and decrease the psychosocial effects of disasters, and to decrease occurrence of mental disorders and the following influence in psychosocial function, so to prevent generalization of mental problem, promote the post traumatic mental health rebuilding, protect the mental health of rescuers, and to provide reference materials for the future. Meanwhile, provide evidence for building the perfect, scientific and effective psychological crisis intervention system.MethodsTo determine the Level.2 group among the disaster victims (4.28 Jiaozhou -Jinan Railway Accident), which included the policemen and fire-fighters (236 persons), medical rescuers (212 persons) and volunteers (177 persons) was target group. In 1 week, common status research, psychological crisis structured interview questionnaire and Acute Stress Disorder (ASD) diagnosis were processed. Those who met the diagnosis criteria of ASD were focus people. 180 persons screened include 69 policemen and fire-fighters, 56 medical rescuers and 55 volunteers. According to the random number table, they were divided into two groups, intervention group (90 persons, 35, 28 and 27 respectively) and non-intervention group (90 persons, 34, 28 and 28 respectively). In 1 week, psychological assesses were processed to the two groups: PTSD Checklist-Civilian Version(PCL-C), Self-Rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), generic quality of life inventory (GQOLI), Social Disability Screening Schedule (SDSS), the Social Support Rating Scale (SSRS), Simplified Coping Style Questionnaire (SCSQ) and Eysenck Personality Questionnaire(EPQ). Psychological crisis management was processed to the non-intervention group; systematic psychological crisis intervention from different aspects of psycho-social and biology (psychological first aid, psychological debriefing, emotion stabilization technology, relax technique, cognitive-behavioral therapy, eye movement desensitization and reprocessing, supportive psychotherapy, psychological catharsis, coping style and drug intervention etc.) were taken, focusing on multi - dimension of intervention. Accidental psychological crisis intervention was more urgent in 4 weeks, and 4 weeks later corresponding intervention strategies were made and adjust the intervention project in time according to the accesses of the earlier intervention. Further measures were taken according to different people and stress situation to ensure the effects of intervention. Integrate different intervention modals and supportive resources, so as to reach the best effects of intervention. At about 1, 3 and 6 month after the intervention psychological assessments were adapt to the two groups again, and post traumatic stress disorder (PTSD) diagnosis was taken. Comparison and longitudinal observations between the two groups were processed to study the short-term and long-term effects. Multi-factorial logistic regression analysis of factors associated with the mental state of those rescuers was done to explore the risk factors and protective factors.Results(1)Result of psychological crisis structured interview showed the on-the-spot rescuers had the bigger psychological behavior problems that, about half of the rescuers had panic, flashback, nightmare, sleeping disorder, anxiety and tension; 1/3 rescuers had repeated thought, shock response, headache, feeling of fatigue and lower emotion. (2) The clinical detection rate of ASD was 28.80%, among which policemen and fire-fighters were 29.24%, medical rescuers were 26.41%, volunteers were 31.07% respectively. (3) PCL-C total score and every subscale score of intervention group at 1, 3, 6 month after intervention got lower in turn, and there were significant differences compared with non-intervention group and before intervention. (4) The event rate of PTSD of intervention group at the three time points after intervention became lower and lower, there were significant differences compared with non-intervention group. (5) The score of SAS and SDS of intervention group at the three time points after intervention decreased gradually, and there were significant differences compared with non-intervention group and before intervention. (6) The total and every dimension score of GQOLI of intervention group at the three time points after intervention became higher and higher, and there were significant differences compared with non-intervention group and before intervention. (7) The score of SDSS of intervention group at the three time points after intervention got lower compared with non-intervention group and before intervention. Significant differences were found. (8) The total and every factor score of SSRS of intervention group at the three time points after intervention got higher, and there were significant differences compared with before intervention and non-intervention group. (9) The scores of positive coping style of SCSQ of intervention group at three time points got higher after intervention while the scores of negative coping style got lower, and there were significant differences compared with non-intervention group and before intervention. (10) Logistic regression analysis was performed taking the total score of PCL-C as the dependent variable and the 21 factors as the independent variable. There were 7 factors enrolled in the regression equation before intervention. The risk factors are continuous working period, EPQ-N, on-the-spot contact duration and career from strong to weak; the protective factors were EPQ-E, work age or soldier age and stress experience in turn. 9 factors were enrolled in regression equation 1 month after intervention. The risk factors were continuous working period, EPQ-N, negative coping style and on-the-spot contact duration from strong to weak; the protective factors are psychological crisis intervention, EPQ-E, social support and availability, positive coping style and stress experience in turn.9 factors were enrolled in regression equation 6 month after intervention. The risk factors are negative coping style, EPQ-N, continuous working period, and on-the-spot contact duration from strong to weak; the protective factors are psychological crisis intervention, positive coping style, social support and availability, EPQ-E, and stress experience in return.Conclusions and Suggestions The mental influence of accidental disaster events to the on-the-spot rescuers was widespread and serious, and incidence of ASD was nearly 1/3. Psychological crisis intervention could obviously decrease the PTSD symptoms of the rescuers and the incidence of PTSD. Anxiety and depression improved obviously, and the quality of life and social function were promoted obviously. Social support, objective and subjective support and the support application dimension were improved. The intervention could also increase using positive coping style and decrease using negative coping style. The psychological crisis intervention could not only prevent the crisis of rescuers but also help them to learn new coping techniques, and to turn negative emotion into the power of rebuilding their psychology structure, in order to reach a same or better psychological balance as before. Among the influence factors, career was only a risk factor before intervention, and effects on the mental health state from strong to weak were volunteer, policemen and fire-worker, medical rescuer; work age or soldier age was only protective factor before intervention; EPQ-N and EPQ-E at before intervention, 1 and 6 month after intervention were risk factors and protective factors respectively; on-the-spot contact duration and continuous working period were risk factors at the three time points; stress experience was protective factors at the three time points; social support and the support application dimension, positive coping style, and psychological crisis intervention were protective factors at 1 and 6 month after intervention while negative coping style was risk factor. So it's important to reduce or avoid risk factors and take protective factors during psychological crisis intervention procedure so as to retrieve mental health.Suggestions: Against accidental disasters psychological crisis intervention can be taken as following: First, to establish crisis intervention system and develop the psychological aid actively. Second, to develop the study of psychological stress and establish social supporting system (the epidemiological and clinical study about stress-related disorders, the rating scales about stress reaction and research on mental health crisis rescue preplan ).Third, to form the positive psychological qualities and cultivate the public psychological endurance. From this study, we can get some enlightenment: First, to construct social psychological warning system of accidental events. Second, to build psychological crisis intervention network to emergencies. Third, to integrate supportive resources and establish coordination mechanism. Fourth, to strengthen intervention to different groups. Fifth, to improve the training of specialists on psychological crisis intervention and establish training mechanism. Sixth, to perfect psychological intervention system (include advance prevention, going on intervention and afterward correction of related mechanism ).Seventh, to establish the long effect mechanism of psychic trauma intervention, strengthen return visit and rebuilding plan of mental health. Eighth, to establish and improve the security system of laws and rules. Furthermore, the intervention of psychological crisis is a systematic project and joint action of multiple agencies is needed. The first suggestion is that the government lead and coordinate relevant departments, start immediately service activities which focus on the theme of "psychological intervention", and concentrate training systematic mental health service group by group, so as to let people can recognize mental disorder and grasp psychological intervention skills. Using the political force, encourage them to find and help more and more people who need psychological aid, so as to intervene in time and promote the post-disaster reconstruction. Second, to enhance publicity of science, and popularize knowledge about psychology to high-risk people and group, so as to improve their capability of coping with psychological crisis, and decrease the occurring of negative life events. Third, to treat those who have serious mental problem by deep psychotherapy. Fourth, prolong mental health service work from high-risk people to general people. Combine the popularization of psychology, group counseling, and individual deep counseling and therapy, not only to make them universal but also to deepen at point. The main content including PTSD, depression and recognize and control of suicide. Fifth, technical work can be undertaken by the medical institutions which have ability. Establish sub-center for mental health of center for disease control and prevention, and construct corresponding working conditions.
|
PDF Full Text Request