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DOI: 10.1055/s-2006-940014
Persistierende Dissoziation als Prädiktor posttraumatischer Belastungsstörungen bei psychosozialen Fachkräften
Persistent Dissociation as Predictor of Posttraumatic Stress Disorder in Psychosocial Disaster WorkersPublication History
Eingegangen: 1. März 2005
Angenommen: 17. Mai 2006
Publication Date:
28 June 2006 (online)
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Zusammenfassung
Theoretischer Hintergrund: Mittels prospektivem Studiendesign wird untersucht, inwieweit persistierende Dissoziation akute und chronische Posttraumatische Belastungsstörungen (PTBS) bei psychosozialen Einsatzkräften (Notfallpsychologen, Psychotherapeuten, Kriseninterventionsteams und Notfallseelsorger) nach einer Katastrophe vorhersagen kann. Methode: 135 psychosoziale Einsatzkräfte wurden über zwei Zeitpunkte hinweg (t1 = 6 Wochen; t2 = 6 Monate) mithilfe der Acute Stress Disorder Scale (ASDS), der Posttraumatic Stress Diagnostic Scale (PDS) sowie dem Fragebogen zu dissoziativen Symptomen (FDS-20) untersucht. Ergebnisse: Persistierende Dissoziation und Symptome der Akuten Belastungsstörung korrelierten mit akuter und chronischer PTBS. Gemeinsam erklärten persistierende Dissoziation und Akute Belastungsstörung 74 % (m)/36 % (w) der akuten und 58 % (m)/44 % (w) der Varianz der chronischen Posttraumatischen Belastungsstörungen. Schlussfolgerungen: Persistierende Dissoziation ist ein wesentlicher Prädiktor für akute und chronische Posttraumatische Belastungsstörungen bei Einsatzkräften.
Abstract
Background: The author prospectively examined the power of persistent dissociation in predicting acute and chronic posttraumatic stress disorder symptoms (PTSD) in psychologists, psychotherapists, crisis intervention teams and clergymen after a disaster. Methods: 135 psychosocial disaster workers were assessed (6 weeks and 6 months after the catastrophe) with the Acute Stress Disorder Scale (ASDS), the Posttraumatic Stress Diagnostic Scale (PDS) and the German short version of the Dissociative Experience Scale (FDS-20). Correlational analysis and a hierarchical multiple regression analysis were conducted. Results: Persistent dissociation and acute stress symptoms were correlated with later acute and chronic PTSD diagnosis. Together, persistent dissociation und acute stress symptoms accounted for 74 % (m)/36 % (w) of the acute and 58 % (m)/44 % (w) of the variance in PTSD symptoms. Conclusions: The results support that persistent dissociation is a main predictor of acute and chronic posttraumatic stress symptoms in disaster workers.
Key words
Dissociation - acute stress disorder - PTSD - psychosocial disaster worker - longitudinal study
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Priv.-Doz. Mag. Dr. Gernot Brauchle
Institut für Hygiene, Mikrobiologie und Sozialmedizin · Medizinische Universität Innsbruck
Sonnenburgstraße 16
6020 Innsbruck · Österreich
Email: Gernot.Brauchle@uibk.ac.at