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新研究结果显示，强烈的意志认知可能是决定严重外伤后精神健康预后一个最重要的因子。
来自华盛顿特区Howard大学的研究者们发现，在259位曾经发生至少一件严重外伤事件的个体中，生命的意志是决定个体维持基本精神健康状态、或是恢复与外伤有关精神疾病最关键的预测因子。
第一作者Tanya N. Alim医师写到，强烈的意志意识可能预测外伤过后恢复的结果，当重新有意志意识可能是恢复过程中的关键。
这项研究线上发表于11月17日的美国精神医学期刊上。
【很高比例的外伤与精神健康问题未被报导出来】
外伤会增加许多精神异常的风险，然而，许多个体能够采取对其生活影响最小的方式（具有韧性），而其他人可以回到发生外伤前的功能状态（恢复）。
为了更进一步了解与对抗严重压力有关的精神特征，研究者们检验259位过去至少曾有一件严重外伤事件的非裔美人病患特定精神因子，这些病患从城区单一中心初级照护诊所收纳而来。
有严重外伤事件的受试者，例如身体上或是性虐待，他们接受由受过训练的临床访谈者进行面对面的访谈，以评估终生的精神异常。
接着病患被归类为：
* 具有韧性组（共47位）－没有精神疾病病史者
* 恢复组（共85位）－过去至少有一次精神异常，但是目前没有异常。
* 目前仍有疾患组（共127位）－那些符合至少有一次精神异常条件的病患
作者们表示，值得注意的，那些在目前仍有疾患组的受试者，仅有9%（12/127）表示接受任何特定精神健康治疗，且来自这三个诊断组的病患中，仅有37%表示有与他们的初级照护者谈论到他们的外伤、或是精神健康的问题。
【PTSD是最常见的诊断】
受试者也完成自我通报测试，来评估他们乐观的程度、生命的意志，以及在他们生命中的控制感、出席宗教服务、宗教信仰与处理这些问题的方法。
研究受试者的精神异常诊断主要包括忧郁症、焦虑症与物质滥用异常。创伤后压力症候群（PTSD）是最常见的诊断。
在恢复组中，终生创伤负担显著较低，且女性为目前仍处于疾患者的预测因子。
除了生命中强烈的意志感，相较于目前仍处于疾患，有控制感（以支配描述）显著地与恢复有关。
除此之外，研究者们发现，出席宗教服务的频率越高，显著地与恢复状态有关，但是当考虑到个人宗教或是信仰时则没有显著相关性。
根据研究者表示，最近一项由医学机构（IOM）的报告指出，许多PTSD治疗缺乏足够疗效证据，这突显了需要更多针对暴露在外伤个体治疗的研究。
我们希望未来对于精神因素的研究可以确认这项与其他研究，这最终将可以引领新形式的预防与治疗介入的研发。
需要未来的研究来找出哪些精神因子一致地与恢复有关，且决定这些因子的程度是否可以透过临床介入来修饰。作者写到，将需要纵向研究来厘清恢复因子与临床预后之间的因果途径。
这项研究由国家精神健康研究机构、Howard大学、与国家卫生研究院赞助。
Sense of Purpose Predicts Mental Health Outcomes Following Severe Trauma
By Caroline Cassels
Medscape Medical News
A strong sense of purpose may be the single most important factor in determining mental health outcomes following serious trauma, new research suggests.
Investigators from Howard University, in Washington, DC, found that, among 259 individuals exposed to at least 1 severe traumatic event, purpose in life was the key predictor of an individual's ability to maintain a baseline mental health status or recover from a trauma-related psychiatric illness.
"A strong sense of purpose predating trauma exposure may promote resilient outcomes, while regaining a sense of purpose may be central to the process of recovery," the authors, with first author Tanya N. Alim, MD, write.
The study is published online November 17 in the American Journal of Psychiatry.
High Rate of Unreported Trauma, Mental Health Complaints
Trauma can increase the risk for a range of psychiatric disorders. However, many individuals are able to adapt with minimal disruption to their lives (resilience) and others are able to return to their baseline level of functioning (recovery).
To better understand the psychological characteristics associated with resistance to severe stress, researchers examined specific psychosocial factors among 259 African American patients exposed to at least 1 severe traumatic event in their lifetime and recruited from primary-care offices at a single center in an urban setting.
Subjects who had experienced a serious traumatic event, such as physical or sexual assault, then underwent a structured face-to-face interview conducted by trained clinical interviewers to assess lifetime psychiatric disorders.
Patients were then categorized accordingly:
Resilient group (n = 47) — Those who had no history of psychiatric disorders.
Recovered group (n = 85) — Those who had at least 1 past psychiatric disorder but no current disorder.
Currently ill group (n = 127) — Those who met the criteria for at least 1 current psychiatric disorder.
It is notable, say the authors, that of those in the currently ill group, only 9% (12/127) reported receiving any specialized mental health treatment, and that, among a subset of 123 individuals from all 3 diagnostic groups, only 37% reported discussing their trauma or any mental health problem with their primary-care provider.
PTSD Most Common Diagnosis
The participants also completed self-report tests to measure their optimism, purpose in life, and sense of control over their life, attendance at religious services, sense of spirituality, and coping skills.
Psychiatric diagnoses in the study sample consisted primarily of depression, anxiety, and substance-use disorders. Posttraumatic stress disorder (PTSD) was the most common diagnosis.
Among the resilient group, there was a significantly lower lifetime trauma load, and female sex was predictive of currently ill status.
In addition to a strong sense of purpose in life, having a sense of control (described as "mastery") was significantly associated with recovered vs currently ill status.
In addition, researchers found a higher frequency of religious-service attendance was significantly associated with resilient status, but considering oneself religious or spiritual was not.
According to the investigators, a recent report by the Institute of Medicine concluded that many PTSD treatments lack sufficient evidence of efficacy, highlighting the need for further research on treatments in individuals exposed to trauma.
"It is our hope that further research on psychological factors identified by this and other studies will ultimately lead to the development of new types of preventive and treatment interventions.
"Future studies need to identify which psychosocial factors are consistently associated with resilience and determine to what extent these factors may be modifiable through clinical intervention. Longitudinal studies are needed to clarify causal pathway between resilience factors and clinical outcomes," the authors write
The study was supported by the National Institute of Mental Health, Howard University, and the National Institutes of Health.
Am J Psychiatry. Published online November 17, 2008.