Prevalence of post-traumatic stress disorder in Sichuan Province, China after the 2008 Wenchuan earthquake

The psychosocial impact of natural disasters among adult survivors: an integrative review

The aim of this review was to identify the psychosocial impact of natural disasters on adult (over the age of 18 years) survivors. Databases searched included PsycInfo, CINAHL, Proquest, Ovid SP, Scopus, and Science Direct. The search was limited to articles written in English and published between 2002 and 2012. A total of 1,642 abstracts and articles were obtained during the first search; 39 articles were retained. The results indicate that PTSD is the most-studied psychosocial impact after a disaster. Mental health nurses have a significant role to play in supporting survivors and can assist with the development of resilience in community members.

Post-traumatic stress disorder among survivors two years after the 2010 Mount Merapi volcano eruption: A survey study

The Mount Merapi volcanic eruption in October 2010 was one of Indonesia's largest and most recent natural disasters. A cross-sectional study was undertaken to measure the psychosocial impact of the eruption on survivors in two locations in Yogyakarta, Java, Indonesia. The Impact of Event Scale Revised was used to assess participants' symptoms of post-traumatic stress disorder. Post-Traumatic Stress Disorder responses and demographic characteristics were compared in both locations by conducting bivariate analysis using Mann-Whitney and t tests. The relative contributions of demographic variables and psychosocial impact were examined using multiple linear regression analyses. Two years after the eruption, survivors from the area closest to the eruption had significantly higher Impact of Event Scale Revised scores than those in the comparison area. In particular, females, adults between the ages of 18 and 59, and people who owned their own home experienced the highest levels of psychosocial impact. Nurses and other health professionals need to be aware of the impact of natural disasters on survivors and develop interventions to help people adjust to the psychosocial impact of these events.

Gender differences in DSM-5 versus DSM-IV-TR PTSD prevalence and criteria comparison among 512 survivors to the L'Aquila earthquake

BACKGROUND

Post-traumatic Stress Disorder (PTSD) has demonstrated gender-specific prevalence and expressions across the different DSM definitions, since its first introduction in DSM-III. The DSM-5 recently introduced important revisions to PTSD symptomatological criteria. Aim of the present study is to explore whether gender moderates rates of DSM-5 PTSD expression in a non-clinical sample of survivors to a massive earthquake in Italy.

METHODS

512 survivors of the L'Aquila 2009 earthquake, previously investigated for the presence DSM-IV-TR PTSD, were reassessed according to DSM-5 criteria in order to explore gender differences. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR).

RESULTS

Females showed significantly higher DSM-5 PTSD rates and rates of endorsement of almost all DSM-5 PTSD criteria. Significant gender differences emerged in almost half of PTSD symptomatological criteria with women reporting higher rates in 8 of them, while men in only one (a new symptom in DSM-5: reckless or self-destructive behavior). Considering the impact of the three new DSM-5 symptoms on the diagnosis, significant gender differences emerged with these being crucial in almost half of the PTSD diagnoses in males but in about one-fourth in females. By using ROC curves, DSM-5 criteria E and D showed the highest AUC values in males (.876) and females (.837), respectively.

LIMITATIONS

The use of self-report instrument; no information on comorbidity; homogeneity of study sample; lack of assessment on functional impairment.

CONCLUSIONS

This study provides a contribution to the ongoing need for reassessment on how gender moderates rates of expression of particular disorders such as PTSD.

Psychological consequences and associated risk factors among adult survivors of the 2008 Wenchuan earthquake

BACKGROUND

In 2008, a devastating earthquake measuring 8.0 on the Richter scale struck Wenchuan, China. Following this disaster, several studies were conducted which assessed the degree of mental disorders in the affected population, but very few considered that several disorders may occur at the same time. This paper aims to investigate the psychological effects and risk factors among adult survivors one-year after the earthquake event.

METHODS

2080 adult earthquake survivors from 19 counties in the affected areas were interviewed. A stratified sampling strategy was used to collect the information. Earthquake survivors completed self-report questionnaires, which included a post-traumatic stress disorder (PTSD) checklist, a self-rating depression scale and a self-rating anxiety scale.

RESULTS

Fifty nine percent of the participants were male. The prevalence of probable PTSD in the sample was 40.1% (based on the DSM-IV criteria). Significant differences in the demographic variables were found in the levels of anxiety, depression, and PTSD. Anxiety levels were found to be positively correlated with depression (r = 0.438, p < 0.01) and PTSD (r = 0.322, p < 0.01). Risk factors for each symptom were also identified. Being female, having a low income level and having a low perceived level of social support were found to be the risk factors associated with anxiety, depression, and PTSD. There appeared to be no obvious relationship between the distance from the epicenter of the earthquake event and the severity of the psychological problems.

CONCLUSIONS

PTSD, anxiety, and depression were prevalent among the survivors. Most findings on the predictors were found to be consistent with current research. Positive adjustment and social support were found to be needed for the highest-risk population.

Prevalence and determinants of depression among survivors 8 months after the Wenchuan earthquake

The current study assessed the estimated rate of depression and associated risk factors among survivors 8 months after the 2008 Wenchuan earthquake in China. A stratified random sample of 1514 participants was recruited from all temporary camp communities in a county town 45 km away from the epicenter. The estimated rate of depression was 35.7%. The severity of depressive symptoms was significantly associated with female sex, perceived livelihood security, loss of a family member, residential house damage or collapse, and not living in an urban area, whereas married status is a protector against depressive symptoms. The results suggest that community-based effective, sustainable, and culturally sensitive interventions and services are warranted and should be directed to the groups at high risk for mental health problems.

Assessment of prevalence and determinants of posttraumatic stress disorder and depression symptoms in adults survivors of earthquake in Haiti after 30 months

BACKGROUND

On January 12, 2010, a powerful 7.0 magnitude earthquake struck the Republic of Haiti and destroyed Port-au-Prince, the capital and others cities across the country. While some studies have examined the long-term traumatic effects of the seismic event on children and adolescents victims, so far no study has examined the consequences on adults generally. As such, this study aims to investigate the traumatic consequences of the earthquake among adults related to degree of exposure, peritraumatic distress, depressive symptoms and sociodemographic factors two and a half years after. In addition, predictive factors of PTSD and depressive symptoms were also identified.

METHODS

From June to July 2012, a total of 1355 adults (660 women) was assessed by means the traumatic exposure questionnaire, the Life Events Checklist subscale, the Peritraumatic Distress Inventory (PDI), the Impact of Event Scale - Revised (IES-R) and the Beck Depression Inventory (BDI), in addition to social demographic characteristics.

RESULTS

The prevalence rates of PTSD and depressive symptoms were 36.75% (498 cases) and 25.98% (352 cases) respectively. The risk factors for PTSD and depressive symptoms were young and old age, female gender, unemployed status and low level of education. The bests predictives variables were peritraumatic distress for PTSD (β=.57, p<.0001) and for depressive symptoms (β=.21, p<.0001). The commorbidity between PTSD and depression was 13.36%.

CONCLUSIONS

This study found that psychological symptoms are frequent event 30 months after the earthquake. The different mental health care providers, the public health ministry, NGOs working on the ground in Haiti should design programmes in order to aid the psychological wellbeing of the population focussing on youth, older and retired adults, females, people with low levels of education and those who do not work.

Solastalgia: living with the environmental damage caused by natural disasters

Forced separation from one's home may trigger emotional distress. People who remain in their homes may experience emotional distress due to living in a severely damaged environment. These people experience a type of 'homesickness' similar to nostalgia because the land around them no longer resembles the home they knew and loved. What they lack is solace or comfort from their home; they long for the home environment to be the way it was before. "Solastalgia" is a term created to describe feelings which arise in people when an environment changes so much that it negatively affects an individual's quality of life. Such changed environments may include drought-stricken areas and open-cut mines. The aim of this article is to describe how solastalgia, originally conceptualized as the result of man-made environmental change, can be similarly applied to the survivors of natural disasters. Using volcanic eruptions as a case example, the authors argue that people who experience a natural disaster are likely to suffer from solastalgia for a number of reasons, which may include the loss of housing, livestock and farmland, and the ongoing danger of living in a disaster-prone area. These losses and fears challenge people's established sense of place and identity and can lead to feelings of helplessness and depression.

Post-traumatic stress disorder among adult survivors of the Wenchuan earthquake in China: a repeated cross-sectional study

The objective of the study was to examine trends in the prevalence of Posttraumatic Stress Disorder (PTSD) in Wenchuan, China, over the four-year period following its 2008 earthquake, and to explore the risk factors related to current PTSD. Chi-square analysis and multivariate logistic regression analysis were used to assess PTSD morbidity and identify associated risk factors. The results indicated that the prevalence of PTSD was 58.2% at two months, 22.10% at 8 months, 19.8% at 14 months, 19.0% at 26 months, and 8.0% at about 44 months after the earthquake. Female gender, being married, low education, non-drinking, and poor self-perceived health status were significantly associated with PTSD during the early period following the earthquake. Depression was significantly associated with survivors' PTSD throughout the study period.

A cross-sectional study on risk factors of depression severity among survivors of the 2008 Sichuan earthquake

To examine depression severity and associated risk factors 1 year later among survivors of the May 12, 2008 Wenchuan earthquake in China, a cross-sectional study was conducted. Subjects included 704 survivors, ages 18-64, 367 (52.1 %) of whom were from heavily damaged counties and the rest from moderately damaged ones. Subjects were interviewed for socio-demographic variables, exposure level, and administered standardized scales for depression, anxiety, resilience, and social support. 23.0 % (N = 162) and 13.8 % (N = 97) of all subjects had moderate and severe depression, respectively, with depression severity being higher in severely damaged counties compared to moderately damaged ones (18.2 vs 8.9 %). Multiple regression analysis indicated that depression severity varied with gender, age, education level, exposure level, income, housing status, and social support. The association between income level and symptoms of depression were partially mediated by social support (ratio of mediation effects: 41.9 and 22.3 % for heavily and moderately damaged counties, respectively). The data support the need for early mental health intervention and provision of social support in this vulnerable population.

Post-traumatic stress disorder in DSM-5: estimates of prevalence and criteria comparison versus DSM-IV-TR in a non-clinical sample of earthquake survivors

BACKGROUND

The latest edition of DSM (DSM-5) introduced important revisions to PTSD symptomatological criteria, such as a four-factor model and the inclusion of new symptoms. To date, only a few studies have investigated the impact that the proposed DSM-5 criteria will have on prevalence rates of PTSD.

METHODS

An overall sample of 512 adolescents who survived the L'Aquila 2009 earthquake and were previously investigated for the presence of full and partial PTSD, using DSM-IV-TR criteria, were reassessed according to DSM-5 criteria. All subjects completed the Trauma and Loss Spectrum-Self Report (TALS-SR).

RESULTS

A DSM-5 PTSD diagnosis emerged in 39.8% of subjects, with a significant difference between the two sexes (p<0.001), and an overall 87.1% consistency with DSM-IV-TR. Most of the inconsistent diagnoses that fulfilled DSM-IV-TR criteria but not DSM-5 criteria can be attributed to the subjects not fulfilling the new criterion C (active avoidance). Each DSM-5 symptom was more highly correlated with its corresponding symptom cluster than with other symptom clusters, but two of the new symptoms showed moderate to weak item-cluster correlations. Among DSM-5 PTSD cases: 7 (3.4%) endorsed symptom D3; 151 (74%) D4; 28 (13.7%) both D3 and D4; 75 (36.8%) E2.

LIMITATIONS

The use of a self-report instrument; no information on comorbidity; homogeneity of study sample; lack of assessment on functional impairment; the rates of DSM-IV-TR qualified PTSD in the sample was only 37.5%.

CONCLUSIONS

This study provides an inside look at the empirical performance of the DSM-5 PTSD criteria in a population exposed to a natural disaster, which suggests the need for replication in larger epidemiological samples.

Risk factors of posttraumatic stress disorder after an earthquake disaster

This study sought to predict posttraumatic stress disorder (PTSD) from women's reproductive health events after an earthquake experience. Data on antenatal care, pregnancy outcomes, family planning, socioeconomic status, earthquake experiences, and mental health were collected from a random sample of 425 women of reproductive age using the Centers for Disease Control and Prevention Reproductive Health Assessment Toolkit and the Harvard Trauma Questionnaire. Data were analyzed using multivariate regression analysis to predict PTSD symptoms from posttrauma care variables and reproductive health events. Restricted social participation, use of temporary accommodation, pregnancy complications, and use of injectable contraceptives were significant risk factors of PTSD. These factors may be exacerbated by the social context of conservative societies, traditions about health care-seeking behavior, and access to health care. Antecedent reproductive health events influence women's reaction to major trauma including events such as an earthquake.

Dysfunction and post-traumatic stress disorder in fracture victims 50 months after the Sichuan earthquake

BACKGROUND

This study aimed to evaluate the effectiveness of a rehabilitation intervention on physical dysfunction (PDF) and post-traumatic stress disorder (PTSD) in fracture victims 50 months after the Sichuan earthquake of 2008 and to identify risk factors for PTSD.

METHODS

This is a retrospective cohort study. Four hundred and fifty-nine earthquake-related fracture victims from Mianzhu city, Sichuan Province who did not qualify for disability pension participated. Two hundred and forty-five subjects received regular rehabilitation and 214 did not. Muscle strength, joint range of motion (ROM),sensory function, and sit-to-stand balance capacity were evaluated to assess PDF. The PTSD Checklist-Civilian Version (PCL-C) was administered to screen for PTSD. An ordinary least square regression was used to predict PTSD, and a logistic regression was used to predict PDF. In addition a Least Angle Regression (LARS) was carried out for PTSD to study the effects of rehabilitation and PDF at the same time.

RESULTS

Unadjusted and adjusted group differences in physical dysfunction (p<0.01) and PTSD prevalence (p<0.05) were significant in favor of the rehabilitation group. In addition, being female, average or above family income, having witnessed death and fearfulness were found risk factors for PTSD symptoms 50 months after the earthquake. Both PDF and rehabilitation were selected predictors by LARS demonstrating opposite effects.

CONCLUSION

PDF and PTSD were significantly reduced by the rehabilitation intervention. Future medical intervention strategies should consider rehabilitation in order to assist survivors in dealing with both physical and psychological effects of natural disaster.

Post-traumatic stress disorder status in a rescue group after the Wenchuan earthquake relief

Previous studies have suggested that the incidence of post-traumatic stress disorder in earthquake rescue workers is relatively high. Risk factors for this disorder include demographic characteristics, earthquake-related high-risk factors, risk factors in the rescue process, personality, social support and coping style. This study examined the current status of a unit of 1 040 rescue workers who participated in earthquake relief for the Wenchuan earthquake that occurred on May 12(th), 2008. Post-traumatic stress disorder was diagnosed primarily using the Clinician-Administered Post-traumatic Stress Disorder Scale during structured interviews. Univariate and multivariate statistical analyses were used to examine major risk factors that contributed to the incidence of post-traumatic stress disorder. Results revealed that the incidence of this disorder in the rescue group was 5.96%. The impact factors in univariate analysis included death of family members, contact with corpses or witnessing of the deceased or seriously injured, near-death experience, severe injury or mental trauma in the rescue process and working at the epicenter of the earthquake. Correlation analysis suggested that post-traumatic stress disorder was positively correlated with psychotic and neurotic personalities, negative coping and low social support. Impact factors in multivariate logistic regression analysis included near-death experience, severe injury or mental trauma, working in the epicenter of the rescue, neurotic personality, negative coping and low social support, among which low social support had the largest odds ratio of 20.42. Findings showed that the occurrence of post-traumatic stress disorder was the result of the interaction of multiple factors.

A randomised controlled pilot study: the effectiveness of narrative exposure therapy with adult survivors of the Sichuan earthquake

BACKGROUND

Post-Traumatic Stress Disorder (PTSD) is a common psychological reaction after large-scale natural disasters. Given the number of people involved and shortage of resources in any major disaster, brief, pragmatic and easily trainable interventions are needed. The aim of this study is to evaluate the efficacy of Narrative Exposure Therapy (NET) as a short-term treatment for PTSD using Chinese earthquake survivors.

METHODS

A randomized waiting-list control pilot study was conducted between December 2009 and March 2010, at the site of the Sichuan earthquake in Beichuan County, China. Adult participants with newly diagnosed Post Traumatic Stress Disorder (PTSD) were randomly allocated to Narrative Exposure Therapy (NET) or a Waiting-List (WL) condition. The latter received NET treatment after a two-week waiting period. To compare the effectiveness of NET in traumatised earthquake survivors, both groups were assessed on PTSD symptoms, general mental health, anxiety and depression, social support, coping style and posttraumatic change before and after treatment and two months post treatment.

RESULTS

Adult participants (n=22) were randomly allocated to receive NET (n=11) or WL (n=11). Twenty two participants (11 in NET group, 11 in WL) were included in the analysis of primary outcomes. Compared with WL, NET showed significant reductions in PTSD symptoms, anxiety and depression, general mental stress and increased posttraumatic growth. The WL group later showed similar improvements after treatment. These changes remained stable for a two-month follow-up. Measures of social support and coping showed no stable effects.

CONCLUSIONS

NET is effective in treating post-earthquake traumatic symptoms in adult Chinese earthquake survivors. The findings help advance current knowledge in the management of PTSD after natural disasters and inform future research. Larger sample sizes are needed to extend the present findings.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-TRC-12002473.

Mental health problems among the survivors in the hard-hit areas of the Yushu earthquake

Background

On April 14, 2010, an earthquake registering 7.1 on the Richter scale shook Qinghai Province in southwest China. The earthquake caused numerous casualties and much damage. The epicenter, Yushu County, suffered the most severe damage. As a part of the psychological relief work, the present study evaluated the mental health statuses of the people affected and identified the mental disorder risk factors related to earthquakes.

Methods

Five hundred and five earthquake survivors living in Yushu County were investigated 3–4 months after the earthquake. Participant demographic data including gender, age, marital status, ethnicity, educational level, and religious beliefs were collected. The Earthquake-Specific Trauma Exposure Indicators assessed the intensity of exposure to trauma during the earthquake. The PTSD Checklist-Civilian version (PCL-C) and the Hopkins Symptoms Checklist-25 (HSCL-25) assessed the symptoms and prevalence rates of probable Posttraumatic Stress Disorder (PTSD) as well as anxiety and depression, respectively. The Perceived Social Support Scale (PSSS) evaluated subjective social support.

Results

The prevalence rates of probable PTSD, anxiety, and depression were 33.7%, 43.8% and 38.6%, respectively. Approximately one fifth of participants suffered from all three conditions. Individuals who were female, felt initial fear during the earthquake, and had less social support were the most likely to have poor mental health.

Conclusions

The present study revealed that there are serious mental problems among the hard–hit survivors of the Yushu earthquake. Survivors at high risk for mental disorders should be specifically considered. The present study provides useful information for rebuilding and relief work.

Psychiatric Morbidity and Work and Social Adjustment Among Earthquake Survivors Extricated from under the Rubble

OBJECTIVES

This cross-sectional study examined psychiatric co-morbidity and work and social adjustment after a natural disaster among survivors who were extricated from under the rubble.

MATERIALS AND METHODS

Individuals (N=40) belonging to district Muzaffarabad, a severely earthquake affected area on 8(th) October 2005, were interviewed. The examination included the MINI International Neuropsychiatric Interview for DSM-IV Axis I disorders, Work and Social Adjustment Scale, and questions covering background characteristics and disaster exposure.

RESULTS

The most prevalent disorders were posttaumatic stress disorder (32.5%), major depressive disorder (17.5%), dysthymia (15.0%), agoraphobia (25.0%), and panic disorder (20.0%). Moreover, 77% of the respondents have been diagnosed with at least one psychiatric disorder. Work and soical adjustment was found to have an inverse relationship with the psychiatric co-morbidity.

CONCLUSION

Small sample size and lack of comparison group from non-earthquake struck areas may limit the generalizability of the psychatric disorders. Psychiatric disorders other than PTSD, especially depressive and anxiety disorders, are of clinical importance when considering long-term mental health effect of disasters.

A cross-sectional study on posttraumatic stress disorder among elderly Qiang citizens 3 years after the Wenchuan earthquake in China

OBJECTIVE

To determine the prevalence of posttraumatic stress disorder (PTSD) and to identify the associated risk factors among elderly citizens belonging to the Qiang ethnic minority group 3 years after the Wenchuan earthquake in China.

METHODS

A cross-sectional survey of 287 respondents aged 60 years and older was conducted to collect data in Beichuan County, a heavily damaged area. PTSD was assessed according to the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Independent demographic, socioeconomic and trauma exposure variables were also measured. Association between the independent variables and PTSD was analyzed using logistic regression analysis.

RESULTS

The prevalence of PTSD was 22.65% among elderly Qiang citizens in Beichuan County. Being female, being widowed, having a low level of education, having low monthly income, suffering bodily injury, being bereaved, and having a low level of social support were risk factors significantly related to the development of PTSD.

CONCLUSION

The results indicate that PTSD remained at an elevated level among elderly Qiang citizens in the heavily damaged area 3 years after the Wenchuan earthquake. Effective and sustainable mental health services are needed and should be directed particularly to the elderly Qiang citizens who are among the groups most vulnerable to the direct impact of the earthquake.

Quality of life, physical diseases, and psychological impairment among survivors 3 years after Wenchuan earthquake: a population based survey

Background

Few research studies have addressed the long-term effects caused by catastrophes, and no study has ever explored the life quality, physical diseases, and psychological impairment of earthquake survivors at the same time. This study seeks to reveal survivors' quality of life, physical diseases, and mental health.

Methods

A cross-sectional survey was conducted through multi-stage sampling approach three years after the Wenchuan earthquake.

Results

A total of 2525 subjects were interviewed. Symptoms of PTSD were reported by 8.8% of the respondents from the seriously affected areas and 0.5%, the less hit areas. Prevalence of chronic diseases was 39.2% and 22.1% respectively, and two-week prevalence rate, 24.9% and 12.7% respectively. In the multivariate analysis, two-week prevalence, displacement, no regular income, receiving mental health support after the disaster, family members died or missing, injured due to the quake, and person who witnessed someone being killed or injured were independently associated with higher prevalence for symptoms of PTSD. Most subscales of SF-12 negatively correlated with age, chronic diseases, two-week prevalence, injured due to the disaster, home or property loss, and score of the 3-year PTSD symptoms, but positively correlated with higher education and higher household income.

Conclusions

The rates of physical diseases and symptoms of PTSD were relatively high, and the quality of life was poor among victims in the hard-hit areas 3 years after the earthquake. Physical impairment correlated with symptom of PTSD, and both were negatively associated with quality of life.

One-year follow-up analysis of cognitive and psychological consequences among survivors of the Wenchuan earthquake

The catastrophic Wenchuan earthquake measuring 8.0 on the Richter scale occurred on May 12, 2008 in the West of the Sichuan basin in China and caused severe damage. A project was undertaken to examine the cognitive and psychological effects one year after the disaster among 2080 individuals in the local area. We evaluated the influence of gender, age, education level, and ethnic group on five aspects: work satisfaction, living satisfaction, health self-perception, psychological pressure, and psychological recovery. Male subjects had a better performance in all five aspects, which indicated that women were more affected. Subjects of different ethnic groups showed significantly different attitudes with respect to psychological pressure and psychological recovery. Significant differences for all the five aspects were also found in education level and age. The results showed that older people and those with a lower education level probably had more psychological problems. There were significant correlations between work satisfaction and living satisfaction, living satisfaction and health self-perception, living satisfaction and psychological recovery, and psychological pressure and psychosocial recovery. Living satisfaction and education level were significant predictors of psychological pressure. For psychological recovery, significant predictors were living satisfaction, age, work satisfaction, education level, and gender. The study findings indicated that government programs should provide more support for females, older people, those with a lower education level, and those in lower living conditions. Attention should be given not only to the psychological effects on each victim, but also to related issues such as work and living conditions to promote psychological wellbeing. Limitations of this study are addressed.

Cognitive and psychological reactions of the general population three months after the 2011 Tohoku earthquake and tsunami

Background

The largest earthquake on record in Japan (magnitude 9.0) occurred on March 11, 2011, and the subsequent tsunami devastated the Pacific coast of Northern Japan. These further triggered the Fukushima I nuclear power plant accidents. Such a hugely complex disaster inevitably has negative psychological effects on general populations as well as on the direct victims. While previous disaster studies enrolled descriptive approaches focusing on direct victims, the structure of the psychological adjustment process of people from the general population has remained uncertain. The current study attempted to establish a path model that sufficiently reflects the early psychological adaptation process of the general population to large-scale natural disasters.

Methods and Findings

Participants from the primary disaster area (n = 1083) and other areas (n = 2372) voluntarily participated in an online questionnaire study. By constructing path models using a structural equation model procedure (SEM), we examined the structural relationship among psychological constructs known related to disasters. As post-traumatic stress symptoms (PTS) were significantly more present in people in the primarily affected area than in those in secondary- or non-affected areas, the path models were constructed for the primary victims. The parsimoniously depicted model with the best fit was achieved for the psychological-adjustment centered model with quality of life (QoL) as a final outcome.

Conclusion

The paths to QoL via negative routes (from negative cognitive appraisal, PTS, and general stress) were dominant, suggesting the importance of clinical intervention for reducing negative cognitive appraisal, and for caring for general stress and PTS to maintain QoL at an early stage of psychological adaptation to a disaster. The model also depicted the presence of a positive route where positive cognitive appraisal facilitates post-traumatic growth (PTG) to achieve a higher QoL, suggesting the potential importance of positive psychological preventive care for unexpected natural disasters.

Posttraumatic stress disorder and depression among new mothers at 8 months later of the 2008 Sichuan earthquake in China

On May 12, 2008, a magnitude 8.0 earthquake struck China's southwestern Sichuan province. Recent studies have identified mental health problems among the survivors, but little is known about the impact of the Sichuan earthquake on the mental health of new mothers in the area. The main objective was to assess the impact of the Sichuan earthquake on the posttraumatic stress disorders (PTSD) and depression of new mothers. A total of 317 new mothers were interviewed in the hospital from January 2009 to March 2009. Symptoms of PTSD were measured using the impact of event scale-revised, and symptoms of postpartum depression were measured using the Center for Epidemiologic Studies Depression scale. The prevalence rates of PTSD and postpartum depression were 19.9% and 29.0%, respectively. Women with high earthquake exposure had higher risks of PTSD (odds ratio (OR), 5.91; 95% confidence interval (CI), 1.75-19.97; P < 0.001) and postpartum depression (OR, 7.28; 95% CI, 2.51-21.08; P < 0.001) than women without earthquake experience. In addition, women with low monthly family income and farm workers had a higher risk of having PTSD; women who were unemployed or with lower monthly family income and poor sleep had a higher risk of having depression. Earthquake experience increased the risks of having PTSD and depression among new mothers at 8 months later of the earthquake.

The impact of the catastrophic earthquake in China's Sichuan province on the mental health of pregnant women

BACKGROUND

On May 12, 2008, a magnitude 8.0 earthquake struck China's southwestern Sichuan province. Recent studies have identified mental health problems among the survivors, but little is known about the impact of the Sichuan earthquake on the mental health of pregnant women in the area. The main objective was to assess the impact of the Sichuan earthquake on the mental health of pregnant women in earthquake stricken areas.

METHODS

During November 2009 and January 2010, 311 pregnant women were interviewed. Symptoms of PTSD were measured using IES-R, while symptoms of antenatal depression were measured using EPDS.

RESULTS

The prevalence rate of PTSD symptoms was 12.2% (95% CI, 9.0-16.4). The rate of major depression was 40.8% (95% CI, 35.5-46.4). Living through an earthquake has been significantly correlated with PTSD but no significant correlation has been found with depression. The perceived stresses of pregnancy are significantly correlated with both depression and PTSD.

LIMITATIONS

Lack of long term follow up data and comparison group from non earthquake struck area.

CONCLUSIONS

18 months after the Sichuan earthquake, the incidence of depression and PTSD were still quite high among pregnant women in the earthquake stricken areas. Depression was more common than PTSD. Living through an earthquake has been significantly correlated with PTSD but not with depression.

Impact of traumatic loss on post-traumatic spectrum symptoms in high school students after the L'Aquila 2009 earthquake in Italy

BACKGROUND

On April 6th 2009, the town of L'Aquila, Italy, was struck by an earthquake (6.3 on the Richter scale) that lead large parts of the town to be destroyed and the death of 309 people. Significant losses in the framework of earthquakes have been reported as a major risk factor for PTSD development. Aim of this study was to investigate post-traumatic spectrum symptoms in a sample of adolescents exposed to the L'Aquila 2009 earthquake 21 months earlier, with particular attention to the impact of loss.

METHODS

475 students (203 women and 272 men), attending the last year of High School in L'Aquila, were assessed by: Trauma and Loss Spectrum-Self Report (TALS-SR) and Impact of Event Scale (IES). The presence of full and partial PTSD was also assessed.

RESULTS

72 students (15.2%) reported the loss of a close friend or relative in the framework of the earthquake. Full PTSD was reported by 146 (30.7%) students and partial PTSD by 149 (31.4%) students. There was a significant difference reported in PTSD between bereaved and non bereaved subjects. Significantly higher post-traumatic symptom levels were reported by bereaved subjects.

LIMITATIONS

The lack of information on the relationship with the deceased and the number of losses experienced, besides the use of self report instruments are the limitations of this study.

CONCLUSIONS

Our results show high rates of post-traumatic spectrum symptoms in adolescents who survived the L'Aquila earthquake. Having experienced the loss of a close friend or a relative in the framework of the earthquake seems to be related to higher PTSD rates and more severe symptomatology. These results highlight the need to carefully explore adolescents exposed to a significant loss as consequence of an earthquake.

Prevalence and predictors of posttraumatic growth among adult survivors one year following 2008 Sichuan earthquake

BACKGROUND

The aim of this study was to explore prevalence and predictors of posttraumatic growth, including its relationship with PTSD symptoms among adult survivors of a severe earthquake.

METHODS

A stratification random sampling strategy was adopted and 2080 adult survivors of the 2008 Sichuan earthquake were surveyed. Posttraumatic Growth Inventory and Impact of Event Scale - Revised were used in the assessment of posttraumatic growth (PTG) and posttraumatic stress disorder (PTSD) symptoms, respectively. Hierarchical multiple regression analyses were used to explore the best predictors.

RESULTS

At one year following the earthquake, prevalence rates for posttraumatic growth and PTSD symptoms were 51.1% and 56.8%, respectively. Best predictors of posttraumatic growth were being female, younger age, higher level of education, higher degree of earthquake-related exposure and PTSD symptoms, including intrusion and hyperarousal symptoms.

LIMITATIONS

The limitations of this study lie in that no comparison was made due to the lack of pre-disaster data, so it is very hard to conclude to what extent did this earthquake affect the people there. Our participants were mainly workers from different fields. Survey of affected population in rural and remote areas was unavailable. More representative samples are needed to examine the generalizability of these findings.

CONCLUSIONS

Psychological interventions and care for survivors of Sichuan earthquake disaster should focus on females and older people who can be more affected by disasters. Besides, in order to produce positive outcomes after disasters, programs on adjustment and management of posttraumatic stress disorder symptoms should be implemented.

Complicated grief associated with hurricane Katrina

BACKGROUND

Although losses are important consequences of disasters, few epidemiological studies of disasters have assessed complicated grief (CG) and none assessed CG associated with losses other than death of loved one.

METHODS

Data come from the baseline survey of the Hurricane Katrina Community Advisory Group, a representative sample of 3,088 residents of the areas directly affected by Hurricane Katrina. A brief screen for CG was included containing four items consistent with the proposed DSM-V criteria for a diagnosis of bereavement-related adjustment disorder.

RESULTS

Fifty-eight and half percent of respondents reported a significant hurricane-related loss: Most-severe losses were 29.0% tangible, 9.5% interpersonal, 8.1% intangible, 4.2% work/financial, and 3.7% death of loved one. Twenty-six point one percent respondents with significant loss had possible CG and 7.0% moderate-to-severe CG. Death of loved one was associated with the highest conditional probability of moderate-to-severe CG (18.5%, compared to 1.1-10.5% conditional probabilities for other losses), but accounted for only 16.5% of moderate-to-severe CG due to its comparatively low prevalence. Most moderate-to-severe CG was due to tangible (52.9%) or interpersonal (24.0%) losses. Significant predictors of CG were mostly unique to either bereavement (racial-ethnic minority status, social support) or other losses (prehurricane history of psychopathology, social competence.).

CONCLUSIONS

Nonbereavement losses accounted for the vast majority of hurricane-related possible CG despite risk of CG being much higher in response to bereavement than to other losses. This result argues for expansion of research on CG beyond bereavement and alerts clinicians to the need to address postdisaster grief associated with a wide range of losses.

Risk factors of posttraumatic stress disorder among survivors after the 512 Wenchuan earthquake in China

This study investigated the psychological reactions of survivors of the 512 Wenchuan earthquake in China and the risk factors associated with those reactions. The Impact of Event Scale-Revised (IES-R), Type D Scale-14 (DS14), a self-developed trauma experience questionniare, and a demographic questionnaire were administered to 956 earthquake survivors (389 males and 567 females) in Mianzhu, one of the cities most affected by the earthquake. The results showed that postraumatic stress disorder (PTSD) symptoms affected 84.8% of survivors one to two months after the earthquake. Significant risk factors associated with PTSD symptoms included: (1) being female; (2) older age; (3) higher exposure to traumatic events during the earthquake; and (4) negative affect in Type-D personality.

A cross-sectional study among survivors of the 2008 Sichuan earthquake: prevalence and risk factors of posttraumatic stress disorder

OBJECTIVE

The objective of this study is to estimate the prevalence of probable posttraumatic stress disorder (PTSD), explore the related risk factors among Sichuan earthquake survivors in different counties and compare the findings in our study to others.

METHOD

A cross-sectional sample survey was conducted to collect data in heavily (n=367) and moderately damaged counties (n=337). We used the PTSD Check List-Civilian Version (PCL-C), which consists of 17 items corresponding to each symptom of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

RESULTS

The prevalence of probable PTSD in heavily damaged counties (48.2%) was higher than that in moderately damaged counties (14.5%). Many associated risk factors were identified in the cross-sectional study.

CONCLUSION

Female, Han nationality, low monthly income, fear during earthquake and low social support in the past year were significant risk factors in heavily damaged counties, while the probable PTSD in moderately damaged counties was related to female, youth, fear during earthquake and low social support.

Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience

Background

The reproductive and mental health of women contributes significantly to their overall well-being. Three of the eight Millennium Development Goals are directly related to reproductive and sexual health while mental disorders make up three of the ten leading causes of disease burden in low and middle-income countries. Among mental disorders, depression and anxiety are two of the most prevalent. In the context of slower progress in achieving Millennium Development Goals in developing countries and the ever-increasing man-made and natural disasters in these areas, it is important to understand the association between reproductive health and mental health among women with post-disaster experiences.

Methods

This was a cross-sectional study with a sample of 387 women of reproductive age (15-49 years) randomly selected from the October 2005 earthquake affected areas of Pakistan. Data on reproductive health was collected using the Centers for Disease Control reproductive health assessment toolkit. Depression and anxiety were measured using the Hopkins Symptom Checklist-25, while earthquake experiences were captured using the Harvard Trauma Questionnaire. The association of either depression or anxiety with socio-demographic variables, earthquake experiences, reproductive health and access to health facilities was estimated using multivariate logistic regression.

Results

Post-earthquake reproductive health events together with economic deprivation, lower family support and poorer access to health care facilities explained a significant proportion of differences in the experiencing of clinical levels of depression and anxiety. For instance, women losing resources for subsistence, separation from family and experiencing reproductive health events such as having a stillbirth, having had an abortion, having had abnormal vaginal discharge or having had genital ulcers, were at significant risk of depression and anxiety.

Conclusion

The relationship between women's post-earthquake mental health and reproductive health, socio-economic status, and health care access is complex and explained largely by the socio-cultural role of women. It is suggested that interventions that consider gender differences and that are culturally appropriate are likely to reduce the incidence.

Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China

This study examined the estimated prevalence rate of posttraumatic stress disorder (PTSD) symptoms and associated risk factors among Chinese adult survivors 7 to 8 months after the 2008 Sichuan earthquake. The sample was recruited from 2 areas close to the epicenter but of different distances. The estimated rate of PTSD symptoms was 55.6% and 26.4% respectively in the two areas. Loss of a child was a strong predictive factor for PTSD symptoms for the parents. Other predictive factors included female gender, loss of a parent, loss of friends or neighbors, residential house damage or collapse, and proximity to the epicenter. Effective and sustainable mental health services are needed and should be directed particularly to bereaved survivors.

Physical and mental health status of soldiers responding to the 2008 Wenchuan earthquake

OBJECTIVE

While internationally major disasters occur frequently, for any one country they are unusual events. In this project we aimed to identify public health issues arising from the physical and mental health symptoms suffered by the soldier volunteers deployed in an emergency relief task during the Wenchuan earthquake.

METHODS

Health problems identified in other emergency volunteer populations guided the development of a questionnaire. A cohort of 1,187 soldier volunteers completed the questionnaire, which measured physical and mental health symptoms during their rescue mission. The results were compared with a population norm of soldiers, although baseline data of the respondents were unavailable.

RESULTS

Half the respondents reported suffering from skin and mucous membrane problems, followed by respiratory symptoms (38%), digestive (29%) and nervous (22%) symptoms. Despite a low response rate (53%) to the mental health component, nearly half (49%) of those who did respond reported mental health problems. The incidence of the above symptoms were significantly higher than the general soldier population.

CONCLUSIONS

Health complaints were common in the soldiers, who had not received any formal training in rescue operations.

IMPLICATIONS

Non-professional rescue workers who are not appropriately prepared for the role may suffer more than their professional counterparts. Attention needs to be paid to the health and safety of non-professional rescue workers, which has been ignored in most disaster management plans. These findings can be used to enhance the understanding of emergency response programs within and outside China, where this particular disaster occurred.

Diagnostic Utility of the PTSD Checklist in Detecting PTSD in Chinese Earthquake Victims

By using the posttraumatic stress disorder (PTSD) module of the Mini International Neuropsychiatric Interview (MINI) as the gold standard to identify PTSD, the current study investigated the diagnostic efficiency of the PTSD Checklist (PCL) as a screening questionnaire in a sample of 152 Chinese victims of the Wenchuan earthquake. The results showed that the area under the receiver operating characteristic (ROC) curve was .96 ( SE = .02), and the optimally efficient cut-off score was 44. The findings provide preliminary support of the PCL as a screening questionnaire among Chinese earthquake victims. The present study may contribute to further PTSD-related research and practices in Chinese disaster settings.

Social support and Quality of Life: a cross-sectional study on survivors eight months after the 2008 Wenchuan earthquake

Background

The 2008 Wenchuan earthquake resulted in extensive loss of life and physical and psychological injuries for survivors. This research examines the relationship between social support and health-related quality of life for the earthquake survivors.

Methods

A multistage cluster sampling strategy was employed to select participants from 11 shelters in nine counties exposed to different degrees of earthquake damage, for a questionnaire survey. The participants were asked to complete the Short Form 36 and the Social Support Rating Scale eight months after the earthquake struck. A total of 1617 participants returned the questionnaires. The quality of life of the survivors (in the four weeks preceding the survey) was compared with that of the general population in the region. Multivariate logistic regression analysis and canonical correlation analysis were performed to determine the association between social support and quality of life.

Results

The earthquake survivors reported poorer quality of life than the general population, with an average of 4.8% to 19.62% reduction in scores of the SF-36 (p < 0.001). The multivariate logistic regression analysis showed that those with stronger social support were more likely to have better quality of life. The canonical correlation analysis found that there was a discrepancy between actual social support received and perceived social support available, and the magnitude of this discrepancy was inversely related to perceived general health (rs = 0.467), and positively related to mental health (rs = 0.395).

Conclusion

Social support is associated with quality of life in the survivors of the earthquake. More attention needs to be paid to increasing social support for those with poorer mental health.

Public health status and influence factors after 2008 Wenchuan earthquake among survivors in Sichuan province, China: cross-sectional trial

OBJECTIVES

On 12 May 2008, an earthquake with a magnitude of 8.0 on the Richter scale struck in Sichuan province, China. After the disaster, approximately 5 million people were living in temporary shelters. The objectives of this study were: (1) to provide the basic information on public health outcomes among the survivors; (2) to compare these outcomes between counties affected to differing extents by the earthquake; and (3) to identify important policies and programmes associated with public health outcomes.

STUDY DESIGN

Cross-sectional multicluster sample surveys were employed using data collected from two counties.

METHODS

Cross-sectional surveys were conducted in August 2008 in two counties in Sichuan province. The study outcomes [physical component summary (PCS) and mental component summary (MCS)] were measured using Short Form-12. Independent demographic, socio-economic and trauma exposure variables were also measured. Multivariate regression analysis was conducted to investigate associations between the independent variables and PCS and MCS outcomes.

RESULTS

In total, 3862 interviews were completed in the two counties. The mean PCS score was 37.6 [95% confidence interval (95% CI 35.13-41.97) in Beichuan county and 45.4 (95% CI 44.30-45.95) in Langzhong county. MCS scores were 36.8 (95% CI 33.61-40.71) in Beichuan county and 49.6 (95% CI 49.69-50.01) in Langzhong county, well below the instrument norm of 50. Variables with negative associations with physical or mental health included: female gender, living in a temporary shelter, higher income, deaths among family/friends, family property damaged and illness within the past 2 weeks. Higher frequencies of trauma exposure (more than six trauma exposure events) showed a strong significant negative association with PCS and MCS in both counties.

CONCLUSIONS

Interventions should be designed to focus on people without a household income (or a lower income), living in shelters or temporary houses. Governments should support income-generating activities and improve living conditions and public health status.