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

Short-Term Preliminary Evaluation of Suicide Following the 2024 Noto Peninsula Earthquake in Japan Using Time Series Analysis

Background: The impact of earthquakes on mental health is profound. Aim: This study examines the short-term impact of the Noto Peninsula earthquake (magnitude 7.6) in Japan in January 2024 on the number of suicides and investigates the existence of the pulling together effect or honeymoon phase in suicide trends. Method: Suicide data from disaster-affected areas in Ishikawa Prefecture from January 2017 to June 2024 were analyzed using Poisson regression and prophet models. Results: Both models identified fewer suicides than predicted for 3 consecutive months (March-May 2024). This trend was observed even when the affected areas were subdivided into multiple regions. Limitations: Economic factors and data on suicide attempts or mental disorders were not included in the analysis. Conclusion: This study provides evidence supporting the pulling together effect or honeymoon phase, suggesting that increased community support following a disaster temporarily reduces suicide risk.

Assessing the qualities of sleep and life for menopausal women after the February 6 earthquake

Earthquakes can cause significant changes in the qualities of sleep and life of menopausal women. The aim of this study is to determine the qualities of sleep and life of menopausal women after the earthquake. This cross-sectional and correlational study was conducted with 182 menopausal women who applied to the State Hospital between 24 June and 14 September 2023. The data were collected using a Personal Information Form, the Pittsburgh Sleep Quality Index (PSQI), and the Menopause-Specific Quality of Life Scale (MENQOL). In addition to descriptive statistics, t-test and Mann Whitney U test, One-Way ANOVA, Kruskal Wallis test, Correlation, and Multiple Linear Regression analyses were used to analyze the data. In the study, it was determined that the women's PSQI and MENQOL total mean scores were 8.21 ± 4.34, and 118.75 ± 45.73, respectively. There was a positive, significant, and moderate correlation between PSQI and MENQOL. Age, loss of a relative in the earthquake, place of residence, and PSQI total score accounted for 35.3% of the total variance for MENQOL. In the post-earthquake period, the menopausal women had a poor quality of sleep and a moderate menopause-specific quality of life. Their qualities of sleep and life were correlated with each other. Deteriorated sleep quality in menopausal women after the earthquake negatively affected their quality of life specific to menopause. In this regard, it is important to evaluate the sleep problems of menopausal women and prioritize them in disaster management strategies.

Shattered ground, shaken minds: Mental health consequences of earthquakes

Despite growing recognition of the importance of mental health status for the achievement of the global development goals, substantial challenges persist in addressing this issue in both developed and developing countries. The literature has pointed to a variety of conditions as triggers for mental health problems, including exposure to unexpected natural disasters. Contributing to the literature, our study quantifies the mental health consequences of the devastating 2006 Yogyakarta earthquake in Indonesia. We combine the Modified Mercalli Intensity from the United States Geological Survey with individual-level data from the Indonesia Family Life Survey to assess the impacts on municipalities with varying earthquake intensities. Employing a difference-in-differences approach, we identify a significant and persistent deterioration in the mental health condition for individuals in municipalities with stronger earthquake severity. To explore the mechanisms underlying this impact, we analyze the roles of family casualties, physical health declines, and socio-economic disruptions, identifying family loss and worsened physical health as particularly influential factors driving the observed mental health outcomes.

A prospective cohort study of persistent endocrine-disrupting chemicals and perceived stress

Persistent endocrine-disrupting chemicals (EDCs) can dysregulate the stress response. We evaluated associations between persistent EDCs and perceived stress among participants in the Study of Environment, Lifestyle, and Fibroids (n = 1394), a prospective cohort study of Black women. Participants completed the Perceived Stress Scale 4 (PSS-4) at baseline and every 20 months through 60 months (score range: 0-16); higher scores indicate higher stress. Endocrine-disrupting chemicals, including per- and polyfluoroalkyl substances, polychlorinated biphenyls (PCBs), polybrominated diphenyl ethers (PBDEs), and organochlorine pesticides, were quantified in plasma samples at baseline. We fit bayesian kernel machine regression and linear mixed-effects models to estimate associations of EDCs (as a mixture and individually) with PSS-4 scores at baseline and at each follow-up visit, respectively. Increasing percentiles of the mixture were not strongly associated with PSS-4 scores at baseline, and no interactions were observed among EDCs. Several individual EDCs (eg, perfluorodecanoic acid, PCB 118, PBDE 99) were associated with higher PSS-4 scores at baseline or follow-up, and other EDCs (eg PCB 138/158) were associated with lower PSS-4 scores at baseline or follow-up. The directionality of associations for individual EDCs was inconsistent across follow-up visits. In conclusion, specific EDCs may be associated with perceived stress in Black women. This article is part of a Special Collection on Environmental Epidemiology.

Natural Disasters as a Maternal Prenatal Stressor and Children's Neurodevelopment: A Systematic Review

The intrauterine period is a time of high sensitivity in the development of the embryo and the fetus. Therefore, low levels of maternal stress are closely associated with healthy brain development in the neonatal and early childhood periods. There is increasing evidence linking natural disasters as prenatal maternal stress (PNMS) to neurodevelopmental disorders (including subclinical manifestations). Natural disasters involve many factors in addition to the trauma they cause, including loss and the physical and psychosocial difficulties that result from that trauma. This review article aims to bring together research findings on the neurodevelopmental effects of natural disasters on children as PNMS. It also looks at how factors such as gestational age and gender contribute to these effects. We conducted a systematic review on PubMed, Web of Science, and Scopus, with 30 studies meting the inclusion criteria. This systematic review was conducted in accordance with the PRISMA guidelines. A total of 1,327,886 mother-child dyads participated in the included studies. The results of the studies indicate that natural disasters have a negative impact on children's outcomes in terms of cognitive development, language development, autism/autism-like features, motor skills, performance in mathematics, mental development, sleep, attention, behavioral and emotional problems, and various psychiatric comorbidities.

Pregnant women's depression and posttraumatic stress levels after the large-scale Turkey earthquakes: a cross-sectional study

Depression and posttraumatic stress disorder are two common mental disorders after negative life events. This study was conducted to evaluate the depression and posttraumatic stress levels of pregnant women after the large-scale earthquakes that occurred in Turkey in 2023. The study was carried out with 395 pregnant women who visited maternity outpatient clinics of a public hospital in a province in southern Turkey. The data were collected with the Beck Depression Inventory (BDI) and the Post-Traumatic Stress Disorder Checklist - Civilian Version (PCL-C). Descriptive statistics, the independent-samples t-test, and the Pearson correlation test were used in the analyses of the data. Among all participants, 3.8 percent had a likely depression risk, and 31.9 percent exhibited posttraumatic stress disorder symptoms. A statistically significant relationship was found between the earthquake exposure of the participants and their BDI and PCL-C total scores (p < .05). The BDI scores of the participants also had statistically significant relationships to their PCL-C scores (p < .05). In this study, it was discerned that posttraumatic stress disorder symptoms were prevalent among pregnant women in the post-earthquake period. Psychological support is needed to improve the mental health of the pregnant women after earthquakes.

Per- and polyfluoroalkyl substances (PFAS), perceived stress, and depressive symptoms in a prospective cohort study of black women

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are endocrine-disrupting chemicals with neurotoxic properties. PFAS have been associated with depressive symptoms among women in some studies, but little research has evaluated the effects of PFAS mixtures. Further, no study has investigated interactions of PFAS-depression associations by perceived stress, which has been shown to modify the effects of PFAS on other health outcomes.

OBJECTIVE

In a prospective cohort study of reproductive-aged Black women, we investigated associations between PFAS and depressive symptoms and the extent to which perceived stress modified these associations.

METHODS

We analyzed data from 1499 participants (23-35 years) in the Study of Environment, Lifestyle, and Fibroids. We quantified concentrations of nine PFAS in baseline plasma samples using online solid-phase extraction-liquid chromatography-isotope dilution tandem mass spectrometry. Participants reported perceived stress via the Perceived Stress Scale (PSS-4; range = 0-16) at baseline and depressive symptoms via the Center for Epidemiologic Studies Depression Scale (CESD; range = 0-44) at the 20-month follow-up visit. We used Bayesian Kernel Machine Regression to estimate associations between PFAS concentrations, individually and as a mixture, and depressive symptoms, and to assess effect modification by PSS-4 scores, adjusting for confounders.

RESULTS

Baseline perfluorodecanoic acid concentrations were associated with greater depressive symptoms at the 20-month follow-up, but associations for other PFAS were null. The PFAS were not associated with depressive symptoms when evaluated as a mixture. The association between the 90th percentile (vs. 50th percentile) of the PFAS mixture with CES-D scores was null at the 10th (β = 0.03; 95 % CrI = 0.20, 0.25), 50th (β = 0.02; 95 % CrI = -0.16, 0.19), and 90th (β = 0.01; 95 % CrI = 0.18, 0.20) percentiles of PSS-4 scores, suggesting perceived stress did not modify the PFAS mixture.

CONCLUSION

In this prospective cohort study, PFAS concentrations-assessed individually or as a mixture-were not appreciably associated with depressive symptoms, and there was no evidence of effect modification by perceived stress.

Obstetric care for environmental migrants

BACKGROUND

Migration due to environmental factors is an international crisis affecting many nations globally. Pregnant people are a vulnerable subgroup of migrants.

AIM

This article explores the potential effects of environmental migration on pregnancy and aims to draw attention to this rising concern.

METHODS

Based on the study aim, a semi-structured literature review was performed. The following databases were searched: MEDLine (PubMed) and Google Scholar. The search was originally conducted on 31st January 2021 and repeated on 22nd September 2022.

RESULTS

Pregnant migrants are at increased risk of mental health disorders, congenital anomalies, preterm birth, and maternal mortality. Pregnancies exposed to natural disasters are at risk of low birth weight, preterm birth, hypertensive disorders, gestational diabetes, and mental health morbidity. Along with the health risks, there are additional complex social factors affecting healthcare engagement in this population.

CONCLUSION

Maternity healthcare providers are likely to provide care for environmental migrants over the coming years. Environmental disasters and migration as individual factors have complex effects on perinatal health, and environmental migrants may be at risk of specific perinatal complications. Obstetricians and maternity healthcare workers should be aware of these challenges and appreciate the individualised and specialised care that these patients require.

Maternal anxiety, depression and posttraumatic stress disorder (PTSD) after natural disasters: a systematic review

OBJECTIVE

To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters.

METHODS

A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants.

RESULTS

Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%.

CONCLUSION

Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Importance

Anxiety disorders are associated with poor maternal and neonatal outcomes. Women in low- and middle-income countries (LMICs) are thought to be disproportionally burdened by these disorders, yet their prevalence is unclear.

Objective

To conduct a systematic review and meta-analysis to determine the prevalence of 6 anxiety and related disorders among perinatal women in LMICs.

Data Sources

Embase, MEDLINE, PsycINFO, Cochrane Library, CINAHL, and Web of Science databases were searched from inception until September 7, 2023.

Study Selection

Studies conducted in World Bank-defined LMICs and reporting prevalence of generalized anxiety disorder, obsessive-compulsive disorder, social anxiety disorder, posttraumatic stress disorder, panic disorder, or adjustment disorder during the perinatal period (conception to 12 months post partum) using a validated method were included.

Data Extraction and Synthesis

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Study eligibility, extracted data, and risk of bias of included studies were assessed by 2 independent reviewers. Random-effects meta-analysis was used to estimate pooled point prevalence. Subgroup analyses were performed by specific anxiety disorder.

Main Outcomes and Measures

Main outcomes were prevalence estimates of each anxiety disorder, measured as percentage point estimates and corresponding 95% CIs.

Results

At total of 10 617 studies were identified, 203 of which met the inclusion criteria and reported the outcomes of 212 318 women from 33 LMICs. Generalized anxiety disorder was the most reported (184 studies [90.6%]) and most prevalent disorder at 22.2% (95% CI, 19.4%-25.0%; n = 173 553). Posttraumatic stress disorder was the second most prevalent (8.3%; 95% CI, 5.0%-12.2%; 33 studies; n = 22 452). Adjustment disorder was least prevalent (2.9%; 95% CI, 0.0%-14.1%; 2 studies; n = 475). The prevalence of generalized anxiety varied by country income status, with the highest prevalence among lower-middle-income countries (27.6%; 95% CI, 21.6%-33.9%; 59 studies; n = 25 109), followed by low-income (24.0%; 95% CI, 15.3%-33.8%; 11 studies; n = 4961) and upper-middle-income (19.1%; 95% CI, 16.0%-22.4%; 110 studies; n = 138 496) countries.

Conclusions and Relevance

These findings suggest that 1 in 5 women living in LMICs experience anxiety disorders during pregnancy and post partum. Targeted action is needed to reduce this high burden.

Earthquake exposure during adolescence and later-life depressive symptoms: A national cross-sectional survey

Background

This study aimed to examine the association between exposure to the 1976 Great Tangshan Earthquake (GTE) in adolescence and later-life depressive symptoms and to investigate the potential mechanisms underlying this association.

Methods

Data were from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The 10-item short form of the Center for Epidemiologic Studies Depression scale (CESD-10) was chosen to measure depressive symptoms. We used the difference-in-difference (DID) method, binary logistic regression models, and multilevel logistic regression models to explore the association of earthquake exposure during adolescence with later-life depressive symptoms. Additionally, multilevel mediation analysis with structural equation modeling (MMSEM) was conducted to investigate potential mechanisms.

Results

We identified that adolescent exposure to earthquakes was related to a lower risk of depressive symptoms in later life (OR = 0.90, P = 0.019; OR = 0.48, P = 0.031; OR = 0.47, P = 0.034, respectively). However, this significant association was observed only in females (OR = 0.83, P = 0.028; OR = 0.46, P = 0.053; OR = 0.42, P = 0.037, respectively). Moreover, social activity participation played a mediating role in the association between exposure to earthquakes in adolescence and later-life depressive symptoms.

Conclusions

We observed a lower risk of depressive symptoms in later life in survivors of earthquake exposure during adolescence. Further, we found the mediating role of social participation in the association between earthquake exposure in adolescence and later-life depressive symptoms, which gives support for the posttraumatic growth (PTG) theory. Our findings imply that, in order to lower the risk of depression in later life following exposure to a natural disaster in adolescence, it is necessary to take into account the buffering effect of social participation.

Women's mental health and climate change Part II: Socioeconomic stresses of climate change and eco-anxiety for women and their children

Climate change is a significant public health crisis that is both rooted in pre-existing inequitable socioeconomic and racial systems and will further worsen these social injustices. In the face of acute and slow-moving natural disasters, women, and particularly women of color, will be more susceptible to gender-based violence, displacement, and other socioeconomic stressors, all of which have adverse mental health outcomes. Among the social consequences of climate change, eco-anxiety resulting from these negative impacts is also increasingly a significant factor in family planning and reproductive justice, as well as disruptions of the feminine connection to nature that numerous cultures historically and currently honor. This narrative review will discuss these sociologic factors and also touch on ways that practitioners can become involved in climate-related advocacy for the physical and mental well-being of their patients.

How Maternal Trauma Exposure Contributed to Children's Depressive Symptoms following the Wenchuan Earthquake: A Multiple Mediation Model Study

Although well-established literature has indicated the burden of mental health among victims after the Wenchuan earthquake, no research has focused on the mental health of mothers and their children who experienced the earthquake and were pregnant during or shortly after it. This study investigates the relationship between maternal trauma exposure (TE) and children's depressive symptoms after the Wenchuan earthquake and explores the risk and protective factors underlying this relationship. A sample of 547 mother-child dyads, in which the mother experienced the Wenchuan earthquake, was used to assess maternal depressive symptoms, maternal TE, children's depressive symptoms, children's perceived impact of the earthquake and maternal posttraumatic growth (PTG). The results showed that maternal TE had two significant one-step indirect associations with children's depressive symptoms (through children's perceived impact of the earthquake and maternal PTG) and one two-step indirect association with children's depressive symptoms (through maternal depressive symptoms via children's perceived impact of the earthquake). The results indicated that maternal depressive symptoms, children's perceived impact of the earthquake and maternal PTG mediated the association between maternal TE and children's depressive symptoms. These findings highlight the importance of mothers in supporting the mental health of these children. Maternal depressive symptoms and PTG, two posttraumatic outcomes, played positive and negative roles in the intergenerational transmission of trauma. Thus, post-disaster interventions should reduce the maternal transmission of trauma-related information and improve maternal PTG to support children's mental health.

Influenza virus vaccine compliance among pregnant women during the COVID-19 pandemic (pre-vaccine era) in Israel and future intention to uptake BNT162b2 mRNA COVID-19 vaccine

The influenza virus vaccine, used worldwide as an annual preventive measure, is especially recommended for at-risk populations. Older adults and pregnant women are therefore offered the flu shot free of charge in Israel. The Israel Ministry of Health's rationale for giving the influenza vaccine to pregnant women is to avoid serious complications that could harm both mother and foetus. In Israel, the winter of 2020/2021 was marked by a third surge of COVID-19, raising the risk of contracting the SARS-CoV-2 virus and the level of fear among the population. The influenza vaccine protects individuals from the flu and thus helps prevent an additional burden on medical centres treating COVID-19 patients. The aim of the present study was to assess compliance of pregnant and postpartum women to influenza vaccine uptake during winter 20/21 period. A survey questionnaire was distributed to examine factors predicting women's attitudes toward the influenza vaccine. Questionnaire items based on the Heath Belief Model examined participants' perceptions regarding influenza and the vaccine. The questionnaire also evaluated participants' hypothetical willingness to get immunized with the Pfizer COVID-19 vaccine upon its arrival in Israel. The results showed a higher prevalence of influenza vaccine uptake among Jewish women than Arab women, while level of trust in healthcare providers was stronger among Arab participants than among Jewish participants. The findings indicate that the pregnant and postpartum community needs better information dissemination and education regarding the importance of the influenza vaccine. Decisions regarding uptake of the COVID-19 vaccine upon future availability were found to be unrelated to influenza vaccine perceptions. The results call for raising public awareness regarding influenza immunization in addition to offering the vaccine at routine pregnancy follow-up appointments.

A Critical Appraisal: Development and Use of Perceived Stress Scale in U.S. Immigrants

Few studies have critically appraised Perceived Stress Scale (PSS) in immigrants. The purpose of the article is to determine if PSS is adequately developed and properly used with U.S. immigrants. Searching via PubMed and PsycINFO databases resulted in 10 research papers published between 2009 and 2019 that met the selection criteria and were integrated for this review. Most of the studies do not have adequate theoretical models and do not have proper consideration of socio-cultural factors. Five studies used the PSS translated into different languages but only one study validated the translated version. Six studies reported the reliability of the PSS. The PSS-14 and PSS-10 may be appropriately used in immigrants to measure psychological stress. Some issues, such as the PSS's reliability and validity, need to be addressed in future use in immigrants.

Psychological outcomes for young adults after disastrous events: A mixed-methods scoping review

RATIONALE

Young adulthood (18 to 34) is a time of transitional change where individuals can be highly susceptible to mental health concerns. Despite similar vulnerabilities to their adolescent counterparts, the psychological outcomes for young adults following disasters are not well understood.

OBJECTIVE

This scoping review aimed to explore the literature on the psychological outcomes for young adults after disaster events.

METHODS

A systematic search of the literature was conducted in seven electronic databases, including PsycINFO, Medline, CINAHL, PILOTS, EMBASE, Scopus, and ProQuest dissertations and theses global. In total, 91 reports from 15 countries were included.

RESULTS

Findings suggested that young adults experience a range of psychological consequences after disasters, including posttraumatic stress symptoms, depression, anxiety, and other psychological outcomes, such as general/non-specific psychological distress. Pre-disaster, peri-disaster, and post-disaster factors were also found to influence the degree of psychological outcomes experienced by young adults, including prior psychological functioning and disaster exposure, among a host of other factors.

CONCLUSION

Future research is recommended to better understand young adults' psychological outcomes, experiences, and service needs following disasters.

Birth outcomes, pregnancy complications, and postpartum mental health after the 2013 Calgary flood: A difference in difference analysis

Background

In June 2013, the city of Calgary, Alberta and surrounding areas sustained significant flooding which resulted in large scale evacuations and closure of businesses and schools. Floods can increase stress which may negatively impact perinatal outcomes and mental health, but previous research is inconsistent. The objectives of this study are to examine the impact of the flood on pregnancy health, birth outcomes and postpartum mental health.

Methods

Linked administrative data from the province of Alberta were used. Outcomes included preterm birth, small for gestational age, a new diagnoses of preeclampsia or gestational hypertension, and a diagnosis of, or drug prescription for, depression or anxiety. Data were analyzed using a quasi-experimental difference in difference design, comparing flooded and non-flooded areas and in affected and unaffected time periods. Multivariable log binomial regression models were used to estimate risk ratios, adjusted for maternal age. Marginal probabilities for the difference in difference term were used to show the potential effect of the flood.

Results

Participants included 18,266 nulliparous women for the pregnancy outcomes, and 26,956 women with infants for the mental health analysis. There were no effects for preterm birth (DID 0.00, CI: -0.02, 0.02), small for gestational age (DID 0.00, CI: -0.02, 0.02), or new cases of preeclampsia (DID 0.00, CI: -0.01, 0.01). There was a small increase in new cases of gestational hypertension (DID 0.02, CI: 0.01, 0.03) in flood affected areas. There were no differences in postpartum anxiety or depression prescriptions or diagnoses.

Conclusion

The Calgary 2013 flood was associated with a minor increase in gestational hypertension and not other health outcomes. Universal prenatal care and magnitude of the disaster may have minimized impacts of the flood on pregnant women.

Measuring mental health burden in humanitarian settings: a critical review of assessment tools

BACKGROUND

The effects of disasters and conflicts are widespread and heavily studied. While attention to disasters' impacts on mental health is growing, mental health effects are not well understood due to inconsistencies in measurement.

OBJECTIVE

The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters and conflicts.

METHOD

Tools that assess posttraumatic stress disorder, depression, substance use disorder, and general mental health were examined. This review began with a search for assessment tools in PubMed, PsycINFO, and Google Scholar. Next, validation studies for the tools were obtained through snowball sampling. A final search was conducted for scientific studies using the selected tools in humanitarian settings to collect the data for analysis. The benefits and limitations described for each tool were compiled into a complete table.

RESULTS

Twelve assessment tools were included, with 88 studies using them. The primary findings indicate that half of the studies used the Impact of Events Scale-Revised. The most common limitation discussed is that self-report tools inaccurately estimate the prevalence of mental health problems. This inaccuracy is further exacerbated by a lack of cultural appropriateness of the tools, as many are developed for Western contexts.

CONCLUSION

It is recommended that researchers and humanitarian workers reflect on the effectiveness of the mental health assessment tool they use to accurately represent the populations under study in emergency settings. In addition, mental health assessment should be coupled with action.

Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China:a cross-sectional study

Background

Studies have shown that the outbreak of infectious diseases would result in mental health problems. Females are in greater risk for psychological problems than males. The present study investigated gender differences of depression and anxiety and explored associated factors during the COVID-19 epidemic among Chinese social media users.

Methods

We recruited 3088 participants through social media cross China. Participants completed sociodemographic and the COVID-19 epidemic related questions, the 2-item Patient Health Questionnaire (PHQ-2), and the 2-item Generalized Anxiety Disorder Scale (GAD-2), the Chinese version of the 10-item Connor-Davidson Resilience Scale. We applied Chi-square test and ANOVA for data description and linear regression analysis for exploring factors associated with depression and anxiety.

Results

Of 3063 participants eligible for analysis, the total prevalence of depression and anxiety was 14.14 and 13.25%. Females were experiencing more severe stress and anxiety symptoms, while males showed better resilience to stress. The severity of depression symptoms would decrease with the increase of age resilience, and it would increase if being unemployed, feeling less adapted, being more stressed. The severity of anxiety symptoms would decrease with higher education and better resilience, and it would increase if being female, spending over 60 min on COVID-19 related information, less adapted, and being more stressed.

Conclusion

The findings show the increased prevalence of depression and anxiety in Chinese population during the COVID-19 epidemic, and females are experiencing more severe anxiety symptoms than males. As social media is the current main resource of information related to COVID-19, interventions should be implemented to help users to limit the time they spend on social media and to get key information related to the epidemic from authoritative and authentic resource to avoid infodemic and prevent mental health problems.

The relationship among fear and anxiety of COVID-19, pregnancy experience, and mental health disorder in pregnant women: A structural equation model

INTRODUCTION

Coronavirus pandemic causes stress and anxiety for pregnant women worldwide. The present study was conducted for the path analysis of the relationship among fear and anxiety caused by coronavirus, pregnancy experience, and the mental health of pregnant women.

METHODS

This cross-sectional study was conducted on 222 pregnant women who were referred to Kamali Hospital in Alborz province in 2020. The eligible individuals entered the study through convenience sampling, and data were collected using five questionnaires including the Fear of COVID-19 Scale, the Anxiety of COVID-19 Scale, the pregnancy experiences Scales, Depression Anxiety Stress scale, and demographic checklist. The obtained data were then analyzed using SPSS-16 and Amos software.

RESULTS

According to results of the path analysis, the anxiety of COVID-19 and concerns during pregnancy were variables that were positively and significantly correlated with mental health only through one path, which was direct, and anxiety of COVID-19 had also the highest positive direct correlation among them (B = 0.32). The next variable was the happiness during pregnancy experiencing, which had a significantly negative and direct correlation with mental health disorder (B = 0.29). Moreover, fear of COVID-19 through the mediating concerns of pregnancy experiences was shown to have a significant positive relationship with mental health through an indirect path (B = 0.05).

CONCLUSION

Based on the result of this study, it is necessary to pay more attention to the mental health of pregnant women during a pandemic. In addition, it is recommended to provide a virtual training group to reduce anxiety caused by coronavirus and pregnancy concerns, as well as emphasizing the feeling of enjoying happiness caused by pregnancy experience during a pandemic.

Paternal Psychological Stress After Detection of Fetal Anomaly During Pregnancy. A Prospective Longitudinal Observational Study

Background and Aims

Knowledge of carrying a fetus with a prenatal diagnosed anomaly may cause acute psychological stress to the parents. Most studies focus on maternal stress, yet fathers are often present at the ultrasound examinations and birth, and therefore may be affected, similarly, to the expectant mother. However, to date no existing studies have examined how detection of a fetal anomaly emotionally affects the expectant fathers throughout the pregnancy. Our aim was to longitudinally examine general health perceptions, social dysfunction and psychological distress in a subgroup of men where fetal anomaly was detected during pregnancy.

Methods and Results

This study is part of the SOFUS study, a prospective, longitudinal, observational study. Participants were recruited when referred for an ultrasound examination conducted by a specialist in fetal medicine at Oslo University Hospital on suspicion of fetal malformation (study group). We examined differences between the men in the study group (N = 32) and a comparison group (N = 83) on the General Health Questionnaire (GHQ), Impact of Event Scale (IES) and Edinburgh Postnatal Depression Scale (EDPS) across four time points in pregnancy. Results from repeated measured ANOVA suggests that depression decreased over time among men in both groups (η² = 0.15, p < 0.001). This effect was stronger in the study group, and differed from the comparison group (η² = 0.08, p < 0.001). There was also a main effect of time on IES scores, which decreased over time for both men in the study group and in the comparison group (η² = 0.32, p < 0.001). That is, men in the study group were higher on IES initially, but this effect decreased more in the study group than in the comparison group. Men in the study group and comparison group did not differ on perceived general health (GHQ: p = 0.864).

Conclusion

Results suggests that detection of a fetal anomaly has implications for paternal mental health during pregnancy. Expectant fathers scored higher on EPDS and IES than the comparison group in the acute phase after detection of fetal anomaly, thus there is impetus to provide psychological support for fathers, as well as mothers, at this difficult time.

Experiences of an earthquake during pregnancy, antenatal mental health and infants' birthweight in Bhaktapur District, Nepal, 2015: a population-based cohort study

Background

Infant birthweight is an important public health indicator that is a proxy of maternal and baby’s health. Earthquakes can cause acute distress, but can also contribute to chronic stress through long-term disruptions to social, economic and domestic circumstances. The aims of this study were to examine the direct effect of earthquake experiences on the birthweight of infants of women who experienced the 2015 Nepal Earthquakes during pregnancy and whether mental health mediated this relationship.

Methods

This is a prospective, population-based cohort study. Pregnant women in Bhaktapur District, Nepal who had experienced the 2015 earthquakes after conception were recruited. Baseline data were collected in structured individual interviews. Follow up was a short telephone interview two weeks after the baby’s birth. Infant birthweight recorded on the hospital-issued birth certificate. The direct effect of earthquake experiences on birthweight and the indirect effect via antenatal common mental disorders (CMDs) were tested using Sobel tests simultaneously.

Results

In total 497/498 women contributed baseline data and 469 (94.4%) women also provided the birth weight of their infants. In total 6% of infants had low birth weight (< 2.5 kg). The earthquake experiences did not have a significant direct effect on birthweight (p = 0.116). However, the effect of earthquake experiences had a significant indirect effect on infant birthweight via CMDs. When 15 covariates were controlled, women who had moderate to severe earthquake experiences had an increase of 1.58 scores of antenatal CMD symptoms that resulted in their babies being 20.50 g lighter than those who had low earthquake experiences (p = 0.026).

Conclusions

The findings from this study indicate that the relationship is mediated by the mental health of women during pregnancy. Data demonstrate that the mental health of women who are pregnant should be prioritised in post-disaster management not only because of the burden experienced by women but also because of the risk for the growth and development of their babies.

Prevalence and risk factors of post-traumatic stress disorder among elderly survivors six months after the 2008 Wenchuan earthquake in China

BACKGROUND

Several studies indicate that older age is a risk factor for probable post-traumatic stress disorder (PTSD). However, evidence on the prevalence and risk factors for elderly disaster survivors is limited.

METHODS

Multi-stage stratified sampling was applied in this cross-sectional study. The Revised Version of the Impact of Event Scale (IES-R) was used to evaluate symptoms of PTSD. Chi-squared test was used for univariable analysis of prevalence of probable PTSD by possible determinants. Multivariable logistic regression analysis was utilized to further explore risk factors for PTSD.

RESULTS

427 elderly survivors age 60 or older participated. The prevalence of probable PTSD was 40.5, 36.3, and 21.5% according to a cut off score of the IES-R of 33, 35, and 2 points on average across items, respectively. In multivariable logistic regression, elderly survivors with a higher number of diagnosed chronic illnesses were more likely to be screened positive for PTSD and those with a greater number of family members living in the same home were less likely to be classified as having probable PTSD for all cut off scores. Elderly survivors with improved economic status and those with primary school or lower education were more often estimated to have probable PTSD with a cut off score of 35 and 2 points on average.

CONCLUSIONS

Elderly survivors in a high impact area following a major earthquake are at high risk for developing PTSD. Those who live alone and report pre-existing chronic illness are particularly vulnerable.

Perceived stress and mental health: The mediating roles of social support and resilience among black women exposed to sexual violence

BACKGROUND

Black women disproportionately suffer from violence and its subsequent mental health outcomes. Increasing levels of perceived stress are associated with greater symptoms of depression and post-traumatic stress disorder (PTSD). Social support and resilience can potentially mediate the negative consequences of perceived stress on women's mental health. This study assesses the association between perceived stress and mental health outcomes among Black women. In addition, this study examines social support and resilience as mediators of association between perceived stress and mental health.

METHODS

Black women residing in Baltimore, MD (n = 310) were recruited from STD clinics into a retrospective cohort study (2013-2018) on sexual assault and HIV risk. Social support and resilience served as coping variables and were assessed as mediators in the associations between perceived stress and mental health. Analyses were stratified by exposure to sexual violence in adulthood.

RESULTS

Almost half of our sample (46%) experienced severe depression and about one-third (27%) experienced severe PTSD. Resilience partially mediated the association between perceived stress and severe depressive symptoms among exposed women. Social support partially mediated the association between perceived stress and severe PTSD symptoms among exposed women.

LIMITATIONS

Since this is a cross-sectional analysis, we are unable to determine the temporal relationship between outcome and exposure variables. The CES-D-10 and NSESSS are scales that measure the severity of depressive and PTSD symptoms, respectively, and are not clinical diagnoses.

CONCLUSION

There is a critical need to develop interventions focused on reducing the burden of stress on mental health.

Dispositional mindfulness mediates the relations between neuroticism and posttraumatic stress disorder and depression in Chinese adolescents after a tornado

Previous studies have shown that neuroticism is associated with higher levels of posttraumatic stress disorder (PTSD) and depression in individuals who have experienced traumatic events. This study investigated dispositional mindfulness as one pathway in which neuroticism is related to PTSD and depression symptoms among Chinese adolescents who have experienced trauma by considering the role of dispositional mindfulness. Participants were 443 Chinese adolescents who had experienced a severe tornado a year prior to this study. The results showed that our model fitted the data well (χ²/df = 2.113, comparative fit index (CFI) = 0.981, Tucker-Lewis index (TLI) = 0.969, root mean square error of approximation (RMSEA) (90% confidence interval (CI)) = 0.061 [0.047, 0.080]) and revealed that dispositional mindfulness partially mediated the relationship between neuroticism and PTSD and depression symptoms. The clinical implications and limitations of our research and recommendations for future research are discussed in this article.

The prevalence and risk of DSM-IV axis I disorder in adults with early-life earthquake stress: A cross-sectional study

OBJECTIVES

Tangshan earthquake which had a magnitude of 7.8 killed approximately 250,000 people in China in 1976. In the present study, we sought to determine the prevalence and risks of mental disorders in adults who experienced earthquake as an infant or in the prenatal period.

METHODS

This cross-sectional cohort study recruited participants based on the urban resident registry of Tangshan, Hebei province, 2013 using a multistage stratified cluster sampling method with selection probabilities proportional to size. We recruited subjects who were born between July 29, 1975 and April 28, 1978 that was one year before and 1.9 years after the occurrence of Tangshan Earthquake, respectively. Current psychiatric diagnoses and lifetime psychiatric diagnoses were obtained through the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Research Version. Unconditional logistic regression analysis was performed to analyze risk factors of mental disorders.

RESULTS

Totally1380 subjects were included with 392 subjects exposed to the earthquake in the fetal period, 399 subjects who experienced the earthquake during their infancy, and 589 subjects who had no exposure to the earthquake. Twenty-one (2.7%; current 1.9%) subjects exposed to earthquake were diagnosed with major depressive disorderversus 2.3% (current 1.5%) in the non-exposure group. Five (0.6%; current 0.6%) subjects with exposure to earthquake had bipolar disorder versus 0.9% in the non-exposure group.Thirteen (1.6%; current 1.6%) subjects with exposure to earthquake had schizophreniaversus 0.2% in the non-exposure group (P=0.006). Furthermore, 5.2% (current 3.7%) subjects with exposure to earthquake had anxiety disorders versus 5.7% (current 3.9%) in the non-exposure group. Moreover, 8.1% (current 7.0%)subjects with exposure to earthquake had alcohol use disorders versus 7.1% (current 5.3%) in the non-exposure group. Furthermore, the prevalence of schizophrenia of the prenatal exposure group (2.3%) was significantly higher than the other two groups (χ² = 10.273, P = 0.006); however, no statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders among the three groups (P > 0.05). Our multivariate regression analysis showed that prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders.

CONCLUSION

Adults who were exposed to earthquake in the prenatal period had a significantly higher rate of schizophrenia than those who were not exposed or who experienced earthquake in their infancy. No statistically significant difference was found in the current and lifetime prevalence of other DSM-IV axis I disorders between those exposed and those not exposed to earthquake. Furthermore, prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders.

Infant Behavior and Competence Following Prenatal Exposure to a Natural Disaster: The QF2011 Queensland Flood Study

This study utilized a natural disaster to investigate the effects of prenatal maternal stress (PNMS) arising from exposure to a severe flood on maternally reported infant social-emotional and behavioral outcomes at 16 months, along with potential moderation by infant sex and gestational timing of flood exposure. Women pregnant during the Queensland floods in January 2011 completed measures of flood-related objective hardship and posttraumatic stress (PTS). At 16 months postpartum, mothers completed measures describing depressive symptoms and infant social-emotional and behavioral problems (n = 123) and competence (n = 125). Greater maternal PTS symptoms were associated with reduced infant competence. A sex difference in infant behavioral problems emerged at higher levels of maternal objective hardship and PTS; boys had significantly more behavioral problems than girls. Additionally, greater PTS was associated with more behavioral problems in boys; however, this effect was attenuated by adjustment for maternal depressive symptoms. No main effects or interactions with gestational timing were found. Findings highlight specificity in the relationships between PNMS components and infant outcomes and demonstrate that the effects of PNMS exposure on behavior may be evident as early as infancy. Implications for the support of families exposed to a natural disaster during pregnancy are discussed.

Prevalence and determinants of symptoms of antenatal common mental disorders among women who had recently experienced an earthquake: a systematic review

BACKGROUND

Antenatal common mental disorders (CMDs) including anxiety, depressive, adjustment, and somatoform disorders are prevalent worldwide. There is emerging evidence that experiencing a natural disaster might increase the risk of antenatal CMDs. This study aimed to synthesise the evidence about the prevalence and determinants of clinically-significant symptoms of antenatal CMDs among women who had recently experienced an earthquake.

METHODS

This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search included both electronic and manual components. Five major databases were searched. A data extraction table was used to summarise study characteristics and findings. Two authors examined the quality of studies independently using a quality assessment tool. A narrative synthesis of the findings reported.

RESULTS

In total seven articles met inclusion criteria. Quality scores ranged from six to seven out of ten. All the studies were cross-sectional surveys and were conducted in high and middle-income countries. Sample sizes varied among studies. The prevalence of clinically-significant symptoms of antenatal CMD ranged from 4.6% (95% CI, 3.2; 6.5) experiencing 'psychological stress' in Japan to 40.8% (95% CI, 35.5; 46.4) 'depression' in China. While all studies were conducted in an earthquake context, only four examined some aspect of earthquake experiences as a risk factor for antenatal CMDs. In multivariable analyses, higher marital conflict, poor social support, multiparity, stresses of pregnancy and the personality characteristic of a negative coping style were identified as risks and a positive coping style as protective against antenatal CMDs.

CONCLUSIONS

This systematic review found that women who have recently experienced an earthquake are at heightened risk of antenatal mental health problems. It indicates that in addition to the establishment of services for safe birth which is recognised in post-disaster management strategies, pregnancy mental health should be a priority. The review also revealed that there is no evidence available from the world's low-income nations where natural disasters might have more profound impacts because local infrastructure is more fragile and where it is already established that women experience a higher burden of antenatal CMDs.

TRIAL REGISTRATION

PROSPERO- CRD42017056501 .

Prevalence and predictors of PTSD and depression among adolescent victims of the Summer 2016 tornado in Yancheng City

The aim of this study was to investigate the prevalence rate of probable posttraumatic stress disorder (PTSD) and depression in the adolescents who experienced the 2016 Yancheng tornado 3 months ago, as well as to analyze the related risk factors. A total of 247 tornado adolescent survivors were recruited to complete child PTSD symptom scale and Center for Epidemiologic Studies Depression Scale for Children. Results showed that 57.5% and 58.7% of the participants reported suspected symptoms of PTSD and depression respectively. PTSD is highly comorbid with depression. Risk factors of these two disorders were age and tornado exposure. Finally, the implications of intervention and prevention of mental health problems among adolescents who experienced tornado were discussed.

Effect of the 2015 Nepal Earthquakes on symptoms of common mental disorders among women who are pregnant

BACKGROUND

Antenatal mental health problems are of concern globally not only because of the burden and limits to participation experienced by women but also because of risks for foetal neurocognitive development and adverse birth outcomes. The aim was to describe the indicative prevalence of and risk and protective factors for clinically-significant symptoms of antenatal common mental disorders (CMDs) among women who experienced the 2015 Nepal earthquakes during pregnancy.

METHODS

A population-based cross-sectional study in Bhaktapur, one of 14 districts highly affected by the 2015 Nepal earthquakes. The primary outcome, clinically significant symptoms of CMDs, was ascertained using the Nepali validation of the Edinburgh Postnatal Depression Scale (EPDS-N). In order to investigate potential trauma reactions, a subset of EPDS items as indicators of trauma symptoms was constructed. Standardised instruments and study-specific questions were used to measure potential risk and protective factors. Data were collected in individual structured interviews by trained health researchers. Hierarchical multiple linear regression models were used to establish risk and protective factors for clinically significant symptoms of CMDs and indicators of post-earthquake trauma reaction.

RESULTS

Overall, 497/498 eligible pregnant women provided complete data. We found that 21.9% (95% CI, 18.4; 25.8) of participants had EPDS-N scores > 12 and another 17.1% (95% CI 13.9; 20.7) scored 10-12 indicating a high prevalence of clinically significant CMD symptoms. In total, 20 factors were included in the final hierarchical multiple linear regression model and together explained 33.3% of the variance in EPDS total scores; seven factors, including earthquake experiences and lifetime experience of intimate partner violence, increased risk and five including having income-generating work and a kind, and encouraging partner were protective. The association between earthquake experiences and the indicators of trauma symptoms was not significant in the hierarchical multiple linear regression analysis.

LIMITATIONS

The EPDS has not yet been formally validated in Nepal for use during pregnancy. Data were collected 6 months post-earthquake, so we were not able to capture the experiences of women who had spontaneous or induced abortions or premature births in the immediate aftermath of the earthquake.

CONCLUSIONS

In addition to the restoration of antenatal and obstetric services, the mental health of women who are pregnant requires specific consideration and interventions after natural disasters. This should take into account the additional adverse impact of violence perpetrated by an intimate partner.

Suicidality associated with PTSD, depression, and disaster recovery status among adult survivors 8 years after the 2008 Wenchuan earthquake in China

It has been eight years since the Wenchuan earthquake. We don't know how the lives of those affected by the disaster may remain blighted by its effects, or how many remain thus affected. The aim of the present study was to examine the relationship of disaster exposure, PTSD, depression and suicidal behaviors, using data from a cross-sectional survey conducted in earthquake-affected areas of China. 1369 participants were recruited from two different sites that were severely affected by the Wenchuan earthquake. The survey assessed suicidality (suicidal ideation, plans and attempts) and other mental health issues. Probable PTSD was assessed using the Impact of Event Scale-Revised (IES-R). The Center for Epidemiologic Studies Depression Scale (CES-D) Chinese edition was used to assess depressive symptoms. The results showed that 11.2% of participants felt that their lives had not yet recovered from the effects of the Wenchuan earthquake, even after eight years. Suicidal ideation, plans, and attempts were reported by 9.1%, 2.9%, and 3.3%, respectively, of the respondents. PTSD, depression, and perceived non-recovery were highly associated with suicidality. These results indicate that suicidality can be a long-term mental health sequela of disaster. Targeted, long-term suicide prevention programs for adult survivors should be further developed.

Maternal PTSD following Exposure to the Wenchuan Earthquake Is Associated with Impaired Mental Development of Children

The purpose of this study was to explore whether earthquake-related maternal Post-Traumatic Stress Disorder (PTSD) is associated with impaired development of infants. Participants included 86 women who were pregnant during or after the earthquake in Ningqiang county, and their children. Data were collected from February to March of 2012. PTSD questionnaire (PTSD Checklist, Civilian Version (PCL-C)) was used to measure the effect of the earthquake on mothers, and that the scores greater than 50 were used to indicate presence of PTSD. Each child was assessed using the mental Developmental Screening Test (DST) according to age. Among the 86 women, PTSD scores equal to or greater than 50 accounted for 20.93%. Among the 86 children, 25.60% of development quotient (DQ) scores and 19.80% of mental index (MI) scores were less than 85. The correlation coefficient analysis showed that PTSD scores were inversely related to DQ and MI scores. Maternal PTSD following earthquake exposure is associated with relatively lower intellectual development in children age 0–3 years. Further research is needed to assess the persistent effects of this influence on offspring of mothers exposed to earthquake.

Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: A prospective longitudinal observational study

In this longitudinal prospective observational study performed at a tertiary perinatal referral centre, we aimed to assess maternal distress in pregnancy in women with ultrasound findings of fetal anomaly and compare this with distress in pregnant women with normal ultrasound findings. Pregnant women with a structural fetal anomaly (n = 48) and normal ultrasound (n = 105) were included. We administered self-report questionnaires (General Health Questionnaire-28, Impact of Event Scale-22 [IES], and Edinburgh Postnatal Depression Scale) a few days following ultrasound detection of a fetal anomaly or a normal ultrasound (T1), 3 weeks post-ultrasound (T2), and at 30 (T3) and 36 weeks gestation (T4). Social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression) were the main outcome measures. The median gestational age at T1 was 20 and 19 weeks in the group with and without fetal anomaly, respectively. In the fetal anomaly group, all psychological distress scores were highest at T1. In the group with a normal scan, distress scores were stable throughout pregnancy. At all assessments, the fetal anomaly group scored significantly higher (especially on depression-related questions) compared to the normal scan group, except on the IES Intrusion and Arousal subscales at T4, although with large individual differences. In conclusion, women with a known fetal anomaly initially had high stress scores, which gradually decreased, resembling those in women with a normal pregnancy. Psychological stress levels were stable and low during the latter half of gestation in women with a normal pregnancy.

Post-traumatic stress disorder and depression among adult survivors 8 years after the 2008 Wenchuan earthquake in China

BACKGROUND

The Wenchuan earthquake was China's worst natural disaster of the past three decades. Although the psychological sequelae of disasters can last for many years, the long-term sequelae and their risk factors tend to receive little research attention.

OBJECTIVES

The objectives of the present study were to estimate the prevalences of symptomalogical PTSD and depression among survivors 8 years after the Wenchuan earthquake, and to identify the shared and unshared risk factors associated with PTSD and depression, using data from a cross-sectional survey.

METHODS

1369 participants were recruited from two different sites in the areas that were severely affected by the earthquake. Symptomalogical PTSD was assessed by the Impact of Event Scale-Revised (IES-R). The Chinese edition of the Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression. Traumatic exposure to the Wenchuan earthquake was assessed using an exposure checklist designed by this study.

RESULTS

Eight years after the Wenchuan earthquake, 11.8% of the respondents had symptomalogical PTSD, and 24.8% of respondents had probable depression. The results also indicated that female gender, low education, poor perceived health, and traumatic experiences after the earthquake were associated with higher odds of both PTSD and depression among survivors. Direct exposure to the earthquake was associated with comorbid symptomalogical PTSD and depression (OR=1.86; 95% CI=1.42, 2.44). Those having only depression were more likely to be unmarried/divorced/widowed, and to have experienced fear at the time of the earthquake (OR=1.34; 95% CI=1.04, 1.72), while those with only symptomalogical PTSD were likely to be from the township of Yongan as opposed to Guangji (OR=1.86; 95% CI=1.06, 3.31).

LIMITATIONS

This is a cross-sectional study, and thus is insufficient for determining causal relationships with regard to chronic PTSD or depression.

CONCLUSIONS

The results of this study indicate that symptomalogical PTSD and depression persist among many survivors of the Wenchuan earthquake, 8 eight years later. Objective earthquake exposure is associated with symptomalogical PTSD, while subjective exposure is associated with long-term depression.

Negative Life Events and Antenatal Depression among Pregnant Women in Rural China: The Role of Negative Automatic Thoughts

BACKGROUND

Few studies have looked at the relationship between psychological and the mental health status of pregnant women in rural China. The current study aims to explore the potential mediating effect of negative automatic thoughts between negative life events and antenatal depression.

METHODS

Data were collected in June 2012 and October 2012. 495 rural pregnant women were interviewed. Depressive symptoms were measured by the Edinburgh postnatal depression scale, stresses of pregnancy were measured by the pregnancy pressure scale, negative automatic thoughts were measured by the automatic thoughts questionnaire, and negative life events were measured by the life events scale for pregnant women. We used logistic regression and path analysis to test the mediating effect.

RESULTS

The prevalence of antenatal depression was 13.7%. In the logistic regression, the only socio-demographic and health behavior factor significantly related to antenatal depression was sleep quality. Negative life events were not associated with depression in the fully adjusted model. Path analysis showed that the eventual direct and general effects of negative automatic thoughts were 0.39 and 0.51, which were larger than the effects of negative life events.

CONCLUSIONS

This study suggested that there was a potentially significant mediating effect of negative automatic thoughts. Pregnant women who had lower scores of negative automatic thoughts were more likely to suffer less from negative life events which might lead to antenatal depression.

Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake

Post-traumatic stress disorder (PTSD) widely occurs among victims or witness of disasters. With flashbacks, hyperarousal, and avoidance being the typical symptoms, PTSD became a focus of psychological research. The earthquake in Wenchuan, China, on May 12, 2008, was without precedent in magnitude and aftermath and caused huge damage, which drew scientists' attention to mental health of the survivors. We conducted a systematic overview by collecting published articles from the PubMed database and classifying them into five points: epidemiology, neuropathology, biochemistry, genetics and epigenetics, and treatment. The large body of research during the past 6 years showed that adolescents and adults were among the most studied populations with high prevalence rates for PTSD. Genomic and transcriptomic studies focusing on gene × environment studies as well as epigenetics are still rare, although a few available data showed great potential to better understand the pathophysiology of PTSD as multifactorial disease. Phytotherapy with Chinese herbs and acupuncture are rarely reported as of yet, although the first published data indicated promising therapy effects. Future studies should focus on the following points: (1) The affected populations under observation should be better defined concerning individual risk factor, time of observation, spatial movement, and individual disease courses of patients. (2) The role of social support for prevalence rates of PTSD should be observed in more detail. (3) Efficacy and safety of Chinese medicine should be studied to find potential interventions and effective treatments of PTSD.

Immediate Needs and Concerns among Pregnant Women During and after Typhoon Haiyan (Yolanda)

Introduction: Pregnant and postpartum women are especially vulnerable to natural disasters. These women suffer from increased risk of physical and mental issues including pregnant related problems. Typhoon Haiyan (Yolanda), which hit the Philippines affected a large number of people and caused devastating damages. During and after the typhoon, pregnant women were forced to live in particularly difficult circumstances. The purpose of this study was to determine concerns and problems regarding public health needs and coping mechanisms among pregnant women during and shortly after the typhoon.

Methods: This study employed a cross-sectional design utilizing focus group discussions (FGDs). Participants were 53 women (mean age: 26.6 years old; 42 had children) from four affected communities who were pregnant at the time of the typhoon. FGDs were conducted 4 months after the typhoon, from March 19 to 28, 2014, using semi-structured interviews. Data were analyzed using the qualitative content analysis.

Result: Three themes were identified regarding problems and concerns during and after the typhoon: 1) having no ideas what is going to happen during the evacuation, 2) lacking essentials to survive, and 3) being unsure of how to deal with health concerns. Two themes were identified as means of solving issues: 1) finding food for survival and 2) avoiding diseases to save my family. As the pregnant women already had several typhoon experiences without any major problems, they underestimated the catastrophic nature of this typhoon. During the typhoon, the women could not ensure their safety and did not have a strong sense of crisis management. They suffered from hunger, food shortage, and poor sanitation. Moreover, though the women had fear and anxiety regarding their pregnancy, they had no way to resolve these concerns. Pregnant women and their families also suffered from common health problems for which they would usually seek medical services. Under such conditions, the pregnant woman cooperated with others for survival and used their knowledge of disease prevention.

Discussion: Pregnant women experienced difficulties with evacuation, a lack of minimum survival needs, and attending to their own health issues. Pregnant women were also concerned about needs and health issues of their families, particular, when they had small children. Collecting accurate information regarding the disaster and conducting self-sustainable preparation prior to the disaster among pregnant women will help them to protect their pregnancy status, thereby improving their families’ chance of survival during and after disasters.

Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake

BACKGROUND

This study examines relationships between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors.

METHOD

We used convenient sampling to recruit participants (n=167). They completed six scales, which had been translated into Haitian Creole, including measures such as the Earthquake Experiences Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor-Davidson Resilience Scale (CD- RISC) RESULTS: Among our participants, 51% were male, (mean age=30.5, SD=11.03), 92% (n=155) were believers in some sort of supernatural force and 65% (n=108) endorsed the earthquake as a natural phenomenon. There was significant difference in average scores at peritraumatic distress, PTSD symptoms and Resilience measures between those perceiving a divine origin and/or a punishment through the event and those who did not. Peritraumatic responses were best predictors for PTSD (β=.366, p<.001) and Depression symptoms (β=.384, p<.001). Voodoo adherents appeared to be vulnerable to depression, but reported superior resilience factors.

Depression, Social Support, and Coping Styles among Pregnant Women after the Lushan Earthquake in Ya'an, China

Aim

The aim of this study is to assess the depression of pregnant women in the aftermath of an earthquake, and to identify the social support that they obtained, their coping styles and socio-demographic factors associated with depression.

Methods

A total of 128 pregnant women from three hospitals in the epicenter area were recruited immediately after the Ya’an earthquake. Their depression was investigated using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of 14; the social support that they obtained was measured using the Social Support Questionnaire; and their coping styles were assessed using the Coping Styles Questionnaire.

Results

Immediately after the earthquake, the incidence rate of depression in pregnant women was 35.2%, higher than that of the general pregnant population (7%-14%). The EPDS scores were significantly correlated with gestation age at the time of the earthquake, objective support, subjective support, use of support, negative coping style, and positive coping style. The regression analysis indicated that risk factors of prenatal depression include the number of children, relatives wounded, subjective support, and coping styles. A further analysis of the interaction between social support and two types of coping styles with depression showed that there was interaction effect between subjective social support and positive coping styles in relation to EPDS scores. There was an inverse relationship between low EPDS scores and positive coping styles and high social support, and vice versa.

Conclusion

The timing of the occurrence of the earthquake may not necessarily affect the progress of the illness and recovery from depression, and psychological intervention could be conducted in the immediate aftermath after the earthquake. The impact of coping styles on prenatal depression appeared to be linked with social support. Helping pregnant women to adopt positive coping styles with good social support after a recent major earthquake, which is a stressor, may reduce their chances of developing prenatal depression.

Correlation Between the Great East Japan Earthquake and Postpartum Depression: A Study in Miyako, Iwate, Japan

Objective

This study aimed to explore the correlation between the 2011 Great East Japan Earthquake and postpartum depression among perinatal subjects in the Miyako region of Iwate, an area damaged by earthquakes and tsunamis.

Methods

We retrospectively compared the percentages of women with scores ≥9 on the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) among 3 groups of women who gave birth prior to the disaster (before-disaster group: n=141), within 3 months after the disaster (within-3-months group: n=70), and 4-6 months after the disaster (4-6-months group: n=89) at the Iwate Prefectural Miyako Hospital. The risk factors for EPDS scores ≥9 were estimated with multivariate logistic regression analyses.

Results

Compared with the before-disaster group, a significantly greater number of women in the within-3-months group had EPDS scores ≥9 at hospital discharge (31.4% versus 9.9%, P<.0001), whereas women in the 4-6-months group did not (10.1% versus 9.9%, P=.96). In both the after-disaster groups, the destruction of their home (adjusted odds ratio [AOR], 3.68; 95% confidence interval [CI], 1.46-9.26) and dissatisfaction with their living conditions (AOR, 3.02; 95% CI, 1.20-7.59) were significantly associated with EPDS scores ≥9.

Conclusions

An increase in postpartum depression was observed after the Great East Japan Earthquake among perinatal women. (Disaster Med Public Health Preparedness. 2015;9:307-312)

Long-term outcomes among child and adolescent survivors of the 2010 Haitian earthquake

BACKGROUND

We examined the prevalence and predictive factors of PTSD and depression in relation with peritraumatic distress, trauma exposure, and sociodemographic characteristics among children and adolescent who survived the 2010 Haiti's earthquake.

METHODS

We analyzed data collected between June and July 2012 from a sample of 872 participants aged 7 to 17 in 12 schools, door-to-door canvassing and two centers for street children at Port-au-Prince. Participants completed the Impact of Event Scale Revised (IES-R), Peritraumatic Distress Inventory, Child Depression Inventory 2 (CDI), and sociodemographic and traumatic exposure questionnaires.

RESULTS

Of 872 participants, respectively 322 (36.93%); and 403 (46.21%) reported a clinically significant symptoms of PTSD and depression, which were significantly higher among girls. The best predictive variables are peritraumatic distress for PTSD (β=0.53,P<.0001) a traumatic exposure for depression (β=0.23,P<.0001). The comorbidity between PTSD and depression symptoms is 22.25%.

CONCLUSIONS

This first study in children on the prevalence of PTSD and depression resulting from the 2010 Haiti earthquake demonstrates a need for improvement in treatment aimed at reducing PTSD and depression. Such treatment should be geared primarily toward girls, adolescents between the ages of 14 and 17 and those children and adolescents who have lost a family member in the earthquake.

Changes induced by prenatal stress in behavior and brain morphology: can they be prevented or reversed?

This chapter presents a critical analysis of the behavioral alterations reported in the offspring of women exposed to stress and/or depression during pregnancy and the neurochemical and structural changes underlying them. Among the alterations attributed to prenatal stress in humans and experimental rats of both sexes is impaired regulation of the hypothalamic-pituitary-adrenal (HPA) axis, anxiety and exaggerated fear of novelty, and decreased social interaction. Learning and attention deficits are more prevalent in boys and male rats. Fear of novelty and anxiety are associated with enlargement of the amygdala and its corticotropin-releasing factor content, and decreased socialization, with lower oxytocin activity in the amygdala. Learning deficits are associated with a decrease in neurogenesis, dendritic complexity, and spine number in the dorsal hippocampus. Fostering prenatally stressed (PS) pups onto control mothers prevents the dysregulation of the HPA axis and heightened anxiety, indicating a role for postnatal factors in their etiology. By contrast, learning impairment and decreased socialization are not affected by this fostering procedure and are therefore prenatally mediated.In spite of their widespread use in depressed pregnant women, selective serotonin reuptake inhibitor (SSRI) antidepressants do not normalize the behavior of their children. When administered during gestation to stressed rats, SSRIs do not reduce anxiety or learning deficits in their offspring. Moreover, when given to unstressed mothers, SSRIs induce anxiety in the offspring. The detrimental effect of SSRIs may result from inhibition of the serotonin transporter exposing the brain to excess amounts of 5-hydroxytryptamine (5-HT) at a critical time during fetal development.

Mental disorders of pregnant and postpartum women after earthquakes: a systematic review

OBJECTIVE

The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action.

METHODS

A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes.

RESULTS

Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations.

CONCLUSIONS

Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed.

The Role of Rumination in Elevating Perceived Stress in Posttraumatic Stress Disorder

Rumination has been shown to be important in both the maintenance and severity of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Increased rumination has also been linked to perceptions of increased stress, which in turn are significantly associated with increased PTSD severity. The present study sought to examine this relationship in more detail by means of a mediation analysis. Forty-nine female survivors of interpersonal violence who met Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria for PTSD were administered the Clinician-Administered PTSD Scale (CAPS), the Ruminative Thought Style Questionnaire (RTS), the Perceived Stress Scale (PSS), and the Beck Depression Inventory-II (BDI-II). Results indicated that perceived stress mediates the relationship between rumination and PTSD, but did not do so after controlling for depression. Such results provide further evidence for the overlap between PTSD and MDD, and, in broader clinical practice, translate to a sharper focus on rumination and perceived stress as maintenance factors in both disorders.

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.

Is the health status of female victims poorer than males in the post-disaster reconstruction in China: a comparative study of data on male victims in the first survey and double tracking survey data

BACKGROUND

The health of females is more at risk during disasters. Studies that focus on the comparison of males and time span are few. This article focuses on the health-related quality of life (HRQOL) of female victims in the post-disaster reconstruction in China. We aim to reduce gender health inequalities by comparing and analyzing gender differences in HRQOL. Moreover, we analyze the trends in HRQOL of female victims by using tracking data, and then provide reasonable suggestions to enhance the HRQOL.

METHODS

This article explores the HRQOL of women victims in the post-disaster reconstruction from two perspectives: a comparison between males and a time span of six-month intervals. We conducted the first survey, and the double tracking survey in 2013. This study uses data from half a year later sample surveys collected from five counties (Wenchuan, Qingchuan, Mianzhu, Lushan, and Dujiangyan) in Sichuan in 2013 (N = 2000).

RESULTS

(1) By calculating the Cronbach's alpha coefficients of the SF-12 scale, we found that that reliability of the scale and the internal consistency are good. (2) Using SF-12 instead of SF-36 to measure the HRQOL of survivors is feasible. (3) The ANOVA and non-parametric testing methods show that significant differences exist between the eight dimensions of HRQOL in different genders after the earthquake. (4) After six months, the HRQOL of female victims in the post-disaster reconstruction has also undergone a significant change. (5) Compared with male victims, we should give more attention to female victims' HRQOL issues in the post-disaster reconstruction in Sichuan. (6) The performances of victims in the post-disaster reconstruction in PCS and MCS affect each other.

CONCLUSION

We found that in terms of gender, the male and female victims' HRQOL after the disaster largely varied: (1) In general, significant difference exists between male and female victims in terms of HRQOL. The HRQOL of female victims is poorer than that of male victims. (2) The PCS and MCS of victims affect each other. However, for female victims, the degree of influence of MCS on PCS is larger than that in males. (3) The MCS of female victims is more vulnerable than that of male victims. In terms of time span, the following information was obtained: (1) after six months of rest, victims' HRQOL significantly improved. (2) At this stage, relative to the MCS, the PCS of females should be given more attention.

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.