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

Sleep and Trauma Effects of the Earthquake: A Cross-Sectional Study

AIM

The present study was carried out in order to determine the effects of earthquakes on the sleep quality of earthquake survivors.

DESIGN

The study is a cross-sectional and descriptive design.

METHODS

The research was conducted in the provinces affected by the earthquake, which occurred in Türkiye on 6 February 2023. The study was completed with 428 individuals affected by an earthquake, who voluntarily agreed to participate. Data were collected by using Google Forms and face-to-face data collection. The data collection instruments used here were the Descriptive Information Form, Emotion Assessment Scale for Traumatic Events (EASTE) and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

It was determined that the average scores obtained from the PSQI scale by an individual affected by an earthquake were 11.10 ± 3.44 and they had poor sleep quality. The total EASTE score was 57.93 ± 16.3 points; the mean score from the trauma exposure subscale was 27.44 ± 8.14 points and the mean score from the trauma coping subscale was 30.50 ± 8.91 points, indicating that an individual affected by an earthquake was significantly affected by the trauma.

CONCLUSION

It was also determined that providing physical and psychosocial support for individuals who experienced the earthquake in the short and long term is crucial for their sleep quality, quality of life and overall well-being.

RELEVANCE TO CLINICAL PRACTICE

It is an important study in terms of raising awareness that traumatic situations such as earthquakes affect both the physical and mental health of the individual, and nurses plan the care process on this issue.

PATIENT OR PUBLIC CONTRIBUTION

The scales were filled in by individuals who experienced the earthquake.

Determinants of Posttraumatic Stress Disorder (PTSD) among children and adolescents in the subacute stage of Kahramanmaras earthquake, Turkey

BACKGROUND

Earthquakes are potentially traumatic natural disasters due to their destructive nature, and huge impacts, producing scenes of horror, undesirable and uncontrollable results. Children are affected mainly by earthquakes not only physically but also psychologically. We aimed to evaluate the rates of probable PTSD and related factors in children and adolescents after the February 6 Kahramanmaras earthquake.

METHODS

In this cross-sectional study, 246 children and adolescents were included. The research was conducted in Hatay, one of the most affected provinces, between 06/07/2023-06/08/2023. Sociodemographic form, Children's Depression Inventory, Children's Posttraumatic Response Reaction Index, Screen for Child Anxiety Related Emotional Disorders, Child and Youth Resilience Measure and Social Support Appraisals Scale for Children were applied by face-to-face survey method.

RESULTS

The median age of the participants was 12 (8-18). 133 (54%) of the participants were girls. Probable depression rate was 98%, and probable anxiety disorder rate was 63%. Probable mild, moderate, severe and very severe PTSD rates were 18%, 29%, 43% and 8%, respectively. The probable severe PTSD rate was higher in children who were injured in the earthquake (p = 0.032), who received outpatient treatment (p = 0.016), and who saw people trapped under the collapse (p = 0.012). Also, the children whose sleep routines have changed post-earthquake were found to have more probable severe PTSD (p < 0.001). Access time to the potable water supply (p = 0.045), toilet facilities (p = 0.045), shelter facilities (p = 0.004), heating facilities (p = 0.001), clothing supply (p < 0.001) and healthcare services (p = 0.009) were found to be associated with probable severe PTSD right after the earthquake. In the fifth month of the earthquake, inadequate meeting of clothing needs (p = 0.018), educational services (p = 0.028) and social activity opportunities (p < 0.001) were significantly associated with probable severe PTSD. In the multivariate analysis, the risk of probable severe PTSD was increased 2.9 times in those with post-earthquake sleep changes (p = 0.001) and 11.1 times in those with probable anxiety disorders (p < 0.001). Also, it has been shown that each unit increase in the APP-family score reduces probable severe PTSD risk by 2% (p = 0.002).

CONCLUSION

In the current study, the rates of probable PTSD, depression and anxiety disorders were considerably high. Probable anxiety disorder and sleep disturbance were significant predictors of probable severe PTSD. On the other hand, social support from family was found to be a significant protective factor for severe PTSD risk. We conclude that the lack of meeting needs that increase the risk of probable severe PTSD differs in the acute and subacute phases.

Assessment of post-traumatic stress disorder (PTSD) in elderly survivors of the Wenchuan earthquake: A cross-sectional study

OBJECTIVE

Post-traumatic stress disorder (PTSD) is a prevalent condition characterized by prolonged psychological distress following traumatic events encompassing serious health threats, domestic abuse, and natural disasters. The onset and persistence of PTSD can be attributed to advanced age. This study aimed to explore the occurrence and influencing factors of enduring post-traumatic stress disorder (PTSD) in survivors aged 60 years and over in the main area of the 2008 Wenchuan earthquake 10 years after the disaster.

METHODS

Data were collected using a multistage sampling method from individuals aged 60 years and older living in the main impacted areas of Wenchuan 10 years after the Wenchuan earthquake. The PTSD Checklist-Civilian Version (PCL-C) was used to evaluate PTSD symptoms. We evaluated participants based on their PTSD symptoms: those exhibiting and those without. The latter group was four times the size of the former and was matched based on gender and age (within ± 2 years). Conditional logistic regression was used to discern the risk factors.

RESULTS

Out of the total, 56 participants were recognized as having probable PTSD as per the PCL-C checklist, leading to a rate of 9.4% (56/588). The univariate conditional logistic regression values showed that playing Mahjong/poker (odds ratio (OR) = 0.394, 95% confidence interval (CI) = 0.171-0.911) and displacement (OR = 0.446, 95% CI = 0.220-0.907) were protective factors for the long-term mental health of survivors in the hard-hit areas, while the presence of a 2-week illness (OR = 3.605, 95% CI = 1.751-7.424), possessing insurance (OR = 0.250, 95% CI = 0.072-0.864), suffering from a chronic ailment (OR = 3.132, 95% CI = 1.2-8.174), and having an injured family member (OR = 2.26, 95% CI = 1.136-4.496) emerged as risk factors for PTSD symptoms. Multivariate analysis indicated that the absence of insurance and prevalence of 2-week illness correlated with increased PTSD symptoms.

CONCLUSIONS

Ten years after the Wenchuan earthquake, the prevalence of probable PTSD remained significantly high in the elderly population. The major risk factors were the absence of insurance and the occurrence of a 2-week illness. Policymakers should incorporate these findings when devising strategies for aging societies.

Dynamic structure of posttraumatic growth among victims of the 2021 Henan floods: A 6-month, three-wave longitudinal study

Posttraumatic growth (PTG) following traumatic events is a dynamic and transformational process. However, its dynamic structure is currently unknown. The study aimed to estimate the dynamic structure of PTG at the nuance level based on PTG measurement items using network analysis. A three-wave longitudinal study was conducted from July 20, 2021, to January 30, 2022, among the victims experiencing the 2021 Henan floods. The final sample (n = 297) completed reports of PTG after 0, 3, and 6 months of the disaster. We employed the graphical vector autoregressive model approach to estimate extended network models. Contemporaneous network results revealed strong positive associations between domains of PTG in the same measurement window, especially between new possibilities and personal strength. Moreover, temporal network results-the internal interplays among PTG items across measurement windows-revealed that the domain of relating to others plays a central role in the dynamics of PTG. Although other domains predicted an increase in relating to others, relating to others inhibited the development of other domains, especially new possibilities and personal strength. Our study identifies the culture-specific process of PTG and provides empirical evidence on the explanatory models of PTG and the Janus-Face model of PTG.

Post-traumatic stress disorder and its associated factors among survivors of 2015 earthquake in Nepal

BACKGROUND

Natural disasters cause long term psychological consequences, especially post-traumatic stress disorders. It has been regarded as the most prevalent of psychiatric disorders after a natural disaster. The purpose of this study is to estimate the prevalence of Post-Traumatic Stress Disorder (PTSD) and determine its associated factors in adult survivors three years after the 2015 Nepal earthquake.

METHODS

A cross-sectional descriptive design was used where 1076 adults within the age range of 19-65 were randomly selected and interviewed from four adversely affected districts due to the 2015 earthquake. Instruments included a demographic questionnaire, an earthquake exposure questionnaire, the Oslo Social Support Scale (OSSS), and the Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C). Descriptive and inferential statistics were applied using Statistical Package for Social Science (SPSS) Version 16 for data analysis.

RESULTS

The prevalence of PTSD among earthquake survivors was 18.9%. The multivariate logistic regression showed that gender, ethnicity, education, occupation, social support and severity of damage to house and property were significantly associated with PTSD. Odds of having PTSD was 1.6 times higher among females (AOR = 1.6, 95% CI: 1.1-2.3) and nearly 2 times higher amongst illiterate survivors (AOR = 1.9, 95% CI: 1.2-2.8). Participants from the Janajati ethnic group and those who had a business occupation had a 50% lower risk of having PTSD. Around 39% of the participants had moderate social support and had 60% lower odds of having PTSD compared to those with poor social support (AOR = 0.4, 95%CI: 0.2-0.5, p < 0.001). Participants with medium and very high-level damage to personal property were more likely to have PTSD.

CONCLUSION

Post-traumatic stress disorder remained prevalent amongst survivors three years after the 2015 Nepal Earthquake. It is important to provide psychological and social support for survivors to decrease the health burden from PTSD. Socio-demographic characteristics such as females, farmers, those survivors who endured significant personal property damage were at higher risk.

An Agenda-Setting Account for Psychological Typhoon Eye Effect on Responses to the Outbreak of COVID-19 in Wuhan

During the outbreak of COVID-19 in Wuhan in 2020, we conducted a nationwide survey of 8170 respondents from 31 provinces/municipalities in China via Sojump to examine the relationship between the distance to respondents' city of residence from Wuhan and their safety concerns and risk perception of the epidemic that occurred in Wuhan City. We found that (1) the farther (psychologically or physically) people were from Wuhan, the more concerned they were with the safety of the epidemic risk in Wuhan, which we dubbed the psychological typhoon eye (PTE) effect on responses to the outbreak of COVID-19; (2) agenda setting can provide a principled account for such effect: the risk information proportion mediated the PTE effect. The theoretical and managerial implications for the PTE effect and public opinion disposal were discussed, and agenda setting was identified to be responsible for the preventable overestimated risk perception.

Latent classes of posttraumatic stress disorder among survivors of the Bam Earthquake after 17 years

BACKGROUND

The purpose of this study was to identify latent classes of the severity of post-traumatic stress disorder (PTSD) among the survivors of the earthquake in Bam, south-eastern Iran, 17 years after the disaster. The most influential predictor variables of PTSD classes were also investigated.

METHODS

Eight hundred survivors of the Bam earthquake who were at least four years old in that disaster were selected by multistage sampling. The PTSD Checklist-Civilian Version was used. Latent class analysis was performed to identify subgroups of people with different PTSD symptom profiles. Latent class regression analysis was used to explore the influence of demographic and traumatic variables on each class membership.

RESULTS

We found three latent classes of PTSD, with the following profiles emerging: Low Symptom (56.6% of the participants), Moderate Symptom (23.5%), and Severe Symptom (19.9%). Old age [OR = 2.20, 95% CI = (1.46, 3.32)], physical injury [OR = 1.95, 95% CI = (1.24, 3.06)], being trapped under the rubble [OR = 1.81, 95% CI = (1.15, 2.86)], and death of a family member [OR = 1.86, 95% CI = (1.12, 3.09)] were positive risk factors for PTSD and increased the chance of being in classes having more severe symptoms. Having a high educational level was a negative risk factor [OR = 0.86, 95% CI = (0.67, 1.11)].

CONCLUSIONS

The severity of PTSD 17 years after the earthquake shows that natural disasters such as earthquakes have long-term consequences, and earthquake survivors must have psychological support and long term health care. After any catastrophic earthquake, governments should establish psychology and psychotherapy centers for earthquake victims, and these centers should support earthquake victims for a sufficiently long time.

Posttraumatic Stress Symptoms Among Chinese College Students During the COVID-19 Pandemic: A Longitudinal Study

A longitudinal assessment of the prevalence of posttraumatic stress symptoms (PTSS) and risk factors is indispensable for further prevention and/or treatment. The longitudinal web-based survey enrolled 1,164 college students in China. Measured at two time points (February and August 2020), PTSS, demographic information, adverse childhood experiences (ACEs), resilience and self-compassion information were collected to explicate the prevalence and predictors of PTSS concurrently and over time. Results showed that although PTSS generally declined throughout the 6 months after the outbreak of COVID-19, the prevalence remained relatively high. Resilience and self-compassion negatively predicted PTSS concurrently and longitudinally. While subjective family socioeconomic status (SES) and ACEs at Wave 1 did not predict PTSS under COVID-19 at Wave 1, but both significantly predicted PTSS at Wave 2. Findings implicate potential targets for detecting and intervening on symptoms of trauma in this vulnerable population.

Health Impact and Risk Factors Affecting South and Southeast Asian Women Following Natural Disasters: A Systematic Review

(1) Background: Following natural disasters, women have a higher prevalence of adverse physical and mental health outcomes. Given that the South and Southeast Asia regions are highly disaster prone, a review was undertaken to identify the potential health impact and key risk factors affecting women after disasters in the countries located in South and Southeast Asia regions. (2) Methods: A systematic literature search of four databases yielded 16 studies meeting the inclusion criteria. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidance, between July 2008 and March 2021. (3) Results: The majority of studies reported women's negative/poor mental health, identifying a significant association of socio-demographics, during disaster exposure, post-disaster, and pre-existing risk factors. The six most-cited influences on women's mental health found in the reviewed literature were being female, adult age group, having no formal education, poverty or low economic status, poor physical health/physical injuries, and death of family members. Women's health during the post-disaster period was generally reported as poor among all the countries of the South and Southeast Asia regions. (4) Conclusions: Appropriate social support and the availability of free healthcare access for women are warranted in disaster-affected areas. This review offers a valuable contribution to the knowledge of women's health complications/challenges and associated risk factors related to disasters, essential for the development of strategies to help reduce this burden in the future. Further research is required on natural disasters to identify ways to reduce women's health impacts after natural disasters, especially in the context of low-income and lower-middle-income countries.

Posttraumatic stress disorder and professional burnout among local government staff seven years after the Wenchuan earthquake in China: A longitudinal study

Although local government staff are crucial in post-quake reconstruction, their long-term psychological and professional consequences remain unclear. This longitudinal study investigated changes of posttraumatic stress disorder (PTSD) and professional burnout over seven years, and their underlying relationship. The study assessed 250 staff at one year (T_1y) after the earthquake, and 162 (64.8 %) were followed up at seven years (T_7y). PTSD and professional burnout were assessed with the Short Screening Scale for DSM-IV PTSD and the burnout subscale of Professional Quality of Life Scale (ProQOL), respectively, at both time points. Longitudinal changes in PTSD and burnout were examined and cross-lagged panel analyses were conducted to test the relationship between PTSD and burnout. The rates of positive cases of PTSD screening were 23.2 % at T_1y and 11.1 % at T_7y. The percentages of moderate burnout were 61.7 % at T_1y and 23.5 % at T_7y. Scores of PTSD (z = -5.70, p < 0.001) and burnout (t = 10.07, p < 0.001) from T_1y to T_7y decreased. The cross-lagged analysis indicated that burnout at T_1y predicted PTSD at T_7y (β = 0.19, p = 0.025). In conclusion, the Wenchuan earthquake has long-lasting negative effects on local government staff, although they can recover over time. Interventions to reduce professional burnout after disaster may does be beneficial to decrease the risk of PTSD in the long run.

Trajectories of Posttraumatic Growth and Their Associations With Quality of Life After the 2011 Tohoku Earthquake and Tsunami

The 2011 Tohoku earthquake and tsunami in Japan was an extraordinarily stressful incident that caused harmful psychological reactions, such as posttraumatic stress disorder (PTSD), among affected individuals. However, a proportion of exposed individuals experienced posttraumatic growth (PTG), characterized by a noticeable degree of personal strength, spirituality, life appreciation, perception of new possibilities in life, and enhanced relationships with others. Some researchers have argued that these positive reactions may be an illusory change related to coping with traumatic events. We examined trajectory patterns related to PTG Inventory (PTGI) subscales to elucidate the existence of both real and illusory growth regarding quality of life (QoL), utilizing group-based trajectory models. Three online questionnaires were distributed at 6 months (N = 2,554; M age = 47.04 years, SD = 12.62), 12 months (N = 887; M age = 48.11 years, SD = 12.43), and 42 months (N = 560; M age = 48.86 years, SD = 12.25) postdisaster. Participants responded to items related to demographic characteristics, disaster experiences, posttraumatic stress symptoms, PTG, and QoL. Three main PTG trajectories emerged, characterized by growth, no growth, and illusory growth, with QoL as a time invariant covariate. Compared with the growth trajectory, the odds ratios (ORs) for no growth ranged from 2.27 to 5.04; for illusory growth, the ORs ranged from 2.09 to 4.67. To our knowledge, this was the first study to report growth trajectories related to PTGI subscales and their underlying differences in psychological mechanisms and processes following the 2011 Tohoku earthquake and tsunami.

The Effect of Traumatic Loss on Posttraumatic Growth Among 2011 Van Earthquake Survivors: The Mediating Role of Posttraumatic Stress

OBJECTIVE

Posttraumatic growth (PTG), defined as a positive change after a traumatic event, has become the subject of various studies, and its relationship with posttraumatic stress symptoms (PTSS) has been extensively investigated. However, studies have indicated differences in the relationship between PTG and PTSS. Therefore, this study aimed to investigate the mediating role of PTSS in the relationship between the number of traumatic losses and PTG among the 2011 Van earthquake survivors.

METHODS

The sample of this study consisted of 917 participants who experienced the 2011 Van earthquake. A personal information form, impact of event scale-revised (IES-R), and posttraumatic growth inventory (PTGI) were used as data collection tools.

RESULTS

Survivors with traumatic loss were found to have higher PTSS and PTG than survivors without traumatic loss. The mean scores of the PTGI subscales were higher among survivors with traumatic loss except for changes in self-perception. A positive correlation was found between IES-R and PTGI total scores. In the regression analysis, it was found that PTSS played a mediating role in the relationship between the number of traumatic losses and PTG.

CONCLUSION

This study revealed that PTG is possible with the presence of PTSS. Mental health professionals assisting survivors with traumatic loss should take the enhancement of PTG into consideration in addition to their efforts to reduce PTSS.

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.

Multivariate classification of earthquake survivors with post-traumatic stress disorder based on large-scale brain networks

OBJECTIVE

The identification of post-traumatic stress disorder (PTSD) among natural disaster survivors is remarkably challenging, and there are no reliable objective signatures that can be used to assist clinical diagnosis and optimize treatment. The current study aimed to establish a neurobiological signature of PTSD from the connectivity of large-scale brain networks and clarify the brain network mechanisms of PTSD.

METHODS

We examined fifty-seven unmedicated survivors with chronic PTSD and 59 matched trauma-exposed healthy controls (TEHCs) using resting-state functional magnetic resonance imaging (rs-fMRI). We extracted the node-to-network connectivity and obtained a feature vector with a dimensionality of 864 (108 nodes × 8 networks) to represent each subject's functional connectivity (FC) profile. Multivariate pattern analysis with a relevance vector machine was then used to distinguish PTSD patients from TEHCs.

RESULTS

We achieved a promising diagnostic accuracy of 89.2% in distinguishing PTSD patients from TEHCs. The most heavily weighted connections for PTSD classification were among the default mode network (DMN), visual network (VIS), somatomotor network, limbic network, and dorsal attention network (DAN). The strength of the anticorrelation of FC between the ventral medial prefrontal cortex (vMPFC) in DMN and the VIS and DAN was associated with the severity of PTSD.

CONCLUSIONS

This study achieved relatively high accuracy in classifying PTSD patients vs. TEHCs at the individual level. This performance demonstrates that rs-fMRI-derived multivariate classification based on large-scale brain networks can provide potential signatures both to facilitate clinical diagnosis and to clarify the underlying brain network mechanisms of PTSD caused by natural disasters.

Post-traumatic stress disorder and the role of resilience, social support, anxiety and depression after the Jiuzhaigou earthquake: A structural equation model

This is the first study to investigate the mechanism of Post traumatic stress disorder (PTSD) after the 2017 7.0 Ritcher scale Jiuzhaigou earthquake. In order to identify the mechanism underling interactions among different factors associated with PTSD symptoms. Three months after the earthquake, 607 participants from the heavy damaged areas were recruited in this survey. Demographic information and scale measurements on social support, resilience, anxiety, depression, and PTSD were collected using standardized questionnaire. The result showed that PTSD, anxiety symptoms, and depressive symptoms prevalence in the severely affected area were 52.7 %, 53.8 % and 69.6 %, respectively. Resilience and social support had direct effects on PTSD, as well as indirect effects on PTSD through anxiety and depression. The proposed mechanism on PTSD explained the paths among the measured variables, which explained the risk and protective factors related to PTSD. This current study has important practical implications for understanding mental health status of earthquake victims.

The impact of exposure to memorial reports on the 5.12 Wenchuan earthquake on sleep quality among adult survivors ten years after the disaster: Evidence for nonlinear associations

INTRODUCTION

Very few studies have explored the effect of exposure to disaster memorial reports in the media on long-term sleep quality during the recovery period and post-disaster era. This study investigated the relationship between exposure to memorial reports and adult survivors' long-term sleep quality 10 years after the 5.12 Wenchuan earthquake in 2008, and determined whether exposure to memorial reports are associated with poor sleep quality.

METHOD

Using a cross-sectional methodology, we surveyed participants (N = 1000) recruited from six disaster-affected counties. We measured sleep quality using the Pittsburgh Sleep Quality Index questionnaire (PSQI).

RESULTS

After controlling for the effects of demographic factors, socioeconomic status, and earthquake exposure factors, exposure to memorial reports and the PSQI global score had a strong inverted U-shaped relationship. Relationships among three sub-scores of PSQI (subjective sleep quality, sleep latency, daytime dysfunction) were also found to have similar relationships with memorial report exposure. That is, survivors who were exposed to low or high degrees of memorial reports had better sleep quality than those who were exposed to intermediate memorial reports.

DISCUSSION

The curvilinear relationship between media exposure and sleep quality in the post-disaster era reveals that media exposure could be used to identify victims at risk of poor sleep quality. Clinicians and practitioners may consider adopting psychological intervention programs to enhance victims' psychological controllability to overcome mental disorders caused by media exposure.

Prevalence and predictors of posttraumatic stress disorder and depression among adolescents over 1 year after the Jiuzhaigou earthquake

BACKGROUND

On August 8, 2017, a 7-magtitude earthquake struck Jiuzhaigou County in Sichuan, China. This was the third devastating earthquake in that province. The prevalence and predictors of posttraumatic stress disorder (PTSD), depression, and comorbid PTSD/depression among adolescents were unclear after the Jiuzhaigou earthquake.

METHODS

Participants were 1241 adolescent survivors in Jiuzhaigou. Data were collected using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children.

RESULTS

In total, 46.3% of participants reported PTSD, 64.5% reported depression, and 39.2% reported comorbid PTSD/depression symptoms. Risk factors for symptoms of these disorders were being female, having been injured or trapped, and intrusive rumination. High school students were less likely to report PTSD and comorbid PTSD/depression than middle school students. Participants with family members/friends that were injured or trapped reported more PTSD and comorbid symptoms than those without this experience. Loss of property also predicted PTSD. However, deliberate rumination was a protective factor for depression.

LIMITATIONS

This study did not cover all adolescents in Jiuzhaigou and all potential predictors. As we used a cross-sectional design, this study could not assess the trajectory of PTSD, depression, and comorbid symptoms after the earthquake.

CONCLUSION

The findings are meaningful for mental health care among adolescents after natural disasters such as an earthquake.

Curvilinear relationship between disaster exposure and psychological growth:10 years after the Wenchuan earthquake

The extent of disaster exposure is a crucial predictor of both negative and constructive changes influenced by natural disasters. Posttraumatic growth (PTG) is the typical psychological growth that is defined by significant changes for the better in self-view, relationships, and life philosophy as a result of exposure to a traumatic incident. However, findings of previous studies examining the effects of disaster exposure on PTG are inconsistent. The primary aim of this study was to re-examine the nature of the association between the extent of disaster exposure and PTG in a sample of 1,000 adult survivors of the 5.12 Wenchuan earthquake (occurred in 2008) over 10 years ago in China. The results indicated that, after controlling for the effects of demographic factors (i.e., gender, age, residential area site, and marital status) and socioeconomic status (i.e., educational background and annual household income), disaster exposure showed weak linear but strong inverted U-shaped relationships with different PTG domains. In other words, participants who had been exposed to low or high levels of disaster showed low levels of PTG, while those exposed to moderate levels of disaster exhibited high levels of PTG. The result of the study not only enhanced current understanding of the consequences of disaster exposure but also outlined a long-term support system for post-disaster construction activities.

Posttraumatic stress disorder following the 2008 Wenchuan earthquake: A 10-year systematic review among highly exposed populations in China

BACKGROUND

The 2008 Wenchuan earthquake was unprecedented in Chinese history both in terms of the magnitude of the quake itself and the scale of human suffering. Following the disaster, researchers reported on a wide range of mental health outcomes, especially posttraumatic stress disorder (PTSD). In this review, we assess the cumulative body of research evidence about PTSD across the first 10 years following the earthquake.

METHODS

We searched the literature in the PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases (from May 2008 to February 2018) using Wenchuan earthquake and PTSD as keywords.

RESULTS

We selected 58 relevant studies. Published findings from the selected period suggested a substantial burden of PTSD on highly exposed survivors. Studies have found that symptoms of PTSD have been associated with a range of risk factors, including sociodemographic factors, trauma exposure characteristics, post-disaster cognitive and emotional states, and social support. Studies have explored the factor structure of PTSD in the affected Chinese population, and researchers have developed a Chinese self-report measure of PTSD symptoms. Several treatments for PTSD have been evaluated, including some indigenous intervention methods.

LIMITATIONS

Only a relatively small number of the studies used longitudinal assessments, and the consistency and effectiveness of measurement tools for PTSD require further exploration. More rigorous investigations of the effectiveness of interventions for the prevention and treatment of PTSD are needed.

CONCLUSION

The 10-year body of literature is important for the future deployment of disaster relief and an increased understanding of PTSD in China.

Neuroticism Predicts a Long-Term PTSD After Earthquake Trauma: The Moderating Effects of Personality

Background: The heartache from the devastating 8.0 magnitude Wenchuan earthquake, which killed nearly 90,000 people in western China, is still felt despite the large-scale recovery and reconstruction of the affected areas. This study investigated the relationships of earthquake-trauma exposures and personality with posttraumatic stress disorder (PTSD), to identify the long-term consequences of the Wenchuan earthquake on the survivors and the risk factors related to chronic PTSD. We hope the findings can contribute to developing new health care prevention and interventions for the survivors. Methods: We collected a sample of 490 people over 3 years after the Wenchuan earthquake, using questionnaires about demographic information and the traumatic experience in earthquake, the Impact of Event Scale-Revised (IES-R), and the Eysenck Personality Questionnaires (EPQ), to find the consequences of the Wenchuan earthquake on the survivors and the potential factors related to the long-term morbidity of PTSD. Result: Traumatic experiences, such as witnessing someone being seriously injured, having your house seriously damaged, and having close relatives severely injured, were associated with developing PTSD. Personality measured by EPQ was also closely related to PTSD. Regression analyses indicated that a potential linear model characterized the relationship between PTSD, neuroticism and psychoticism, yet extraversion/introversion were not significant factors. In the multivariate logistic regression, neuroticism (a continuous variable measured by EPQ) was of more significance in predicting the morbidity of long-term PTSD, compared with other variables [odds ratio (OR) = 1.113, 95% confidence interval (CI) = 1.081-1.146, Wald Value = 50.467, P < 0.001]. The final path diagram built a model indicated the moderating role of personality in the relationship between traumatic experiences and PTSD (CMIN/DF = 2.324, P < 0.001; CFI = 0.879 < 0.8; RMSEA = 0.05 < 0.08). Conclusion: This study demonstrated the role of personality traits and subjective exposure experiences regarding the vulnerability associated with PTSD after earthquake. Among all personality traits, neuroticism is considered a vulnerability factor of PTSD, and other personality traits also moderate the effects of traumatic experiences associated with PTSD. These findings might be useful for psychologists to develop intervention strategies for people suffered natural disasters, and to help individuals with PTSD to heal fully.

Complicated grief and post-traumatic stress symptom profiles in bereaved earthquake survivors: a latent class analysis

Background: Studies on mental health following disasters have primarily focused on post-traumatic stress disorder (PTSD), yet severe, enduring, and disabling grief [i.e. complicated grief (CG)] also appears relevant. Objective: The present study examines symptom profiles of PTSD and CG among bereaved Sichuan earthquake survivors 1 year after the disaster. Method: Self-report measures of demographic, disaster, and loss-related characteristics and symptoms of PTSD and CG were administered among 803 survivors (63% women; mean age = 46.7 years). Latent class analysis (LCA) was performed to identify subgroups of people with different PTSD and CG symptom profiles. Results: The LCA demonstrated that a five-class solution yielded the best fit, consisting of a CG class with low PTSD and high CG (N = 208), a combined class with high PTSD and high CG (N = 205), a class with low PTSD and partial CG (N = 145), a class with partial PTSD and CG (N = 136), and a resilient class with low PTSD and CG (N = 108). Being a woman (vs man), losing a child or spouse (vs other), being injured (vs non-injured), and/or having a missing family member (vs non-missing) predicted membership of the CG class compared to other classes. Conclusions: CG appears to be a unique consequence of disasters involving many casualties. Disaster survivors should be screened for CG and provided with appropriate psychological treatment.

The Impact of Earthquake on Poverty: Learning from the 12 May 2008 Wenchuan Earthquake

How to combine disaster prevention and mitigation, post-disaster reconstruction and poverty alleviation has become a new hot issue. On 12 May 2008, a major earthquake devastated the Wenchuan area in Sichuan Province in the heartland of China. After ten-years have passed, it is a good time to review what we learned from the Great Wenchuan earthquake. The impact of Wenchuan earthquake on poverty-stricken counties, poverty-stricken villages, and poverty-stricken households was analyzed. Suggestions for improving the method of combining disaster prevention, post-disaster reconstruction, and poverty alleviation were proposed. The results from this research could serve as an important reference for formulation of the poverty alleviation and development program after a major earthquake.

Media Exposure and General Trust as Predictors of Post-traumatic Stress Disorder: Ten Years after the 5.12 Wenchuan Earthquake in China

There is a paucity of literature on the roles of media exposure, general trust, and their interactions in long-term post-traumatic stress disorder (PTSD) symptoms after a natural disaster. Trying to address this knowledge gap, our study aimed to (a) investigate whether exposure to media coverage during the traumatic event and general trust directly affected adult survivors’ long-term PTSD symptoms 10 years after the 5.12 Wenchuan earthquake, and (b) to identify the potential differential pattern of the influence of media exposure on PTSD symptoms for adult survivors with various levels of general trust. Using cross-sectional methodology, we surveyed participants (N = 1000) recruited from six disaster-affected counties. We assessed PTSD symptoms, media exposure, general trust, demographic characteristics, socioeconomic status, and earthquake exposure. Data were analyzed descriptively and with Tobit regression analyses. Reversed relationships between general trust and PTSD were verified, whereas no direct links were found between media exposure and PTSD. Interaction tests revealed that media exposure alleviated PTSD for high-trust survivors, but aggravated PTSD for low-trust survivors. These results suggest that general trust building should be considered in post-disaster construction activities.

Understanding the Impact of Natural Disasters on Psychological Outcomes in Youth from Mainland China: a Meta-Analysis of Risk and Protective Factors for Post-Traumatic Stress Disorder Symptoms

Post-traumatic Stress Disorder (PTSD) is a mental illness that causes significant distress and impairment. Studies generally indicate lower rates of PTSD post-disaster in Chinese child populations. Irrespective of population examined, findings suggest that trauma alone cannot account for the development of PTSD (Ma et al. 2011). It is important to understand what other variables may contribute to the onset of PTSD. This was the first meta-analysis conducted to investigate risk and protective factors for PTSD (as well as mediating/moderating variables) in children directly impacted by natural disasters in China. Understanding these factors can help guide disaster readiness efforts, as well as post-disaster interventions (Yule et al. 2000). Also, this study is extremely relevant given recent earthquakes in China that have devastated many.

The prevalence of posttraumatic stress in adolescents eight years after the Wenchuan earthquake

In 2008, an 8.0 Richter scale earthquake devastated Wenchuan in China, which resulted in heavy casualties, and had wide-reaching psychological effects on survivors. To examine its impact on the survivors, this study aims to investigate the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in adolescents eight years after the earthquake. The cross-section survey was conducted in two different earthquake-affected areas, and data were collected from 4118 respondents. Instruments included the questionnaire on demographic information, the questionnaire on seismic exposure, PTSD Checklist-Civilian Version (PCL-C) questionnaire, Posttraumatic Growth Inventory (PTGI), Perceived Social Support Scale (PSSS) and Simple Coping Style Questionnaire (SCSQ). During the survey, there were 1998 valid questionnaires from the generally affected area and 2120 questionnaires from the severely affected area. The rate of PTSD is 1.9% in the generally affected area and 2.7% in the severely affected disaster area; there is no significant difference between the two differently affected areas. Occurrences of PTSD and PTG are significantly positively correlated in the generally affected area, nevertheless, there is a significant negative correlation between PTSD and PTG in most systems of the severely affected area. The results of this study help to expand our knowledge regarding posttraumatic stress in adolescents 8 years after the Wenchuan earthquake, and it provides suggestions for specific long-term health interventions in such populations. To prevent earthquake-related psychological issues among adolescent survivors, social support, psychological aid, and improvement of the living environment are necessary to buffer negative posttraumatic stress.

A Meta-Analysis of Risk Factors for Post-Traumatic Stress Disorder (PTSD) in Adults and Children after Earthquakes

PTSD is considered the most common negative psychological reactions among survivors following an earthquake. The present study sought to find out the determinants of PTSD in earthquake survivors using a systematic meta-analysis. Four electronic databases (PubMed, Embase, Web of Science, and PsycInfo) were used to search for observational studies about PTSD following earthquakes. The literature search, study selection, and data extraction were conducted independently by two authors. 52 articles were included in the study. Summary estimates, subgroup analysis, and publication bias tests were performed on the data. The prevalence of PTSD after earthquakes ranged from 4.10% to 67.07% in adults and from 2.50% to 60.00% in children. For adults, the significant predictors were being female, low education level or socio-economic status, prior trauma; being trapped, experiencing fear, injury, or bereavement during the disaster. For children, the significant predictors were being older age, high education level; being trapped, experiencing fear, injury, or bereavement, witnessing injury/death during the earthquakes. Our study provides implications for the understanding of risk factors for PTSD among earthquake survivors. Post-disaster mental health recovery programs that include early identification, on-going monitoring, and sustained psychosocial support are needed for earthquake survivors.

Posttraumatic stress disorder: a serious post-earthquake complication

Abstract Objectives Earthquakes are unpredictable and devastating natural disasters. They can cause massive destruction and loss of life and survivors may suffer psychological symptoms of severe intensity. Our goal in this article is to review studies published in the last 20 years to compile what is known about posttraumatic stress disorder (PTSD) occurring after earthquakes. The review also describes other psychiatric complications that can be associated with earthquakes, to provide readers with better overall understanding, and discusses several sociodemographic factors that can be associated with post-earthquake PTSD Method A search for literature was conducted on major databases such as MEDLINE, PubMed, EMBASE, and PsycINFO and in neurology and psychiatry journals, and many other medical journals. Terms used for electronic searches included, but were not limited to, posttraumatic stress disorder (PTSD), posttraumatic symptoms, anxiety, depression, major depressive disorder, earthquake, and natural disaster. The relevant information was then utilized to determine the relationships between earthquakes and posttraumatic stress symptoms. Results It was found that PTSD is the most commonly occurring mental health condition among earthquake survivors. Major depressive disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, and specific phobias were also listed. Conclusion The PTSD prevalence rate varied widely. It was dependent on multiple risk factors in target populations and also on the interval of time that had elapsed between the exposure to the deadly incident and measurement. Females seemed to be the most widely-affected group, while elderly people and young children exhibit considerable psychosocial impact.

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.

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.

Relational Satisfaction from Providing and Receiving Support is Associated with Reduced Post-Disaster Depression: Data From Within One Year of the 2011 Japan Triple Disaster

This study examined the buffering effect of relational social support satisfaction from providing and receiving support on depression in a non-evacuated community close to the Fukushima power plant damaged by the 2011 Japan Triple Disaster. A self-selected sample (N = 466, 351 female, mean age 60.4 year, SD = 14.0) participated in an intervention program for stress reduction and evaluation within 1 year of the disaster. First, effect sizes for predictor impact and demographic variables on depression were investigated. Then, data from an original instrument tapping satisfaction from social support relations was controlled as covariates. The results showed among survivors relational satisfaction from both providing and receiving support when controlled raised the effect sizes of predictors of depression symptomology, suggesting a buffering effect. Findings highlight the possible positive mental health of self-providing support among certain post-disaster populations.

Mental health problems among survivors in hard-hit areas of the 5.12 Wenchuan and 4.20 Lushan earthquakes

BACKGROUND

Earthquake exposure has often been associated with psychological distress. However, little is known about the cumulative effect of exposure to two earthquakes on psychological distress and in particular, the effect on the development of post-traumatic stress disorder (PTSD), anxiety and depression disorders.

AIMS

This study explored the effect of exposure on mental health outcomes after a first earthquake and again after a second earthquake.

METHODS

A population-based mental health survey using self-report questionnaires was conducted on 278 people in the hard-hit areas of Lushan and Baoxing Counties 13-16 months after the Wenchuan earthquake (Sample 1). 191 of these respondents were evaluated again 8-9 months after the Lushan earthquake (Sample 2), which struck almost 5 years after the Wenchuan earthquake.

RESULTS

In Sample 1, the prevalence rates for PTSD, anxiety and depression disorders were 44.53, 54.25 and 51.82%, respectively, and in Sample 2 the corresponding rates were 27.27, 38.63 and 36.93%. Females, the middle-aged, those of Tibetan nationality, and people who reported fear during the earthquake were at an increased risk of experiencing post-traumatic symptoms.

CONCLUSIONS

Although the incidence of PTSD, anxiety and depression disorders decreased from Sample 1 to Sample 2, the cumulative effect of exposure to two earthquakes on mental health problems was serious in the hard-hit areas. Therefore, it is important that psychological counseling be provided for earthquake victims, and especially those exposed to multiple earthquakes.

Lessons and Challenges of Disaster Relief Work in Rural China

Due to the disastrous Wenchuan earthquake that hit Sichuan, China, on May 12, 2008, approximately 70,000 people died, around 400,000 were injured, 18,467 were missing, and millions were left homeless due to the collapse of their homes. The substantial trauma and loss in the disaster area posed a challenge for disaster relief work focused on survivors’ psychological health. Many of the psychological interventions were based on Western or urban outpatient populations and were thus inappropriate for the uneducated, agriculturally based population of rural China, potentially limiting patient care and sensitivity during this postdisaster relief. This article discusses the therapeutic issues involved and finds that the collectivist nature of the rural Chinese culture and indigenized ways of working with the earthquake survivors are of paramount importance. It adds to the research literature by discussing the importance of relationships through the Chinese concept of Guanxi in the context of disaster relief work in rural China. Consistent with the concept of Guanxi, disaster relief volunteers must fully respect the world of the survivors while remaining flexible and creative in their work to build deeper connections and relationships.

Prevalence and risk factors of posttraumatic stress disorder among teachers 3 months after the Lushan earthquake: A cross-sectional study

Teachers and students often suffer from the same disaster. The prevalence of PTSD in students has been given great attention. However, in acting as mentors to students and their families, teachers are more likely to have vicarious and indirect exposure via hearing stories of their aftermath and witnessing the consequences of traumatic events. There are limited data pertaining to the prevalence of PTSD and its risk factors among teachers. A total of 316 teachers from 21 primary and secondary schools in Baoxing County were administered a project-developed questionnaire which included the items regarding demographic characteristics, earthquake-related experiences, somatic discomforts, emotional reactions, support status, and everyday functioning 2 weeks after the Lushan earthquake, and they finished a 1-to-1 telephone interview for addressing the PTSD criteria of the Mini International Neuropsychiatric Interview (MINI) 3 months after the earthquake. The prevalence of PTSD was 24.4% among teachers. Somatic discomforts (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.06-3.37) were positive risk factors of PTSD. Perceived social support (OR 0.30, 95% CI 0.14-0.62) and being able to calm down (OR 0.25, 95% CI 0.09-0.75) in teaching were negative risk factors. PTSD is commonly seen among teachers after an earthquake, and risk factors of PTSD were identified. These findings may help those providing psychological health programs to find the teachers who are at high risk of PTSD in schools after an earthquake in China.

Cross-Sectional Data Within 1 Year of the Fukushima Meltdown: Effect-Size of Predictors for Depression

This cross-sectional study investigates effect sizes of depression predictors in a community close to the Fukushima, Japan nuclear reactor damaged by the 11 March, 2011 earthquake and tsunami. Subjects volunteered for assessment between December, 2011 and March, 2012. Of 466 individuals (351 female, mean age 60.4 year, SD = 14.0), 23 % of the female participants and 17 % of the male participants could be diagnosed with depression. The strongest predictors were house damage, age, income reduction, home water incursion, and casualty acquaintance. Education level, location during disaster, and workplace damage proved non-significant. The high number of retired/unemployed in the sample may have influenced outcome. Results suggest sampling influences the applicability of Conservation of Resources model to a disaster event.

Emotional Intensity of Trauma Memory as Moderator of the Relationship Between Posttraumatic Cognitions and PTSD Symptoms

Individuals develop three types of cognitions in the aftermath of a traumatic experience: negative cognitions about the self, negative cognitions about the world, and self-blame (Foa et al., 1999 ). Although the relationship of posttraumatic stress disorder (PTSD) symptoms and posttraumatic cognitions has been supported in literature, memory-related responses affecting this relationship need further exploration. It was the intention of the present study to address this gap by examining the moderating role of emotional intensity of trauma memory in the relationship between posttraumatic cognitions and PTSD symptoms. In a sample of survivors of typhoon Haiyan ( N = 632), one of the strongest typhoons ever recorded, it was found that in general, negative cognitions about the self and the world, but not self-blame, predict PTSD symptoms; and emotional intensity of trauma memory generally moderates the relationship between posttraumatic cognitions and PTSD. The findings of the study would be useful in the development and enhancement of interventions to help the survivors of natural disasters in maintaining their mental health and wellbeing.

A Cross-sectional Study on Posttraumatic Stress Disorder and General Psychiatric Morbidity Among Adult Survivors 3 Years After the Wenchuan Earthquake, China

After the Wenchuan earthquake, a large number of studies have focused on postearthquake psychological disorders among survivors; however, most of these studies were conducted within a relatively short period. This study was conducted to examine the symptoms of posttraumatic stress disorder (PTSD) and general psychiatric morbidity among adult survivors 3 years after the Wenchuan earthquake, China. Through a multistage systematic sampling approach, a cross-sectional survey of 360 participants, 18 years or older, was conducted. The prevalence of PTSD and general psychiatric morbidity was 10.3% and 20.6%, respectively. Multivariate analysis revealed significant predictors for PTSD, including female gender and having felt guilt concerning someone’s death or injury. Significant predictors for general psychiatric morbidity included unmarried status and having been in serious danger. These results suggest that mental health services should be continuously available to earthquake survivors.

Longitudinal linkages between posttraumatic stress disorder and posttraumatic growth in adolescent survivors following the Wenchuan earthquake in China: A three-wave, cross-lagged study

The aim of this study is to examine the longitudinal relationships between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) among adolescent survivors of the 2008 Wenchuan earthquake in China. The participants in our study included 245 adolescent survivors who were randomly selected from several primary and secondary schools in the counties of Wenchuan, which are the areas most severely affected by the Wenchuan earthquake. Participants completed the Revised Child PTSD Symptom Scale and the Posttraumatic Growth Inventory (PTGI) at 3.5 years after the earthquake (T1), 4.5 years after the earthquake (T2), and 5.5 years after the earthquake (T3). The results found that PTSD reported in T1 and T2 predicted subsequent PTG reported at T2 and T3 and that PTG did not predict PTSD from T1 to T3. In addition, the cross-sectional correlation between PTSD and PTG weakened from T1 to T3. These results indicate that PTSD and PTG can coexist in individuals after a traumatic experience, and they further suggest that the reduction in PTSD does not indicate the appearance of PTG.

The symptoms of posttraumatic stress disorder and depression among adult earthquake survivors in China

The objective of the study was to examine the relationships between mental health conditions (posttraumatic stress disorder [PTSD] only, depression only, and PTSD and depression) and related factors. A cross-sectional survey was conducted among 1362 adults from two severely affected townships at 6 months after the earthquake. The results of the analyses showed that the prevalence of depression and PTSD were 31.4% and 22.1%, respectively, 6 months after the earthquake. When PTSD and depression were treated as two separate dependent variables, PTSD and depression share almost similar sets of predictive factors. After its four categories (none, PTSD only, depression only, and PTSD and depression) were used as categorical dependent variables, there are different predictive factors. The findings suggest that there are two different groups of individuals, those who develop depression only in response to earthquake exposure and those who develop both depression and PTSD.

Disrupted Functional Brain Connectome in Patients with Posttraumatic Stress Disorder

PURPOSE

To use resting-state functional magnetic resonance (MR) imaging and graph theory approaches to systematically investigate the topological organization of the functional connectome of patients with posttraumatic stress disorder (PTSD).

MATERIALS AND METHODS

This study was approved by the research ethics committee, and all subjects provided informed consent for participation. Seventy-six patients with PTSD caused by an earthquake and 76 control subjects who experienced the same disaster were matched for age, sex, and years of education. The study subjects underwent resting-state functional MR imaging. The whole-brain functional network was then constructed by thresholding partial correlation matrices of 90 brain regions. The topological organization of the constructed network was analyzed by using graph theory approaches. Nonparametric permutation tests were also used for group comparisons of topological metrics.

RESULTS

Compared with the control subjects, patients with PTSD exhibited abnormalities in global properties, including a significant decrease in path length (P = .0002) and increases in the clustering coefficient (P = .0014), global efficiency (P = .0002), and local efficiency (P = .0004). Locally, the patients with PTSD exhibited increased centrality in nodes that are predominately involved in the default-mode network (DMN) and the salience network (SN), including the posterior cingulate gyrus, the precuneus, the insula, the putamen, the pallidum, and the temporal regions.

CONCLUSION

These results suggest that individuals with PTSD exhibit a shift toward "small-worldization" (in which the network transforms from a random or regular network to a small-world network) rather than toward randomization; furthermore, the disequilibrium between the DMN and the SN might be associated with the pathophysiology of PTSD.

Prevalence and risk factors of complicated grief among Sichuan earthquake survivors

BACKGROUND

Disasters usually involves massive casualties, yet few post-disaster studies explore the prevalence of complicated grief (CG) among survivors. Complicated grief is a distinct psychological disorder, and is associated with impaired physical and psychological functions. Given such gap in the literature and the significance of this topic, this study is hoped to offer more information of complicated grief among survivors who lost their loved ones in disaster. Adopting a large scale survey, the prevalence and risk factors of CG among bereaved survivors one year after the Sichuan earthquake in China were explored.

METHODS

In total 803 bereaved survivors participated the study by filling a questionnaire on measuring CG symptoms, posttraumatic stress disorder (PTSD) symptoms, intrapersonal factors, earthquake related factors, bereavement related factors, and an interpersonal factor.

RESULTS

There were 71.1% of the participants scored higher than the cutoff point of CG symptoms. Close relationship with the deceased, PTSD symptoms, losing means of livelihood, physical injury, and terrifying experience in the earthquake, were identified to be risk factors for CG.

LIMITATIONS

The study was cross-sectional and the data was collected through a self-reported questionnaire. The sample was recruited from one of the most severely affected counties, thus the generalizability of the results should be interpreted with caution.

CONCLUSIONS

A large portion of bereaved earthquake survivors suffered from CG symptoms one year after the disaster. Risk factors found in this study can be used to identify high risk groups, who need special care, support, and bereavement interventions.

Impact of DSM-5 PTSD and gender on impaired eating behaviors in 512 Italian earthquake survivors

Considerable comorbidity rates between Post-traumatic Stress Disorder (PTSD) and eating disorders have been recently reported, as well as increased obesity and underweight conditions. The aim of the present study was to investigate the possible associations between DSM-5 PTSD, gender and impaired eating habits in a sample of 512 Italian earthquake survivors evaluated by the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Mood Spectrum-Self Report (MOODS-SR). Alterations in eating behaviors were assessed by means of four MOODS-SR items: n=150 (…there was no food that appealed to you or tasted good to you?), n=151 (…you constantly craved sweets or carbohydrates?), n=152 (…your appetite or weight decreased?), n=153 (…your appetite or weight increased?). In a Decision Tree procedure subjects with PTSD with respect to those without and, in the No-PTSD subgroup, females with respect to males, had a significantly higher ratio of at least one MOODS-SR eating behavior item (MOODS-SR EB). In the No-PTSD subgroup only, subjects with at least one MOODS-SR EB presented a significantly higher mean TALS-SR symptomatological domains total score with respect to those without MOODS-SR EB. In conclusion, alterations in eating behaviors were associated with PTSD after the L׳Aquila earthquake; among survivors without PTSD significant a correlation emerged between MOODS-SR EB and PTSD symptoms.

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.

The relationship between post traumatic stress disorder and post traumatic growth: gender differences in PTG and PTSD subgroups

PURPOSE

This study investigated the post traumatic stress disorder (PTSD) and post traumatic growth (PTG) in 2,300 earthquake survivors 1 year after the 2008 Wenchuan earthquake. This study aimed to investigate the relationship between PTSD and PTG and also tested for the gender differences in PTSD and PTG subgroups.

METHODS

A stratification random sampling strategy and questionnaires were used to collect the data. The PTSD was assessed using the PTSD Check list-Civilian and the PTG was assessed using the Post traumatic growth inventory. 2,300 individuals were involved in the initial survey with 2,080 completing the final questionnaire, a response rate of 90.4%. One-way ANOVA analyses were performed to investigate the gender differences in the PTSD and PTG subgroups.

RESULTS

One year following the earthquake, 40.1 and 51.1% of survivors reported PTSD and PTG, respectively. A bivariate correlation analysis indicated that there was a positive association between PTG and PTSD. The PTG and PTSD variance analysis conducted on female and male subgroups suggested that women were more affected than men.

CONCLUSIONS

Given the relatively high PTG prevalence, it was concluded that researchers need to pay more attention to the positive outcomes of an earthquake rather than just focusing on the negative effects. The surveys and analyses indicated that psychological intervention and care for the earthquake disaster survivors should focus more on females and older people, who tend to be more adversely affected.

Posttraumatic stress disorder and its risk factors among adolescent survivors three years after an 8.0 magnitude earthquake in China

BACKGROUND

Serious and long-lasting psychiatric consequences can be found in children and adolescents following earthquake, including the development of posttraumatic stress disorder (PTSD). Although researchers have been focused on PTSD recently, its prevalence and risk factors after a huge natural disaster are still unclear because of limited sample size. The purpose of this study is to explore the prevalence of posttraumatic stress disorder (PTSD) in adolescent survivors three years after the Wenchuan earthquake, describe PTSD symptoms, and to find out risk factors of PTSD.

METHODS

A total of 4,604 adolescents from three middle schools which located in earthquake-stricken areas were recruited in this study. Instruments included the demographic questionnaire, questionnaire about earthquake exposure, the Social Support Appraisal Scale (SSA), the Posttraumatic stress disorder Checklist-Civilian Version (PCL-C), and the structured clinical interview for DSM-IV Disorders (SCID).

RESULTS

The prevalence rate of PTSD was 5.7% (frequency: n = 261), and the most commonly occurring symptoms of PTSD were distress at reminders (64.5%), difficulty concentration (59.1%), and being easily startled (58.6%). Loss of houses and property, being injured, deaths of family members, and witness of death are positive risk factors of PTSD, and physical exercise and social support are negative risk factors of PTSD.

CONCLUSIONS

Professional and effective interventions are needed to reduce the development of PTSD among adolescents after the Wenchuan earthquake, especially for these who lost their houses or property and lost their family members, witnessed death, and lacked of social support in the earthquake. Moreover, injured adolescents and adolescents who lacked of physical exercise also need intervention due to high risk.

Health education and promotion at the site of an emergency: experience from the Chinese Wenchuan earthquake response

Theories and strategies of social mobilization, capacity building, mass and interpersonal communication, as well as risk communication and behavioral change were used to develop health education and promotion campaigns to decrease and prevent injuries and infectious diseases among the survivors of the Wenchuan earthquake in May 2008. We evaluated the effectiveness of the campaigns and short-term interventions using mixed-methods. The earthquake survivors' health knowledge, skills, and practice improved significantly with respect to injury protection, food and water safety, environmental and personal hygiene, and disease prevention. No infectious disease outbreaks were reported after the earthquake, and the epidemic level was lower than before the earthquake. After a short-term intervention among the students of Leigu Township Primary and Junior School, the proportion of those with personal hygiene increased from 59.7% to 98.3% (p< 0.01). Of the sampled survivors from Wenchuan County, 92.3% reported to have improved their health knowledge and 54.9% improved their health practice (p< 0.01). Thus, health education and promotion during public health emergencies such as earthquakes play an important role in preventing injuries and infectious diseases among survivors.

The public health system response to the 2008 Sichuan province earthquake: a literature review and interviews

This paper describes and analyses the public health system response to the deadly earthquake in Sichuan province, China, in May 2008. Drawing on an experiential learning project consisting of a literature review and field research, including a series of interviews with medical and public health professionals, policy-makers and first responders, a conceptual framework was developed to describe the response. This approach emphasises the pre-existing preparedness level of the medical and public health systems, as well as social, economic and geo-political factors that had an impact on mitigation efforts. This framework was used to conduct post-disaster analyses addressing major response issues and examining methods employed during the public health response to the disaster. This framework could be used to describe and analyse the emergency response to other disasters.

Interpersonal psychotherapy versus treatment as usual for PTSD and depression among Sichuan earthquake survivors: a randomized clinical trial

Background

Without effective treatment, PTSD and depression can cause persistent disability in disaster-affected populations.

Methods

Our objective was to test the efficacy of Interpersonal Psychotherapy (IPT) delivered by trained local personnel compared with treatment as usual (TAU) for Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) among adults affected by the Sichuan 2008 earthquake. A small randomized controlled trial of IPT + TAU versus TAU alone was delivered by local mental health personnel in Shifang, China. Between July 2011 and January 2012, 49 adults ≥ 18 years with PTSD, MDD or both were enrolled and randomized to 12 weekly sessions of IPT + TAU (27) or TAU (22) alone x 12 weeks. IPT was then offered to the TAU group. Unblinded follow up assessments were conducted at three and six months. IPT was a 12 session, weekly one hour treatment delivered by local personnel who were trained and supervised in IPT. TAU was continuation of prescribed psychotropic medication (if applicable) and crisis counseling, as needed.

Main Outcome(s) and Measures (s): Clinician Administered PTSD Scale (CAPS) PTSD diagnosis; Structured Clinical Interview for DSM-IV (SCID) for MDD diagnosis. Secondary measures included PTSD/depression symptoms, interpersonal conflict/anger, social support, self-efficacy and functioning.

Results

Using an intent-to-treat analysis, 22 IPT + TAU and 19 TAU participants were compared at three months post-baseline. A significantly greater reduction of PTSD and MDD diagnoses was found in the IPT group (51.9%, 30.1%, respectively) versus the TAU group (3.4%, 3.4%, respectively). Despite the small sample, the estimates for time-by-condition analyses of target outcomes (2.37 for PTSD (p = .018) and 1.91 for MDD (p = .056)) indicate the improvement was better in the IPT + TAU condition versus the TAU group. Treatment gains were maintained at 6 months for the IPT group. A similar treatment response was observed in the TAU group upon receipt of IPT.

Conclusions

This initial study shows that IPT is a promising treatment for reducing PTSD and depression, the two major mental health disorders affecting populations surviving natural disaster, using a design that builds local mental health care capacity.

Trial Registration

ClinicalTrials.Gov number, NCT01624935.

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.