Protective Effects of Social Support Content and Support Source on Depression and Its Prevalence 6 Months after Wenchuan Earthquake

Perceived social support and longitudinal trajectories of depression and anxiety in World Trade Center responders

PURPOSE

While severely distressing events are known to affect mental health adversely, some survivors develop only short-lived or no psychiatric symptoms in the aftermath of a disaster. In the WTC Health Program General Responder Cohort (WTCHP GRC) we examined whether social support was protective against the development of depression or anxiety symptoms after the 9/11 WTC attacks and explored in a subsample whether trait resilience moderated this relationship.

METHODS

We analyzed data from 14,033 traditional and 13,478 non-traditional responders who attended at least three periodic health monitoring visits between 2002 and 2019. Linear mixed-effects models were used to examine depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder screener; GAD-7) scores. In a subsample of 812 participants, we also assessed if the association between social support and symptoms was moderated by an individual's trait resilience level (Connor-Davidson Resilience Scale, CD-RISC).

RESULTS

For both traditional and non-traditional responders, perceived social support around 9/11 was associated with lower levels of depressive (β = - 0.24, S.E. = 0.017, z = - 14.29, p < 0.001) and anxiety symptoms (β = - 0.17, S. E. = 0.016, z = - 10.48, p < 0.001). Trait resilience scores were higher in responders with at least one source of social support during the aftermath of 9/11 compared to those without (mean 71.56, SD 21.58 vs mean 76.64, SD 17.06; β = 5.08, S.E. = 0.36, p < 0.001). Trait resilience moderated the association between social support and depressive (p < 0.001) and anxiety trajectories (p < 0.001) for traditional responders.

CONCLUSION

Our findings suggest that perceived social support around a severely distressing event may have long-term protective effects on symptoms of depression and anxiety.

Long-term effects of early stress due to earthquake exposure on depression symptoms in adulthood: a cross-sectional study

OBJECTIVE

This study aimed to investigate the long-term effects of early stress by Tangshan earthquake on symptoms of depression in adulthood.

METHOD

A total of 1534 volunteers born and raised in Tangshan were investigated; finally, 1328 subjects were enrolled in the study. They were divided into three groups according to their birth dates: infant exposure, prenatal exposure, and non-exposure. The questionnaires and psychological evaluation of all subjects were completed using a one-on-one psychological test.

RESULTS

The rate of depressive symptoms in the prenatal exposure group was the highest, and the lowest in the non-exposure group, with statistical differences among the three groups (P = 0.002). Moreover, the incidences of depressed mood, suicide ideation and work and loss of interest in the prenatal exposure group were significantly higher than those in the infant exposure group and the non-exposure group (P = 0.008, P = 0.001, P = 0.038, respectively). Multiple logistic regression analysis showed that male could be a protective factor for symptoms of depression in adulthood, and earthquake exposure was an important predictor of the incidence of depression symptoms.

CONCLUSIONS

Fetal or infancy exposure to earthquake might correlate to depression symptoms in adulthood.

Direct participation of people with communication disabilities in research on poverty and disabilities in low and middle income countries: A critical review

INTRODUCTION

An estimated 1 billion people with disabilities live in low and middle income countries, a population that includes people with communication disabilities (PwCD). PwCD are a heterogenous group with a wide range of abilities who may be underrepresented in research due to the communication demands involved in research participation.

METHODS

A critical analysis of 145 studies from a previously published systematic review was undertaken with the aim of documenting the opportunities for direct participation of PwCD in research on poverty and disability in low- and middle- income countries.

RESULTS

The key finding was the high risk of underrepresentation of PwCD in research on poverty and disability in LMICs, despite low rates of explicit exclusion (n = 8; 5.5%). A total of 366 uses of data collection tools were analysed (255 unique tools). The majority of data collection tools had high communication demands (92.9%), including those measuring disability (88.6%) and those assessing poverty (100%). Only 22 studies (15.2%) specifically included PwCD. A subset of these studies (n = 14) presented disaggregated data in a way that allowed for analysis of outcomes for PwCD, suggesting a clear intersection between poverty and communication disability, with findings related to general poverty indicators, reduced access to education, low levels of employment, and additional expenditure.

CONCLUSIONS

The findings suggest a systematic underrepresentation of PwCD in research on poverty and disability with substantial implications for future policy and program planning, directly affecting the availability and provision of services and resources for this population. A failure to provide adequate opportunity for participation of PwCD in research risks leaving those with communication disabilities behind in the pursuit of global poverty eradication.

Association between the social isolation and depressive symptoms after the great East Japan earthquake: findings from the baseline survey of the TMM CommCohort study

BACKGROUND

Social isolation and mental health issues have become a severe problem in disaster areas in the Great East Japan Earthquake. This study examined whether the combination of the house damage and social isolation or the combination of the death of family members and social isolation is associated with depressive symptoms among survivors using the baseline study data of the Tohoku Medical Megabank Project Community-Based Cohort Study (TMM CommCohort Study).

METHODS

We used cross-sectional data from a baseline survey of 48,958 participants (18,423 males, 30,535 females; aged 60.1 ± 11.2 years) to examine the association between social isolation measured by the Lubben social network scale 6 (LSNS-6) and depressive symptoms measured by the Center for Epidemiological Studies-Depressive Scale (CES-D). The presence of social isolation and depressive symptoms was defined by an LSNS-6 score of < 12 and a CES-D score of ≥16, respectively. We performed a logistic regression analysis to determine the multivariable-adjusted odds ratio (95% confidence interval) [AOR (95% CI)] for depressive symptoms according to sex in the social isolation in comparison to without social isolation, and the associations of the combination of the house damage or the death of family members and social isolation and depressive symptoms.

RESULTS

Social isolation was significantly associated with depressive symptoms (males: OR = 1.87; 95% CI = 1.72-2.04, females: OR = 2.13; 95% CI = 2.00-2.26). Both males and females respondents with severe house damage and social isolation had a greater risk of depressive symptoms in comparison to those with an undamaged house and without social isolation (males: OR = 3.40; 95% CI = 2.73-4.24, females: OR = 2.92; 95% CI = 2.46-3.46). The risk of depressive symptoms was also higher in both males and females respondents with the death of family members and social isolation in comparison to those without the death of family members and without social isolation (males: OR = 2.18; 95% CI = 1.90-2.50, females: OR = 2.60; 95% CI = 2.35-2.88).

CONCLUSION

The findings suggested that a combination of social isolation and severe house damage and the death of family members caused by a large-scale natural disaster was associated with a higher risk of depressive symptoms although the interaction was not statistically significant.

Depression and Elevated Inflammation Among Chinese Older Adults: Eight Years After the 2003 SARS Epidemic

BACKGROUND AND OBJECTIVES

This study examined associations between exposure to the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic and Chinese older adults' depression and inflammation 8 years after the crisis. Further, this study investigated the buffering effects of perceived social support and social participation.

RESEARCH DESIGN AND METHODS

Data were drawn from the 2011 China Health and Retirement Longitudinal Survey, including N = 4,341 Chinese adults aged 60 years and older. For the survey, local officials identified whether the 2003 SARS outbreak was one of the major disasters in the history of their communities. Depression was assessed by the Center for Epidemiological Studies-Depression scale and inflammation was measured by C-reactive protein (CRP) collected from participants via venous blood draws.

RESULTS

Results from multilevel logistic regression models revealed that Chinese older adults living in communities exposed to SARS were more likely to have elevated CRP compared to those not living in such communities. Moreover, community SARS exposure was associated with greater risks of depression for Chinese older adults who had no perceived social support. Among Chinese older adults who had low levels of social participation, community SARS exposure was more strongly related to elevated CRP.

DISCUSSION AND IMPLICATIONS

Findings suggest community-level exposure to the SARS epidemic had enduring consequences for Chinese older adults' health. However, active social participation and supportive social ties provided important resources that may buffer against negative effects of exposure to the SARS epidemic.

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.

Culture-related grief beliefs and social support influence depressive symptoms of Shidu parents in rural China

BACKGROUND

Parents who have lost their only child are known as Shidu parents in China. Losing an only child is an enormous tragedy for parents that can trigger severe depressive symptoms. Few studies have explored the influence of cultural beliefs and social support on depressive symptoms.

OBJECTIVE

This study aimed to explore the relationship between culture-related grief beliefs, social support and depressive symptoms among Shidu parents in rural China.

METHOD

This cross-sectional study was conducted in Sujiatun district of Shenyang, China. Data were collected from November 2019 to February 2020 from 228 rural Shidu parents. Questionnaires consisted of the Center for Epidemiologic Studies Depression Scales (CES-D), the Culture-related Grief Beliefs of Shidu Parents Questionnaire (CBSQ), the Social Support Rating Scale (SSRS), and demographic and bereavement-related information. Hierarchical multiple linear regression analysis was conducted to examine the associations among culture-related grief beliefs, social support and depressive symptoms.

RESULTS

Of the 228 Shidu parents, 87.0% reported depressive symptoms (CES-D ≥ 16). The mean age of the participants was 62.91 years, ranging from 50 to 86. Regression analysis indicated that parents' younger age, lower education level and debts were prominent risk factors for depressive symptoms. Perceived stigma (a subscale of CBSQ) was positively associated with depressive symptoms. Social support was negatively associated with depressive symptoms.

CONCLUSIONS

Given the high prevalence of depressive symptoms in rural Shidu parents, there is a critical need to reduce perceived stigma and increase social support to alleviate depressive symptoms among Shidu parents in rural China.

Prevalence of and Risk Factors for Depression Among Older Persons 6 Months After the Lushan Earthquake in China: A Cross-Sectional Survey

BACKGROUND

Older persons are particularly vulnerable to the impact of earthquakes and are more likely to suffer from depression.

OBJECTIVES

We aimed to estimate the prevalence of depression, to compare the prevalence between disaster-affected and non-disaster affected areas, and to explore additional risk factors for depression 6 months after the Lushan earthquake.

DESIGN

A cross-sectional study was conducted.

SETTING

A magnitude 7.0 earthquake occurred in Lushan County, Ya'an Prefecture, Sichuan Province, on April 20, 2013. In total, 196 people were killed, and 11,470 were injured over 5 days.

PARTICIPANTS

A multistage cluster sampling strategy was used. A total of 1,509 older persons (aged 60 or older) participated.

METHODS

The Geriatric Depression Scale-15, the University of California Los Angeles Loneliness scale, the Activities of Daily Living Scale, the Social Support Rating Scale, and the Family Apgar Index scale were used to evaluate symptoms of depression, loneliness, dependence with respect to activities of daily living, perceived social support, and family function, respectively. A generalized linear regression model and multiple logistic regression analysis were employed to identify risk factors for depression.

RESULTS

Using a cutoff score of 8, the prevalence of depression was 29.16% in the hardest-hit disaster area, 29.06% in the hard-hit disaster area, 31.61% in the moderately-hit disaster area, 17.94% in the remote non-disaster area, and 12.28% in the neighboring non-disaster area. The prevalence was significantly higher in the disaster areas than in the non-disaster areas. Risk factors for depression included an educational level of elementary school or lower, a greater number of chronic illnesses, feelings of loneliness, limitations in activities of daily living, family dysfunction, and low levels of social support.

CONCLUSION

Depression was highly prevalent in elderly survivors and was significantly more prevalent in disaster areas than in non-disaster areas. Psychological interventions and care should focus on older survivors.

Adolescent risk substance use behavior, posttraumatic stress, depression, and resilience: Innovative considerations for disaster recovery

Natural and technological disasters cause long-term psychological trauma and increase substance use in adults. It is unclear whether these problems also occur in children and whether trauma influences long-term psychological outcomes due to developmental stages at the time of trauma. One community of interest is located in southeastern Louisiana, where, as children, many locals were exposed to Hurricane Katrina in 2005 and the Deepwater Horizon Oil Spill in 2010. We hypothesized individuals exposed to these disasters in early childhood would exhibit higher rates of anxiety, depression, and alcohol use as adolescents than the general population. To test this, we developed a questionnaire with a focus on severity of disaster exposure, indicators of psychological resilience, and current levels of anxiety, depression, and alcohol use. This survey was administered to over 1000 adolescents in local high schools throughout southeastern Louisiana. Structural equation modeling was performed to test correlations and moderation effects. We found disaster exposure was positively associated with trauma-like symptoms and substance use and psychological resilience was negatively related to these outcomes. These findings demonstrate childhood disaster exposure has the potential to cause chronic psychological distress and predispose individuals to substance use later in life. They also suggest resilience may be protective for disaster survivors. Future studies should expand these concepts to other age groups and types of disasters. Whether resilience-focused psychotherapy may be beneficial in these populations is also a relevant topic for exploration.

Social support moderates association between posttraumatic growth and trauma-related psychopathologies among victims of the Sewol Ferry Disaster

Disasters have numerous harmful effects on the mental health status of trauma-exposed people. We investigated the differences in the association between trauma-related psychopathologies and posttraumatic growth according to the perceived social support level among victims of the Sewol Ferry disaster on April 16, 2014, in South Korea. Data from 241 bereaved family members, survivors, and family members of survivors were used. The Duke-UNC Functional Social Support Questionnaire, Posttraumatic Growth Inventory, PTSD Checklist-5, Posttraumatic Embitterment Disorder Self-Rating Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 were used to evaluate perceived social support, posttraumatic growth, and trauma-related psychopathologies. We found that the severity of depression and anxiety showed inverse correlations with posttraumatic growth only in the low-social support group, while they did not demonstrate significant correlations in the high-social support group. The social support level had correlations with posttraumatic growth and the severity of posttraumatic stress disorder and posttraumatic embitterment disorder only in female respondents. Furthermore, there was a mediation pathway from social support level to posttraumatic growth through depressive symptoms. This study explored the complex relationship between social support, posttraumatic growth, trauma-related psychopathologies, and gender among trauma-exposed individuals in the aftermath of the Sewol Ferry disaster.

Co-occurring patterns of post-traumatic stress disorder and depression among flood victims: A latent profile analysis

This study examined the co-occurring patterns of post-traumatic stress disorder and depression. A sample of 187 victims completed self-report questionnaires after a major flood disaster. Results indicated four classes: low symptoms group (49.7%), mild comorbid symptoms group (24.1%), serious comorbid symptoms group (3.2%), and medium comorbid symptoms group (23.0%). Male victims were less likely and older victims were more likely to belong to the medium comorbid symptoms group; victims with more serious trauma exposure and those using more maladaptive cognition emotional regulation strategies were more likely to belong to both the mild and medium comorbid symptoms groups.

How does social support relieve depression among flood victims? The contribution of feelings of safety, self-disclosure, and negative cognition

BACKGROUND

Depression is one of the most common post-trauma symptoms that can be alleivated by social support. The purpose of this study was to examine the multiple mediating effects of social support on depression via feelings of safety, disclosure, and negative cognition.

METHOD

One hundred and eighty-seven flood victims in Wuhu City, an area affected most severely by a flood during July 2016, were selected to complete a self-report questionnaire package.

RESULTS

Social support has four indirect negative effects on depression, including a one-step indirect path to self-disclosure, 2 two-step paths from feelings of safety to self-disclosure, and from self-disclosure to negative cognition about self, and a three-step indirect path from feelings of life safety via self-disclosure to negative self-cognition.

LIMITATIONS

All variables were measured using self-report scales.

CONCLUSION

Social support may relieve depression in flood victims by inducing feelings of safety and self-disclosure, and by relieving negative cognition.

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.

A meta-analysis of risk factors for depression in adults and children after natural disasters

Background

A number of studies have shown a range of negative psychological symptoms (e.g. depression) after exposure to natural disasters. The aim of this study was to determine risk factors for depression in both children and adults who have survived natural disasters.

Methods

Four electronic databases (PubMed, Embase, Web of Science, and PsychInfo) were used to search for observational studies (case–control, cross-sectional, and cohort studies) about depression following natural disasters. The literature search, study selection, and data extraction were conducted independently by two authors. Thirty-one articles were included in the study, of which twenty included adult participants and eleven included child participants. Summary estimates were obtained using random-effects models. Subgroup analysis, sensitivity analysis, and publication bias tests were performed on the data.

Results

The prevalence of depression after natural disasters ranged from 5.8% to 54.0% in adults and from 7.5% to 44.8% in children. We found a number of risk factors for depression after exposure to natural disasters. For adults, the significant predictors were being female ;not married;holding religious beliefs; having poor education; prior trauma; experiencing fear, injury, or bereavement during the disaster; or losing employment or property, suffering house damage as a result of the disaster. For children, the significant predictors were prior trauma; being trapped during the disaster; experiencing injury, fear, or bereavement during the disaster; witnessing injury/death during the disaster; or having poor social support.

Conclusions

The current analysis provides evidence of risk factors for depression in survivors of natural disasters. Further research is necessary to design interventions to improve the mental health of survivors of natural disasters.