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

Long-term trends in the incidence of depressive disorders in China, the United States, India and globally: A comparative study from 1990 to 2019

Background

Depressive disorders have become an increasingly significant public health issue. This study is intended to show the trend of the incidence of depressive disorders in China, the United States, India and the world from 1990 to 2019, as well as the impact of age, period and cohort on it.

Methods

Extracting incidence data from the Global Burden of Disease Study 2019, we determined trends in the age-standardized incidence rate (ASIR) using Joinpoint regression. An age-period-cohort analysis was implemented to describe the effects of age, period, and cohort, as well as the long-term tendencies.

Results

From 1990 to 2019, the ASIR of depressive disorders in China was lower than that in the United States; India is lower than the United States in the first 5 years, showing a downward trend. The incidence in India and the United States is higher than the global average. The ASIR of women in the three countries is higher than that of men. In China, the elderly, early period and people born around 1954 have a higher risk of depressive disorders. In the United States, young people born around 1999 have a higher risk of depressive disorders. India is similar to China.

Conclusion

From 1990 to 2019, the age effect of China as a whole increased, and the period became stable, and the cohort effect declined. The overall age and period effects of the United States reduced, while the cohort effect increased. The age effect in India increased, while the period and cohort effects decreased. Depressive disorders are becoming ever more serious worldwide, and we'd better take measures to reduce its incidence according to the cohort effect of each age group.

Well-being Effects of Natural Disasters: Evidence from China's Wenchuan Earthquake

This study finds that the Wenchuan earthquake in 2008, one of China's most catastrophic earthquakes, substantially decreased victims' subjective well-being even after incorporating the offsetting effects of post-disaster relief programs. This net well-being impact lasted for nearly 10 years and was on average equivalent to a loss of 67% of the average equivalized household income. Although the post-disaster measures largely restored income, health, and employment, they failed to prevent well-being losses due to family dissolution, as reflected in the higher rates of divorce and widowhood after the earthquake. We find that rural populations, older adults, the less educated, and residents without social insurance were more vulnerable to the earthquake shock. This study uses six waves of a nationally representative dataset of China and a difference-in-differences approach to identify the short- and long-term causal well-being effects of the Wenchuan earthquake. Deeper analyses on mechanisms and heterogeneity suggest that post-disaster policies should focus more on aspects beyond economic factors and on the well-being of disadvantaged populations in particular.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-022-00609-z.

A comparative examination of the health status of earthquake-affected and non-earthquake-affected adolescents in Yushu

Background

Yushu, Qinghai Province, which is located in the remote Tibetan Plateau in western China, was struck by a disastrous earthquake in 2010.

Methods

This study aimed to compare the health status of adolescents who had (Exp-Group) and had not (Non-Group) experienced the Yushu earthquake, 7 years after it occurred; additionally, group-specific predictors of health status were identified. A cross-sectional study was adopted among students from two junior schools in Yushu, whereby two groups were compared. Descriptive statistics, t-tests, Wilcoxon rank-sum tests, Kruskal-Wallis H tests, and stepwise linear regression were used to analyze data.

Results

Exp-Group scored higher than Non-Group on Physiological Component Summary (PCS) but not on Mental Component Summary (MCS). Among Exp-Group participants, lower PCS scores were predicted for "house damaged," "injured," "family member injured," and "family member or friend dead." Lower MCS scores were predicted by "family member or friend dead." Among Non-Group participants, PCS scores were predicted by "residence" and "family member or friend dead." Lower MCS scores were predicted by "not living with parents."

Conclusion

Lower PCS and MCS scores of Exp-Group adolescents mainly contributed to earthquake-related injuries, while lower PCS and MCS scores of Non-Group are related to poor living conditions and the fact of the left-behind child.

Social, Family, and Educational Impacts on Anxiety and Cognitive Empathy Derived From the COVID-19: Study on Families With Children

This research aims to monitor the current situation of confinement in Spanish society motivated by COVID-19 crisis. For this, a study of its socio-family, psychological and educational impact is conducted. The sample (N = 165 families, 89.1% nuclear families with children living in the same household and 20.5% with a relative in a risk group) comes from the Aragonese region (Spain). The instruments used are: Beck-II Depression Inventory (BDI-II); Baron-Cohen and Wheelwright's Empathy Quotient (EQ) with its cognitive empathy subscale, as well as an ad-hoc questionnaire, reviewed by a panel of experts, to learn about socio-personal, family and housing conditions, use of technology, involvement in school tasks and household, and working condition. The multiple regression analysis results show that the anxiety derived from the current situation is explained in 23.1% (p < 0.001) by the variables: gender (t = -2.31, p = 0.022), level of Internet consumption (t = 2.139, p = 0.034), increase of family conflicts (t = 2.980, p = 0.003) and help with school tasks (t = 2.980, p = 0.040). On the other hand, cognitive empathy is explained in 24.6% (p < 0.001) by the variables: gender (t = -4.690, p < 0.001) and mother's hours of teleworking (t = 2.101, p = 0.037). All this leads us to conclusions related to preventive systems of social, psychological, and educational aspects to better serve families. These conclusions can be also be transferred to the future with an inclusive care to family settings from those three parameters.

Prevalence of Post-traumatic Stress Disorder and Depression After the September 19th, 2017 Earthquake in Mexico

BACKGROUND AND AIM

Natural disasters cause mental disorders, the most frequent are Post-traumatic stress disorder (PTSD) and depression, which should be quickly identified for immediate psychological care. The aim of this study was to estimate the frequency of these disturbances in a population with social security, located in the states hit by the earthquake that took place on September 19^th, 2017 in Mexico.

METHODS

To identify persons with PTSD and depression, a random sample of the population was screened (1-2 months' post-earthquake) in primary health care clinics at the Mexican Institute of Social Security (IMSS). A questionnaire for the detection of mental conditions (The Screening Questionnaire for Disaster Mental Health, SQD) was used to select people for group therapy and/or psychotherapeutic support, when identified with severe PTSD and high risk of depression.

RESULTS

Over 44,855 persons (67.9% females, 32.1% males), residents of Mexico City, the State of Mexico, Puebla, Morelos were surveyed. The prevalence of severe PTSD was 11.9% and depression 9.2%. The highest prevalence of PTSD was observed in Mexico City (12.8%) the state with more material damage. Women were at higher risk for PTSD (OR, 2.08; 95% CI 1.97-2.19, p = 0.000) and depression (OR, 1.86; 95% CI 1.72-2.01, p = 0.000).

CONCLUSIONS

The prevalence of PTSD and depression was higher in those states with severe damage caused by the earthquake; women were more susceptible to mental disorders.

Health status of adolescents in the Tibetan plateau area of western China: 6 years after the Yushu earthquake

Background

An earthquake struck Yushu in Qinghai province of China on April 14, 2010, causing 2698 deaths and 12,135 injuries.The present study aimed to assess the health status, and associated determinants, of child survivors in the epicenter of the Yushu earthquake 6 years after the event.

Methods

A cross-sectional survey was performed among students from two junior schools in Yushu County. Descriptive statistics, t-tests, ANOVA, Wilcoxon rank sum tests, Kruskal-Wallis H tests and stepwise linear regression analysis were used for data analysis.

Results

The mean scores onmental component summary (MCS)and physical component summary (PCS) were 42.13 (SD 7.32) and 42.04 (SD 8.07), respectively. Lower PCS in the aftermath of an earthquake was associated with being trapped/in danger, injured to self, receiving no escape training while lowerMCS in the aftermath of an earthquake was associated with a lower grade level, not living with parents, fear during the earthquake, death in the family, and not receiving psychological counseling after the earthquake.

Conclusions

In conclusion, the results of the present study help to expand our knowledge regarding the health status of child survivors 6 years after the Yushu earthquake. Our study provides evidence-based suggestions for specific long-term health interventions in such vulnerable populations.

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

Aim

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

Methods

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

Results

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

Conclusion

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

Health-related quality of life for medical rescuers one month after Ludian earthquake

BACKGROUND

An earthquake struck Ludian in Yunnan province of China on August 3, 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the quality of life and associated determinants among medical rescuers after Ludian earthquake.

METHODS

A cross-sectional survey was performed among personnel from three hospitals that assumed rescue tasks in Ludian earthquake. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis.

RESULTS

The mean scores on the physical component summary (PCS) and mental component summary (MCS) were 49.86 (SD = 6.01) and 35.85(SD = 6.90), respectively. Lower PCS in the aftermath of an earthquake was associated with non-military medical rescuers, elderly age, and being trapped/in danger while lower MSC in the aftermath of an earthquake was associated with non-military medical rescuers, young age, being female, being trapped/in danger and low education degree.

CONCLUSIONS

In conclusion, our study demonstrates that medical rescuers are at risk for a lower HRQoL after exposure to Ludian earthquake. The results of this study help expand our knowledge of health-related quality of life among medical rescuers after the Ludian earthquake.

Health Status and Risk Factors among Adolescent Survivors One Month after the 2014 Ludian Earthquake

Background: An earthquake struck Ludian in Yunnan Province (China) on 3 August 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the health status and associated determinants among adolescent survivors after the Ludian earthquake. Methods: A cross-sectional survey of 845 was conducted at the Ludian No. 1 Middle School. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis. Results: The mean scores on the physical component summary (PCS) and mental component summary (MCS) were 46.23 (SD = 7.10) and 36.34 (SD = 7.09), respectively. Lower PCS scores in the aftermath of an earthquake were associated with being trapped or in danger, being female, being an ethnic minority, injury to self and house damage, while lower MSC scores were associated with fear during the earthquake, Han ethnicity, death in the family, not being involved in the rescue and low household income. Conclusions: In our study, significant associations between demographic, socio-economic, and trauma-related experiences variables and overall physical and mental health of adolescent survivors were presented. The results of this study help expand our knowledge of health status among adolescent survivors after the Ludian earthquake.

Health-related quality of life and the adaptation of residents to harsh post-earthquake conditions in China

OBJECTIVE

This study assessed the health-related quality of life (HRQOL) and the adaptation to harsh conditions (APHC) of residents living in post-earthquake zones in Sichuan Province, China, as well as the effect of HRQOL on APHC.

METHODS

A sample survey was conducted in 5 counties in Sichuan in May and June 2013 (N=2000). The 12-item Short Form Health Survey (SF-12) was used to measure HRQOL. The APHC scale was self-developed and was based on real-life conditions in China. Confirmatory factor analysis and structural equation model were used to analyze how HRQOL affected APHC.

RESULTS

Cronbach α coefficients indicated that the internal reliability of both scales were good. Results showed that the physical component summary significantly affected APHC, while the effect of the mental component summary was insignificant. APHC had the greatest effect on the adaptation to poor infrastructures (r=0.721) and the least effect on the adaptation to poor social security systems (r=0.608).

CONCLUSIONS

The HRQOL of residents living in post-earthquake zones positively affected APHC, particularly physical health. These findings suggested the need for governmental improvement of infrastructures in post-disaster areas. (Disaster Med Public Health Preparedness. 2014;0:1-7).

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.

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

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Solastalgia: living with the environmental damage caused by natural disasters

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

Developing a new perspective to study the health of survivors of Sichuan earthquakes in China: a study on the effect of post-earthquake rescue policies on survivors' health-related quality of life

Background

Sichuan is a province in China with an extensive history of earthquakes. Recent earthquakes, including the Lushan earthquake in 2013, have resulted in thousands of people losing their homes and their families. However, there is a research gap on the efficiency of government support policies. Therefore, this study develops a new perspective to study the health of earthquake survivors, based on the effect of post-earthquake rescue policies on health-related quality of life (HRQOL) of survivors of the Sichuan earthquake.

Methods

This study uses data from a survey conducted in five hard-hit counties (Wenchuan, Qingchuan, Mianzhu, Lushan, and Dujiangyan) in Sichuan in 2013. A total of 2,000 questionnaires were distributed, and 1,672 were returned; the response rate was 83.6%.

Results

Results of the rescue policies scale and Medical Outcomes Study Short Form 36 (SF-36) scale passed the reliability test. The confirmatory factor analysis model showed that the physical component summary (PCS) directly affected the mental component summary (MCS). The results of structural equation model regarding the effects of rescue policies on HRQOL showed that the path coefficients of six policies (education, orphans, employment, poverty, legal, and social rescue policies) to the PCS of survivors were all positive and passed the test of significance. Finally, although only the path coefficient of the educational rescue policy to the MCS of survivors was positive and passed the test of significance, the other five policies affected the MCS indirectly through the PCS.

Conclusions

The general HRQOL of survivors is not ideal; the survivors showed a low satisfaction with the post-earthquake rescue policies. Further, the six post-earthquake rescue policies significantly improved the HRQOL of survivors and directly affected the promotion of the PCS of survivors. Aside from the educational rescue policy, all other policies affected the MCS indirectly through the PCS. This finding indicates relatively large differences in the effects of different post-earthquake rescue policies on the HRQOL of survivors.

Secondary stressors and extreme events and disasters: a systematic review of primary research from 2010-2011

Introduction Extreme events and disasters, such as earthquakes and floods, cause distress and are associated with some people developing mental disorders. Primary stressors inherent in many disasters can include injuries sustained or watching someone die. The literature recognises the distress which primary stressors cause and their association with mental disorders. Secondary stressors such as a lack of financial assistance, the gruelling process of submitting an insurance claim, parents’ worries about their children, and continued lack of infrastructure can manifest their effects shortly after a disaster and persist for extended periods of time. Secondary stressors, and their roles in affecting people’s longer-term mental health, should not be overlooked. We draw attention in this review to the nature of secondary stressors that are commonly identified in the literature, assess how they are measured, and develop a typology of these stressors that often affect people after extreme events. Methods We searched for relevant papers from 2010 and 2011 using MEDLINE®, Embase and PsycINFO®. We selected primary research papers that evaluated the associations between secondary stressors and distress or mental disorders following extreme events, and were published in English. We extracted information on which secondary stressors were assessed, and used thematic analysis to group the secondary stressors into a typology. Results Thirty-two relevant articles published in 2010 and 2011 were identified. Many secondary stressors were poorly defined and difficult to differentiate from primary stressors or other life events. We identified 11 categories of secondary stressors, though some extend over more than one category. The categories include: economic stressors such as problems with compensation, recovery of and rebuilding homes; loss of physical possessions and resources; health-related stressors; stress relating to education and schooling; stress arising from media reporting; family and social stressors; stress arising from loss of leisure and recreation; and stress related to changes in people’s views of the world or themselves. Limitations in this review include its focus on studies published in 2010 and 2011, which may have led to some secondary stressors being excluded. Assumptions have been made about whether certain items are secondary stressors, if unclear definitions made it difficult to differentiate them from primary stressors. Conclusions This is the first review, to our knowledge, that has developed a typology of secondary stressors that occur following extreme events. We discuss the differing natures of these stressors and the criteria that should be used to differentiate primary and secondary stressors. Some secondary stressors, for example, are entities in themselves, while others are persisting primary stressors that exert their effects through failure of societal responses to disasters to mitigate their immediate impacts. Future research should aim to define secondary stressors and investigate the interactions between stressors. This is essential if we are to identify which secondary stressors are amenable to interventions which might reduce their impacts on the psychosocial resilience and mental health of people who are affected by disasters. Corresponding Author: Dr Sarah Lock, Extreme Events and Health Protection, London, 151 Buckingham Palace Road, London, SW1W 9SZ. E-mail: sarah.lock@hpa.org.uk

Emergency medical rescue efforts after a major earthquake: lessons from the 2008 Wenchuan earthquake

Major earthquakes often result in incalculable environmental damage, loss of life, and threats to health. Tremendous progress has been made in response to many medical challenges resulting from earthquakes. However, emergency medical rescue is complicated, and great emphasis should be placed on its organisation to achieve the best results. The 2008 Wenchuan earthquake was one of the most devastating disasters in the past 10 years and caused more than 370,000 casualties. The lessons learnt from the medical disaster relief effort and the subsequent knowledge gained about the regulation and capabilities of medical and military back-up teams should be widely disseminated. In this Review we summarise and analyse the emergency medical rescue efforts after the Wenchuan earthquake. Establishment of a national disaster medical response system, an active and effective commanding system, successful coordination between rescue forces and government agencies, effective treatment, a moderate, timely and correct public health response, and long-term psychological support are all crucial to reduce mortality and morbidity and promote overall effectiveness of rescue efforts after a major earthquake.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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