Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake

Persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms: a one-year follow-up study

BACKGROUND

Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms.

OBJECTIVE

This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms.

METHODS

We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31).

RESULTS

More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r = .286 to .528, p < .001) and longitudinally (r = .181 to .462, p < .001) correlated with depressive symptoms. A sense of current threat (β = .146, p < .05) and negative self-concept (β = .173, p < .05) at baseline significantly predicted depressive symptoms after one year.

CONCLUSIONS

These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice.

The longitudinal associations between PTSD symptoms, depressive symptoms, and academic burnout in adolescence and early adulthood in the postdisaster context

The current study examined the longitudinal associations among posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and academic burnout in a sample of survivors aged 12 to 20 years following the Wenchuan earthquake. The present study had a longitudinal design. A total of 788 participants (Mage = 15.03 years, SD = 1.64; 54.8 % female) completed measures of PTSD symptoms, depressive symptoms, and academic burnout at 12, 18, and 24 months after the 2008 Wenchuan earthquake in China. The results showed that the only cross-lagged effects from PTSD to depressive symptoms, from academic burnout to depressive symptoms or from PTSD symptoms to academic burnout at the first interval and the second interval were significant. Furthermore, the longitudinal associations among PTSD symptoms, depressive symptoms, and academic burnout remained consistent between the different age groups but varied across genders. That is, in male adolescents, only the cross-lagged effects from PTSD symptoms to depressive symptoms and from PTSD symptoms to academic burnout at the first and second intervals were significant. In female adolescents, only the cross-lagged effects from academic burnout to depressive symptoms and from academic burnout to PTSD symptoms at the first and second intervals were significant. Finally, these findings highlight that academic burnout is a useful target for psychological service providers to alleviate PTSD and depressive symptoms in adolescents in a post-disaster context. In addition, PTSD symptoms may also negatively affect adolescents' performance at school.

Longitudinal associations between pandemic post-traumatic stress symptoms and subsequent non-suicidal self-injury in adolescents: A multiple mediation model

BACKGROUNDS

PTSD is one of the most common conditions after people have experienced trauma. While previous studies have found a link between PTSD and non-suicidal self-injury, (NSSI), few studies have longitudinally explored this relationship and the underlying mechanisms.

AIMS

This study explored adolescent NSSI frequency after COVID-19 lockdown experiences, the relationship with early PTSD symptoms, and the mediating role of depression and sleep problems.

METHODS

A cohort of 1609 adolescents completed two surveys during and after the national lockdown in China; one month into the lockdown and six months later; which assessed demographic and pandemic-related exposure variables; PTSD, depression, sleep, and NSSI. Mediation analyses and hierarchical regression were employed to examine the relationships and the paths between these variables.

RESULTS

The NSSI rate was found to be 31.9 % after the three-month lockdown, with 20.6 % of adolescent participants reporting sleeping disorders, and 33.9 % indicating probable depression. Adolescents who had earlier PTSD symptoms, often smoked and/or drank, and had current depression and sleep disorders reported greater NSSI. Early PTSD symptoms were found to predict later NSSI and were mediated by sleep problems and depressive symptoms. Specifically, PTSD avoidance and numbing symptoms were significantly associated with NSSI above and beyond the depressive symptoms, sleeping problems, and the other covariables.

CONCLUSION

It is necessary to be vigilant about the increased risk of NSSI in adolescents who have experienced extended pandemic lockdowns. Preventing early adolescent PTSD symptoms, especially avoidance and numbness, and helping teenagers quit smoking and drinking could reduce the risk of sleep disorders, depression, and NSSI.

How symptoms of prolonged grief disorder, posttraumatic stress disorder, and depression relate to each other for grieving ICU families during the first two years of bereavement

Background

Bereaved ICU family surrogates are at risk of comorbid prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Knowledge about temporal relationships between PGD, PTSD, and depression is limited by a lack of relevant studies and diverse or inappropriate assessment time frames given the duration criterion for PGD. We aimed to determine the temporal reciprocal relationships between PGD, PTSD, and depressive symptoms among ICU decedents’ family surrogates during their first 2 bereavement years with an assessment time frame reflecting the PGD duration criterion.

Methods

This prospective, longitudinal, observational study examined PGD, PTSD, and depressive symptoms among 303 family surrogates of ICU decedents from two academic hospitals using 11 items of the Prolonged Grief Disorder-13, the Impact of Event Scale—Revised, and the depression subscale of the Hospital Anxiety and Depression Scale, respectively, at 6, 13, 18, and 24 months post-loss. Cross-lagged panel modeling was conducted: autoregressive coefficients indicate variable stability, and cross-lagged coefficients indicate the strength of reciprocal relationships among variables between time points.

Results

Symptoms (autoregressive coefficients) of PGD (0.570–0.673), PTSD (0.375–0.687), and depression (0.591–0.655) were stable over time. Cross-lagged standardized coefficients showed that depressive symptoms measured at 6 months post-loss predicted subsequent symptoms of PGD (0.146) and PTSD (0.208) at 13 months post-loss. PGD symptoms did not predict depressive symptoms. PTSD symptoms predicted subsequent depressive symptoms in the second bereavement year (0.175–0.278). PGD symptoms consistently predicted subsequent PTSD symptoms in the first 2 bereavement years (0.180–0.263), whereas PTSD symptoms predicted subsequent PGD symptoms in the second bereavement year only (0.190–0.214). PGD and PTSD symptoms are bidirectionally related in the second bereavement year.

Conclusions

PGD, PTSD, and depressive symptoms can persist for 2 bereavement years. Higher PGD symptoms at 6 months post-loss contributed to the exacerbation of PTSD symptoms over time, whereas long-lasting PTSD symptoms were associated with prolonged depression and PGD symptoms beyond the first bereavement year. Identification and alleviation of depression and PGD symptoms as early as 6 months post-loss enables bereaved surrogates to grieve effectively and avoid the evolution of those symptoms into long-lasting PGD, PTSD, and depression.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-022-04216-5.

Adolescent Loneliness during the COVID-19 Pandemic: The Role of Pre-Pandemic Risk Factors

The COVID-19 pandemic is a global mental health crisis that disproportionately impacts adolescents. Loneliness is a particularly salient pandemic psychosocial outcome to understand; however, research to date on this outcome is sparse and largely cross-sectional. In response, we examined pre-pandemic risk factors for pandemic loneliness. Further, we examined how risk may differ based on key demographics, and whether mediation or moderation models best explained potential disparities in experiencing loneliness. Self-reported, pre-pandemic mental health, trauma exposure, and family conflict survey data were collected at Wave 1 in a diverse sample of 369 adolescents (54.5% female, 45.5% male; 30.1% White; 30.9% Black; 18.4% Hispanic; M_age = 15.04; SD _age  = 1.10). Subsequently, self-reported experiences of loneliness during the pandemic were collected 6 months (April-June 2020) and 12 months (October-December 2020) later. Using a regression-based framework (i.e., PROCESS), we tested (a) which pre-pandemic risks uniquely predicted prospective loneliness and (b) whether loneliness risk was elevated for certain identities (i.e., mediation models) or whether certain identities were more sensitive to specific risks (i.e., moderation models). Overall, pre-pandemic depressive and aggression symptoms predicted early pandemic loneliness (6-month follow-up), whereas anxiety symptoms specifically predicted mid-pandemic loneliness (12-month follow-up). Environmental stressors were moderated by gender, such that females with pre-pandemic trauma exposure were more likely to report pandemic loneliness. Further, pre-pandemic internalizing distress for girls and externalizing symptoms for boys, reflected gender-specific pathways for loneliness. Implications for mental health prevention in the wake of national disasters are discussed.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12187-022-09984-8.

Development and validation of the parents' cognitive perception inventory of disaster effects on children's well-being (PCP-DCWB)

BACKGROUND

Parents' cognition about the type and nature of consequences a disaster may pose on the children's psychosocial health, could be a major protective factor against the long-term overwhelming complications. Given the lack of a reliable instrument to measure parents' cognition about disasters' effects on children's well-being, this study was conducted to develop and validate the parents' cognitive perception inventory of disaster effects on children's well-being (PCP-DCWB).

METHODS

In this cross-sectional study 300 parents of the survived primary school aged children from the Iran's northwest earthquake on August 2012 were recruited in the city of Varzegan. Exploratory factor analysis (EFA) was applied to identify the subcomponents and Cronbach's alpha and Guttmann Split-half coefficients were calculated to assess the internal consistency reliability of the scale.

RESULTS

Structural indicators of the Kaiser-Meyer-Olkin measure (0.69) and Bartlett's test of Sphericity (P < 0.001, df = 153, X² = 618.35) verified interpretability of the EFA output. Applying principal component analysis and direct oblimin rotation in the EFA four latent factors were identified (i.e., perception about child overall mental health, coping with trauma's long-term effects, children or parents' continuing memory of past disaster and perception about behavioral and educational problems) which explained 49.32% of the total variance. The estimated Cronbach's alpha and split-half reliability coefficients (0.71 and 0.52 respectively) supported good internal consistency of the instrument.

CONCLUSION

The study findings revealed sound psychometric attributes of the PCP-DCWB to be applied in assessment of parents' cognition about psychological impacts of a traumatic event on the survived children. The instrument application can shed light on level of pre-disaster preparations in local, national and international scales and help effectiveness assessment of interventions that target maintenance of psycho-social well-being among disaster-affected survivors over time.

PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak

Background:

Increasing evidence highlights the susceptibility of Healthcare Workers to develop psychopathological sequelae, including Post-Traumatic Stress Disorder (PTSD) and depression, in the current COronaVIrus Disease-19 (COVID-19) pandemic, but little data have been reported in the acute phase of the pandemic.

Objective:

To explore Healthcare Workers’ mental health reactions in the acute phase of the COVID-19 pandemic in the first European epicenter (Lodi/Codogno, Italy), with particular attention to post-traumatic stress and depressive symptoms and their interplay with other psychological outcomes.

Methods:

74 Healthcare Workers employed at the Azienda Socio Sanitaria Territoriale of Lodi (Lombardy, Italy) were recruited and assessed by means of the Impact of Event Scale- Revised, the Professional Quality of Life Scale-5, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 item, the Resilience Scale and the Work and Social Adjustment Scale. Socio-demographic and clinical variables were compared across three subgroups of the sample (No PTSD, PTSD only, PTSD and depression).

Results:

A total of 31% of subjects endorsed a diagnosis of PTSD and 28.4% reported PTSD comorbid with major depression. Females were more prone to develop post-traumatic stress and depressive symptoms. Subjects with PTSD and depression groups showed high levels of PTSD, depression, burnout and impairment in functioning. Anxiety symptoms were higher in both PTSD and depression and PTSD groups rather than in the No PTSD group.

Conclusion:

Our results showed high rates of PTSD and depression among Healthcare Workers and their comorbidity overall being associated with worse outcomes. Current findings suggest that interventions to prevent and treat psychological implications among Healthcare Workers facing infectious outbreaks are needed.

Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study

Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels.

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.

Consistencies and differences in posttraumatic stress disorder and depression trajectories from the Wenchuan earthquake among children over a 4-year period

BACKGROUND

Posttraumatic stress disorder (PTSD) and depression are the most prevalent mental disorders following disasters, and they often co-occur. The current study investigated trajectories of PTSD and depression among children after exposure to the Wenchuan earthquake and identified factors associated with PTSD or depression trajectories.

METHODS

Three hundred children who were exposed to the Wenchuan earthquake reported PTSD and depression symptoms 4, 16, 29, 40 and 52 months after the disaster, and potential predictors (age, earthquake exposure, prequake trauma and parental relationship) were identified. The PTSD and depression trajectories were identified with latent growth mixture modeling (LGMM), and the predictors were explored with multinomial logistic regression.

RESULTS

Two depression trajectories emerged: resilient (66.2%) and chronic (33.8%). Three PTSD trajectories emerged: resilient (74.9%), recovery (7.5%) and relapsing (17.7%). Overall, 57.3% of the children had low depression and PTSD symptoms over four years. Depression trajectories were significantly predicted by age and parental relationship, while PTSD trajectories were significantly predicted by trauma exposure and prequake trauma experience.

LIMITATIONS

The children's prequake mental health statuses were unknown, and all assessments relied on self-report questionnaires.

CONCLUSION

The postdisaster developmental course of depression was more stable than that of PTSD, and PTSD and depression had different risk factors. Previous studies that focus only on PTSD or depression trajectories may overestimate children's resilient responses. Longer-term postdisaster intervention should pay more attention to depression than to PTSD.

The relationship between PTSD and depressive symptoms among children after a natural disaster: A 2-year longitudinal study

This study examined the relationship between posttraumatic stress disorder (PTSD) and depressive symptoms among children who survived the Lushan earthquake. Three hundred thirty-three children (154 males, 179 females) were assessed for acute stress disorder (ASD) and depressive symptoms at 2 weeks (T1), and their PTSD and depressive symptoms were recorded at 1.5 (T2), 6 (T3), 12 (T4) and 24 (T5) months after the earthquake. The results showed that ASD predicted PTSD and depressive symptoms from T1 to T2, and PTSD symptoms predicted depressive symptoms from T2 to T5, but not vice versa. Depressive symptoms predicted avoidance from T1 to T5; in turn, avoidance predicted depressive symptoms from T3 to T5. Hyperarousal and intrusive symptoms had an effect on depressive symptoms between T1 and T2, and depressive symptoms predicted hyperarousal and intrusion from T2 to T3; after 12 months they did not significantly predict each other. The results suggest that PTSD symptoms generally precede depressive symptoms, and that hyperarousal and intrusive symptoms are major symptoms of PTSD soon after trauma events, while avoidance symptoms are major symptoms of PTSD late after trauma events. The relationship between PTSD and depressive symptoms mostly fits the interactive model.

Children facing natural, economic and public health crisis in Europe: The risks of a predictable unpredictability

This opening article for the volume dedicated to the diversity of paediatric healthcare systems in Europe, discusses the topic of children facing natural, economic, and public health crises in Europe. The natural and economic adversities and public health crises, which have repeatedly stormed the globe during the past twenty years, have often unveiled a low degree of self-sufficiency and a high degree of unpreparedness by European countries. It is always the case that the most vulnerable take the brunt, and these adverse events have shown their effects and a negative direct impact particularly on the population aged 0–18 years, with important implications for families and communities. The article discusses a rational approach to properly confront future public health emergencies and crises in general. The authors stress the concept that such approaches should be built on past negative experiences, in order to explore, identify, and make clear which are the priorities governing the disaster management activities at all levels in this population group. The authors conclude that safeguarding the health of children could be effectively accomplished by developing adequate, shared emergency management strategies. Improving pediatric preparedness approaches with the use of emergency measures and ongoing collaboration will facilitate a better and more efficient response, able to effectively care for the needs of children in actual crises.

Depicting the associations between different forms of psychopathology in trauma-exposed adolescents

Psychiatric comorbidity in traumatized youth is prevalent, but such associations between two disorders may be confounded with other comorbid conditions. Few studies have examined the unique relationships among multiple disorders. Which disorders maximally explain the relationships between others and whether such disorders differ by sex remain largely unknown. Using a construct-level network approach, this study characterized the independent associations among nine prevalent emotional and behavioral disorders/problems evaluated by the PTSD Checklist for DSM-5, the Revised Children's Anxiety and Depression Scale, and the Youth Self-Report in a sample of 1181 disaster-exposed adolescents (53.9% girls; a mean age of 14.3 ± 0.8 years). The associations were strong among the seven internalizing problems and between the two externalizing ones, but weaker between these two spectra of psychopathology. Major depressive disorder (MDD) was most strongly connected with others, maximally accounting for the associations, especially those between the two spectra. Overall and individual association strength and the connecting role of MDD were generally equivalent across sex. These findings highlight the necessity of MDD in linking comorbid forms of psychopathology in traumatized youth, and suggest MDD as a potential intervention priority in this population.

Patterns of posttraumatic stress disorder and posttraumatic growth among women after an earthquake: A latent profile analysis

It is well known that women are more vulnerable than men to mental health problems following disasters. However, the patterns of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) among women are unclear. This study was conducted to investigate the profiles of PTSD and PTG among women after an earthquake and determine the predictors of profile membership. A total of 1487 women (M_age = 40.66 years, SD = 10.39) completed questionnaires assessing PTSD, PTG, trauma exposure during an earthquake, trauma history, and demographic information. A three-step latent profile analysis was used. Five profiles were identified: mild PTSD/mild PTG (12.4% of the sample), moderate PTSD/moderate PTG (39.4%), high PTSD/moderate PTG (9.6%), mild PTSD/high PTG (17.5%) and high PTSD/high PTG (21.1%). Women who were older, had been injured, or felt horrible and those whose houses were severely damaged in the earthquake were more likely to be in profiles characterized by higher levels of PTSD and PTG, whereas women with lower education levels were more likely to be in profiles characterized by higher levels of PTSD but lower levels of PTG. The results of this study provide a foundation for providing psychological assistance for particular groups of women.

Posttraumatic Stress and Depression in the Aftermath of Environmental Disasters: A Review of Quantitative Studies Published in 2018

PURPOSE OF REVIEW

As interest in the mental health consequences of environmental disasters increases, this review aimed to summarize peer-reviewed studies published in 2018 on posttraumatic stress disorder (PTSD) and depression symptoms after such events.

RECENT FINDINGS

Notable trends in the past year of research included studies focusing on vulnerable populations (e.g., persons with preexisting physical health conditions), assessing the cumulative impact of exposure to multiple disasters, exploring pathway leading to PTSD and depression symptoms, and evaluating the effectiveness of post-disaster interventions. Over 100 articles were identified, focused on 40 disasters that occurred between 1982 and 2017. Prevalence estimates ranged from 0 to 70.51% for PTSD and 1.9 to 59.5% for depression. Consistent predictors of adverse outcomes included female gender, socioeconomic disadvantage, high disaster exposure, and low psychosocial resources. Further research that expands upon recent advances in the literature is critical given the large proportion of the world's population exposed to disasters and the increasing incidence of such events.

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.

Epidemiological Characteristics and Risk Factors of Posttraumatic Stress Disorder in Chinese Children After Exposure to an Injury

OBJECTIVE

The aim of this study is to describe the risk factors of injured children's posttraumatic stress disorder (PTSD) in China and provide the scientific data for PTSD prevention and control in children.

METHODS

Electronic databases, including Medline, Science Direct, Google Scholar, and CNKI (China National Knowledge Infrastructure), were searched for articles published on or before October 30, 2018, searching for the words, "PTSD," "child"/"children," "injury"/"injuries," and "China"/"Chinese." Forty-seven articles met the inclusion criteria and were meta-analyzed using random-effect models.

RESULTS

The total sample size in our meta-analysis was 65 298, and there were 13 402 children diagnosed with PTSD. The prevalence of PTSD after suffering from injury was 20.52% (95% CI = 17%-23%). PTSD occurrence was higher in girls than boys (24.61% vs 19.36%, P < 0.001). The PTSD rate for students was 51.82%, 37.12%, and 14.02% in senior, junior high school children, and primary school student, respectively. PTSD prevalence was 58.93% in rural children and higher than the urban children (57.36%). The prevalence of PTSD in ethnic minority children was significantly higher than that of Han Chinese children (35.38% vs 13.50%).

CONCLUSION

PTSD in injured children is significantly higher in girls, senior high school children, in rural areas, and in ethnic minority children. PTSD prevention and control should be focused on these 4 subgroups.

Traumatic experiences and posttraumatic stress disorder among Chinese rural-to-urban migrant children

BACKGROUND

Children and adolescents are in the developmental periods with the highest risk of experiencing multiple types of traumatic experiences (TEs). Immigrant children are more likely than other children to be exposed to TEs and have a higher risk of mental health problems. However, no epidemiological study has reported the prevalence of TEs and the associated development of posttraumatic stress disorder (PTSD) among Chinese children.

METHODS

The present study focused on trauma exposure among rural-to-urban migrant Chinese children. A large-scale (N = 16,140) cross-sectional survey of rural-to-urban migrant workers' children in grades 4 to 9 was conducted in Beijing. Lifetime exposure to accidents and injuries, interpersonal violence, and trauma within the social network or witnessing traumatic events were measured along with PTSD.

RESULTS

Nearly half of the participants (47.06%) had experienced TEs, and 6.68% of those children met the cutoff for PTSD. Trauma exposure was associated with gender, age, quality of life, parents' marital status, caregivers before the child started school and father's education level. Overall, interpersonal violence was associated with the highest rates of PTSD, and disasters were associated with the lowest rates of PTSD.

LIMITATIONS

The cross-sectional survey design limited the ability to document temporal ordering, and the assessment of lifetime TEs was based on retrospective recall.

CONCLUSIONS

The present study is the first epidemiological study of TEs in Chinese rural-to-urban migrant children. TEs are potentially fairly common among this population. Interventions designed to prevent PTSD should target different TE types according to the victim's gender.

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.

Trajectories of posttraumatic stress disorders among children after the Wenchuan earthquake: a four-year longitudinal study

Background: Previous research has demonstrated heterogeneous patterns of posttraumatic stress disorder (PTSD) among children following disasters. However, no clear consensus has been reached regarding the postdisaster trajectories of PTSD among children. Objective: The current study examined the trajectories of PTSD among children after exposure to the Wenchuan earthquake and explored potential predictors of distinct PTSD trajectories. Methods: A four-year longitudinal study was conducted to follow 301 children who were evaluated for PTSD symptoms following the Wenchuan earthquake. Trauma exposure and some pre-existing characteristics were measured at four months after the disaster, and PTSD symptoms were measured at 4, 16, 29, 40 and 52 months after the disaster. The trajectories were identified with Latent Growth Mixture Modelling, and the predictors were explored with multinomial logistic regression. Results: The following three latent PTSD trajectories were found among children: resilient (74.9%), relapsing (17.7%) and recovery (7.5%). Trauma exposure was more likely to be related to a more severe trajectory of PTSD, having experienced prequake trauma was more likely to be related to the recovery trajectory and school 2 was more likely to be related to the relapsing trajectory. Conclusion: These findings provide novel insights into children's postdisaster response patterns. Individual heterogeneity existed in posttraumatic reactions. This longer-term longitudinal study captured more detailed and accurate information about the development of these trajectories. Trauma exposure and previous traumatic experience were linked to malignant development of PTSD.

Children and natural disasters

The number of children affected by natural disasters each year is alarmingly high and can be expected to rise as climate change continues. The mental consequences have been documented not only in the rates of post-traumatic stress symptoms and post-traumatic stress disorder, but also for depression and other mental health problems. To contribute towards the knowledge in this area, this special issue of the European Journal of Psychotraumatology focuses on how children can be prepared for natural disasters and the mental health aspects of such events. It includes articles on communicating risks to children, involving children in disaster risk reduction, and the mental health consequences for children from an earthquake, a volcanic eruption, a flood and a hurricane. In this special issue specifically focusing on children and natural disasters, we hope to enhance our understanding of some of the complex pathways and pave the way for improving our interventions.