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

PTSD risk factors in earthquake survivors and their families: a systematic review

Background: Exposure to earthquakes can cause adverse effects on the mental health of survivors, including an increased risk of PTSD.Objective: This systematic review aims to analyse the previous secondary studies to identify the risk factors for PTSD from children to elderly earthquake survivors. In addition, it aims to consider the complexity of the joint effects of the individual, relational, and contextual risk factors, to also detect the most at-risk families.Method: After reviewing and screening studies from the literature search through PubMed, Web of Science, Scopus, and EBSCO under the guidance of PRISMA guidelines, ten eligible secondary studies were identified that examine the risk factors for PTSD in individuals (from children to elderly) affected by worldwide earthquakes.Results: The analysis of the included studies allowed the identification of a series of socio-demographic, pre-traumatic, peri-traumatic, and post-traumatic PTSD risk factors in children, adolescents, youth, adults, and elderly survivors. The results represent the complexity of the joint effects of these risk factors at individual, relational, and contextual levels.Conclusions: The consideration of the PTSD risk factors highlights the importance of individual characteristics and the type of experiences and exposure in the period before, during, and after the earthquake. This knowledge could allow the early identification of at-risk individuals of different ages and families and the implementation of intervention programmes.

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.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Post-traumatic positive and negative psychological changes experienced by child and adolescent earthquake survivors in remote rural western China: a cross-sectional study six years after the Yushu earthquake

Background: Yushu, Qinghai province is located in remote Tibetan plateau in Western China, struck by a disastrous earthquake in 2010. The study aimed to find out the positive and negative psychological changes and related risk factors of children and adolescents who had experienced Yushu earthquake, 6 years after it occurred. Methods: A cross-sectional research was adopted in the capital of Yushu Autonomous Prefecture in August 2016. The short form of the Changes in Outlook Questionnaire (CiOQ-S) was used, which is a 10-item self-report instrument consists of two subscales. A total of 591 valid questionnaires completed by local junior students were finally included in our study. Results: The mean scores of the positive and negative psychological changes were 19.28 and 13.08, respectively. The factors associated with positive psychological changes included high level of education, male gender, and uninjured in the earthquake. The factors associated with negative psychological changes included living in a pasture instead of downtown, injured during the earthquake, and not receiving psychological counselling. Conclusions: The current analysis tries to investigate the long-term psychological effects of earthquakes among children and adolescents, which aims to improve the psychological health status for child and adolescent survivors of similar events.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of psycho-social support by teachers on improving mental health and hope of adolescents in an earthquake-affected district in Nepal: A cluster randomized controlled trial

INTRODUCTION

Adolescents can be prone to mental health problems such as post-traumatic stress disorder (PTSD) and depression following disasters. School teachers can provide timely psycho-social support that could instill hope and improve mental health among adolescents in a post-earthquake situation in a low-resource setting. This study examined the effect of training for school teachers on psycho-social support on adolescents' mental health and hope in an earthquake affected district in Nepal.

METHODS

This cluster randomized controlled trial was conducted in 15 schools in Dhading, a severely affected district by the 2015 earthquake in Nepal. The schools were randomized, as a result, 8 were in the intervention group and 7 in the control group. A total of 1,220 adolescents were recruited at baseline of which 605 adolescents belonged to intervention group and 615 to control group. The follow-up rate at 6 months was 83%. This trial was registered with Clinicaltrials.gov with registration number NCT03387007.

RESULTS

The intervention did not show significant effects for PTSD symptoms (Intervention*time, β = 0.33, p = 0.536), depression symptoms (Intervention*time, β = 0.30, p = 0.249), and hope (Intervention*time, β = -0.23, p = 0.588), among the adolescents at 6 months follow-up.

CONCLUSION

The intervention did not improve mental health symptoms and hope among adolescents at 6 months follow-up. More focused and longer training could be necessary to address mental health among adolescents affected by earthquake. Additionally, longer follow-up could be necessary to assess the changes taking place over time.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03387007.

The relationship between PTSD and suicidality among Wenchuan earthquake survivors: The role of PTG and social support

BACKGROUND

Previous studies have found that suicide rates are likely to increase after the occurrence of earthquakes. Most existing studies that examined the relationship between PTSD and suicidality focus on risk factors. It remains unclear whether protective factors, such as post-traumatic growth (PTG) and social support, play a role in this relationship.

OBJECTIVES

The aim of this study was to investigate the role of PTG and social support in the association between PTSD and suicidality, using data from a cross-sectional study conducted in China.

METHODS

1,369 participants were recruited from two study sites that were severely affected by the Wenchuan earthquake. Univariate and multivariate regression analyses were conducted to examine the relationship between PTSD, PTG, social support, and suicidality.

RESULTS

The results indicate that the prevalence of suicidal ideation, suicide plans, and suicide attempts among adult survivors were 9.06%, 2.97% and 3.31%, respectively, even after 8 years following the Wenchuan earthquake. Furthermore, the findings show that PTSD was significantly associated with suicidality (OR = 1.96; 95% CI = 1.53, 2.52). Additionally, individuals reporting lower levels of social support and the acquisition of PTSD (OR = 5.99; 95% CI = 1.66, 21.56) were significantly related to suicidality. Moreover, compared to individuals who reported no presence of PTSD and high PTG, those who lived with PTSD and lower levels of PTG (OR = 2.33; 95%CI = 1.00, 5.42) were more likely to report suicidality.

LIMITATIONS

The cross-sectional design of this study limits our ability to determine causal relationships. Effects of other related factors, such as cultural and life events, were not examined in this study.

CONCLUSIONS

Suicidality is a long-term health issue among survivors of the Wenchuan earthquake. PTG and social support play important roles on the association between PTSD and suicidality and are important contributing factors to understanding this relationship. These results contribute new knowledge of suicidal risk for a number of years after an earthquake and have implications for further mental health promotion following earthquakes.

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

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

Post-Traumatic Stress Disorder and other mental disorders in the general population after Lorca's earthquakes, 2011 (Murcia, Spain): A cross-sectional study

AIMS

To describe the prevalence and severity of mental disorders and to examine differences in risk among those with and without a lifetime history prior to a moderate magnitude earthquake that took place in Lorca (Murcia, Spain) at roughly the mid-point (on May 11, 2011) of the time interval in which a regional epidemiological survey was already being carried out (June 2010 -May 2012).

METHODS

The PEGASUS-Murcia project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia. Main outcome measures are prevalence and severity of anxiety, mood, impulse and substance disorders in the 12 months previous to the survey, assessed using the Composite International Diagnostic Interview (CIDI 3.0). Sociodemographic variables, prior history of any mental disorder and earthquake-related stressors were entered as independent variables in a logistic regression analysis.

FINDINGS

A total number of 412 participants (response rate: 71%) were interviewed. Significant differences in 12-month prevalence of mental disorders were found in Lorca compared to the rest of Murcia for any (12.8% vs 16.8%), PTSD (3.6% vs 0.5%) and other anxiety disorders (5.3% vs 9.2%) (p≤ 0.05 for all). No differences were found for 12-month prevalence of any mood or any substance disorder. The two major predictors for developing a 12-month post-earthquake mental disorder were a prior mental disorder and the level of exposure. Other risk factors included female sex and low-average income.

CONCLUSIONS

PTSD and other mental disorders are commonly associated with earthquake disasters. Prior mental disorders and the level of exposure to the earthquakes are the most important for the development of a consequent mental disorder and this recognition may help to identify those individuals that may most benefit from specific therapeutic intervention.

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.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

Diagnostic interview study of the prevalence of depression among public employees engaged in long-term relief work in Fukushima

AIM

The Great East Japan Earthquake and in particular, the Fukushima Daiichi Nuclear Power Plant accident, have had a serious psychological impact on not only residents, but also relief workers in Fukushima. Although public employees work in highly stressful situations and play a very important role in long-term relief, their psychiatric features have yet to be clarified. The two aims of this study were to identify the current prevalence rate of depression and post-traumatic stress disorder among public employees working in the disaster area using diagnostic interviews, and to speculate on the psychosocial factors affecting their mental condition.

METHODS

We conducted diagnostic interviews and self-administered questionnaires with 168 public employees working in two coastal towns in Fukushima.

RESULTS

Results showed that the current prevalence of depression among public employees is as high as 17.9%, in contrast to the relatively low prevalence of post-traumatic stress disorder (4.8%). Based on the results of self-administered questionnaires and interview contents, frequent exposure to strong complaints or anger from residents and role conflicts were considered the cause of the high prevalence of depression.

CONCLUSION

The present study reveals the serious mental status of public employees working in Fukushima and sheds light on the urgent need to establish an efficient care network to provide adequate psychiatric intervention.