Systematic Review on Post-Traumatic Stress Disorder Among Survivors of the Wenchuan Earthquake

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.

Depression and life satisfaction after Kahramanmaraş earthquakes: The serial mediation roles of life meaning and coping with earthquake stress

This study aims to examine the meaning of life, and the mediating effect of strategies for coping with earthquake stress in the relationship between depression, and life satisfaction in survivors of the 2023 Kahramanmaraş centered earthquakes. The participants of this study were 472 adults (31.1% male, 68.9% female; Mage = 24.52) who were affected by earthquakes. The data of the study were tested with the bootstrapping-based PROCESS macro program (Model-81). The results showed that depression negatively predicted life satisfaction. Meaning of life mediated the relationship between depression and life satisfaction. However, problem solving and cognitive avoidance coping strategies reduced the effects of depression and the meaning of life on life satisfaction. These results can be a resource for mental health services for earthquake victims. At the same time, the study provides evidence that protecting personal resources in disaster situations positively affects life satisfaction in terms of conservation of resources theory (COR).

The association between posttraumatic stress disorder and mental health of adolescents who exposed to the worst disaster of the century: Extensive data from southeast Turkey

PROBLEMS

This study was conducted to examine the association between posttraumatic stress disorder and mental health status of adolescents exposed to the worst disaster of the century.

METHODS

This study was descriptive, cross-sectional, and correlational. This research was conducted between March 31 and July 1, 2023. The study was conducted with earthquake survivors who migrated from Kahramanmaraş, the epicenter of the earthquake, and Adıyaman and Hatay, the other two cities where it was most effective, to Şanlıurfa. The study was conducted with a total of 947 adolescents. "Personal Information Form," "Child Posttraumatic Stress Reaction Index," and "Symptom Distress Check List- (SCL-90)" were used to collect data. Linear regression method was used in the analysis of the research. Path analysis was performed using PATH analysis.

FINDINGS

The mean age of the adolescents participating in the study was 16.69 ± 1.41 years. It was found that the Global Severity Index (GSI) of the adolescents was at the pathological level with a mean of 2.36 ± 0.68. Posttraumatic stress reactions of the adolescents who experienced the earthquake was found to explain 97.2% of their mental symptoms (anxiety, depression, somatization, anger-hostility, obsession-compulsion, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotic symptoms, other problems, and GSI) (p < 0.001). It was found that the age of the adolescents, total number of losses in the earthquake, the time they stayed under the rubble, the time they waited for siblings to be pulled from under the rubble and the state of having loss due to the earthquake explained 74.4% of the posttraumatic stress reactions (p < 0.001).

CONCLUSIONS

As a conclusion, it was found that the adolescents who experienced the earthquake experienced severe posttraumatic stress symptoms. It was also found that adolescents who experienced high levels of trauma symptoms showed pathological mental symptoms. After the earthquake, adolescents should be evaluated periodically in terms of posttraumatic stress symptoms. In the evaluations to be made, it is important to determine how adolescents are affected especially mentally. In this context, interventions should be implemented for the identified mental symptoms (anxiety, depression, somatization, etc.).

The efficacy and acceptability of group trauma-focused cognitive behavior therapy for the treatment of post-traumatic stress disorder in children and adolescents: A systematic review and meta-analysis

BACKGROUND

Group trauma-focused cognitive behavior therapy (TF-CBT) is widely used to treat post-traumatic stress disorder (PTSD) in children and adolescents. However, the available evidence remains unclear.

METHOD

PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest Dissertations, LILACS, and international trial registers were searched from database inception to April 30, 2022. We included randomized controlled trials (RCTs) that compared TF-CBT with any control condition for treating children and adolescents with PTSD. Analyses were performed using Review Manager version 5.3 and Stata 16.0. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. This study was registered with PROSPERO (CRD42020206096).

RESULTS

Eleven RCTs involving 1942 patients were included. Group TF-CBT was significantly more effective than other treatments at post-treatment (standardized mean difference [SMD]: -0.43, 95% confidence interval [CI]: -0.65 to -0.22), follow-up (SMD: -0.33, 95% CI: -0.52 to -0.13), and in relieving depressive symptoms (SMD: -0.29, 95% CI: -0.49 to -0.09), but not in terms of acceptability. Subgroup analyses showed that group TF-CBT was superior to other treatments in studies including children with post-traumatic stress symptoms (PTSS) (SMD: -0.54, 95% CI: -0.79 to -0.28) and psychiatric comorbidities (SMD: -0.48, 95% CI: -0.72 to -0.23).

LIMITATIONS

The small sample sizes of identified studies limited some findings.

CONCLUSION

When considering effectiveness at post-treatment and follow-up or the reduction of depressive symptoms, group TF-CBT could be a good choice for children and adolescents with PTSD. Among these patients, those with PTSS or psychiatric comorbidities may benefit the most.

Preparing children to cope with earthquakes: Building emotional competence

Natural disasters, including earthquakes, can have a traumatic impact on children's psychological wellbeing and development. The efficacy of interventions aimed at enhancing children's socio-emotional learning has been documented in the literature. At the same time, these techniques are the key for training children for possible future disasters by enhancing their knowledge about behavioural preparedness and emotional competence. However, research on evidence-based training programs on earthquakes combining digital and traditional activities is scarce. We tested the efficacy of a 10-unit training program for primary school children, developed within the Emotional Prevention and Earthquakes in Primary School (PrEmT) project. The program aimed at increasing knowledge of and metacognition about earthquakes, safety behaviours, emotions, and coping strategies, through digital (using the web-application HEMOT® , Helmet for EMOTions, developed ad-hoc) and traditional activities (completing paper-and-pencil tasks). The participants were 548 second and fourth-graders from Italian schools. They were divided into an experimental group (participating in the training program) and a control group. Both groups participated in pretests and posttests to evaluate changes in their knowledge of training-related contents. For ethical reasons, we also measured children's wellbeing. Generalized linear mixed models indicated an improvement in the experimental group's knowledge and metacognition about earthquakes, safety behaviours, emotions, and coping strategies after the training program, compared to the control group. Children's general wellbeing did not deteriorate during participation in the project. The results documented the efficacy of the evidence-based training program developed within the PrEmT project. The program provides a preventive method for enhancing earthquake-related resilience that could be generalized to other kinds of disasters.

Prevalence and associated risk factors of post-traumatic stress disorder among survivors of the 2023 Turkey earthquake

BACKGROUND

Earthquakes can cause psychological trauma among survivors as well as physical trauma. This study aims to determine the prevalence of post-traumatic stress disorder (PTSD) and identify associated risk factors among earthquake survivors after the 2023 Turkey earthquake.

METHODS

This prospective cross-sectional study was conducted in the emergency department of a tertiary university hospital between May 6, 2023, and May 16, 2023. An online questionnaire was sent to the participants. The questionnaire form consisted of three parts. In the first part, the sociodemographic characteristics of the participants were included. In the second part, the participants were asked about their experiences with the earthquake. In the third part, the post-traumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, which screens PTSD among the participants, was included. Participants who did not complete all the questions and had severe communication disorders were excluded.

RESULTS

The prevalence of probable PTSD among the participants was 51.4% (n = 197). Age (OR: 0.96 95% CI: 0.93-99), female gender (OR: 4.54 95% CI: 2.39-8.61), being the head of the family (OR: 2.00 95% CI: 1.04-3.82), bereavement (OR: 1.71 95% CI: 1.03-2.82), lost loved ones (OR: 3.15 95% CI: 1.67-5.92), low social support (OR: 1.80 95% CI: 1.12-2.90) and receiving emergency care at the field (OR: 6.67 95% CI: 1.03-43.2) were the associated risk factors of PTSD among earthquake survivors.

CONCLUSIONS

The prevalence of PTSD among survivors three months after the 2023 Turkey earthquake is over half of the survivors. Younger age, female gender, being the head of the family, bereavement, lost loved ones, low social support, and receiving emergency care in the field were the associated risk factors of PTSD among earthquake survivors. Considering survivors may visit EDs until other outpatient clinics are re-established and the high rate of PTSD, rapid psychological evaluations can be performed in emergency departments. Emergency physicians should be aware of possible risk factors and high rate of PTSD.

Prospective network of post-traumatic stress disorder (PTSD) symptoms across adolescent survivors with distinct trajectories of PTSD: A cohort study of the Wenchuan earthquake

There are multiple trajectories of post-traumatic stress disorder (PTSD) symptoms following disasters. Unraveling the patterns of interactions between PTSD symptoms across distinct PTSD trajectories is crucial. This study was aimed at investigating the temporal sequences, changes, and predictive symptoms in PTSD networks over time across distinct PTSD trajectory groups. Data were exacted from the Wenchuan Earthquake Adolescent Health Cohort (WEAHC) study. The current study included 1022 adolescents (424 males) who participated in follow-up surveys at 12 months and 24 months post-earthquake. Self-reported PTSD symptoms were assessed with the Post-traumatic Stress Disorder Self-Rating Scale. The between-person network revealed significant differences across distinct trajectories. In the chronic dysfunction group, "Intrusive thoughts" had the strongest value in predicting on other PTSD symptoms. In contrast, "Difficulty in study or work" in the recovery group and "Physiological cue reactivity" in the resistance group were highly associated with the remission of other PTSD symptoms. These findings underscore the importance of "Difficulty in study or work" and "Physiological cue reactivity" for promoting the spontaneous remission of PTSD and further suggest that "Intrusive thoughts" maybe helpful to minimize the subsequent presence of other PTSD symptoms. Future research should investigate the causality and associations between within-person networks.

Coping Strategies and Psychological Maladjustment/Adjustment: A Meta-Analytic Approach with Children and Adolescents Exposed to Natural Disasters

Background

Following disasters, children and adolescents can use coping strategies to feel better. A growing body of studies investigated the relation between them and maladjustment/adjustment, i.e., negative symptomatology/positive indicators of development. Yet, these constructs are studied separately.

Objective

We conducted two meta-analyses to examine the mean correlation between disaster-related coping strategies and indicators of maladjustment/adjustment following natural disasters in children and adolescents, considering the role of some moderators.

Methods

We used PsycINFO, PubMed, Eric, and Scopus databases to identify articles on natural disasters (filters: participants ≤ 18 years at the disaster, peer-review, English language). Inclusion required investigating the relation between at least one coping strategy and at least one indicator of maladjustment (e.g., post-traumatic stress disorder, depression) and/or adjustment (e.g., self-efficacy, emotion understanding), for a total of 26 studies (k = 64, n = 9692, for maladjustment; k = 37, n = 3504, for adjustment).

Results

There were global positive significant correlations between coping strategies and negative symptomatology (r _pooled  = .23) for maladjustment, and positive indicators (r _pooled  = .17) for adjustment. Negative symptomatology positively correlated with escape (r = .19), social isolation (r = .15), submission (r = .64), and opposition (r = .16); positive indicators positively correlated with problem solving (r = .31), social support (r = .22), and submission (r = .30). We found a moderating role of age, disaster type, and continent for maladjustment.

Conclusions

The study presented an analysis of the coping strategies that can be effective for children and adolescents dealing with natural disasters.

Post-traumatic stress symptoms experienced by healthcare workers in Lebanon four months following Beirut’s ammonium nitrate explosion: a survey-based study

Background

On August 4, 2020, Lebanon faced one of the deadliest mass casualty explosions the world has witnessed during the twenty-first century. The human and emotional tolls were heavy on attending physicians, clinical fellows, residents, interns, medical students, and registered nurses, who were working in dramatic conditions, triaging, and treating thousands of blast-related casualties. We evaluated the risk of developing post-traumatic stress disorder symptoms (PTSS), among these healthcare workers (HCWs) from different Lebanese hospitals.

Methods

This is a multicentered, cross-sectional study that was conducted in December 2020, using an online questionnaire that evaluated the risk of developing PTSS based on the validated self-reported PTSD-Checklist for DSM-V (PCL-5). We also explored possible correlates with the participants’ socio-demographic characteristics, job profile, mental health, and blast-related events.

Results

Out of 519 participants, 44% were at high risk of developing PTSS following Beirut-blast. Nurses, attending physicians, fellows, and participants who are older in age, married, or working at specific hospitals, were at a higher risk. Those identified at higher risk of PTSS were surgeons, anesthesiologists, emergency medicine doctors, or radiologists; and they were more likely to be willing to migrate; having a prior history of psychiatric medication intake for PTSD treatment, a prior history of PTSD, or a personal history of seeking mental health service. At last, the latter two parameters as well as the number of examined injuries, severe home damage, and testing positive for the COVID-19 virus during the two weeks’ period that followed the blast were found to be predictors for the development of PTSS.

Conclusion

Lebanese in-hospital HCWs were found to be at a high risk of developing PTSS following the Beirut-Blast, thus we recommend public health authorities to provide adequate resources to avoid the emergence of mental illnesses among these rescuers.

Analysis of the intellectual and social structure of health system response plan to earthquake studies adopting word co-occurrence and narrative approaches

BACKGROUND AND AIM

Earthquake is a natural disaster severely affecting the societies' health, hygiene, and welfare as such the most effective method to respond to its damages is to develop a readiness plan. This study aimed to discover thematic patterns and co-author relationships extracted from relevant publications to plan an earthquake response.

MATERIALS AND METHODS

This descriptive-analytical study adopted the scientometric approach and used word co-occurrence and social network analysis. The published articles indexed in PubMed were retrieved from 1970 to 2021 using a combination of keywords "earthquake and response." The data were analyzed in VOSviewer, UCINET, and NetDraw software.

RESULTS

The following six thematic clusters with a social map were extracted: Initial response of the healthcare system, response to probabilistic risks after the hazard, response to mental health and community resilience, response to public health, response to post-traumatic stress disorders, and staff's response to the needs assessment and continuity of diagnostic treatment services. Moreover, social network analysis revealed the great impact of Japanese and Chinese authors and institutes.

CONCLUSION

The present study detected many gaps in the literature on earthquake response, which can contribute to developing a general framework to prepare integrated healthcare earthquake response plans to promote the performance of this system.

Clinical, environmental, and molecular factors associated to the occurrence and persistence of posttraumatic stress disorder after an earthquake

Post-traumatic stress disorder (PTSD) is a common and disabling condition with high incidence after an earthquake. The objective of the present study was to identify risk factors associated with the occurrence and persistence of PTSD. Individuals (18-65 years old) who experienced the earthquake of September 19th, 2017, attended the National Institute of Psychiatry (INPRFM) between October and November 2017 (baseline n = 68). Participants were followed 4-6 (first follow-up, n = 40) and 7-9 (second follow-up n = 41) months after the earthquake. Delay returning to normal activities, a negative emotional valence to a previous earthquake, comorbidity with depression, history of childhood maltreatment, and low expression of Glucocorticoid Receptor (GR) were associated with PTSD in the basal assessment. The earthquake-related variable associated with the persistence of PTSD at the second follow-up was that the earthquake had directly affected the participants, either because they were evicted, had damage to their homes, or suffered some injury. Comorbidity with dysthymia, history of childhood maltreatment, and higher severity of PTSD in the basal assessment were associated with persistent PTSD in the second follow-up. The lower expression of the FK506 binding protein 5 (FKBP5) in participants with persistent PTSD in the second follow-up was better explained by childhood physical abuse than with PTSD severity. These findings suggest that acute exposure to earthquake-related stressful situations is relevant for the initial risk of PTSD, while potential long-term stressful conditions are associated with its persistence. Likewise, molecular markers associated with hypothalamus-pituitary-adrenal-axis dysregulation were differentially associated with PTSD diagnosis at the different assessment times.

Posttraumatic Stress Symptoms and Attitudes toward the China Eastern Airlines Plane Crash in Transportation Students

On 21 March 2022, a China Eastern Airlines plane with 132 people on board crashed and all people are presumed dead. This study aimed to explore mental health symptoms and attitudes toward the plane crash among flight and train attendant students and the general public. A cross-sectional online survey was conducted two weeks after the plane crash. Mental health symptoms, including posttraumatic stress symptoms (PTSS), depressive, anxiety, and insomnia symptoms were assessed. A total of 494 participants were included, of which 183 were flight (n = 140) and train (n = 43) attendant students (aged 17.3 ± 1.7 years, 80.9% were female), and 311 were sampled from the general population (aged 26.7 ± 7.8 years, 62.1% were female). The prevalence of depressive, anxiety, and insomnia symptoms, and PTSS was 51.9%, 40.4%, 25.1%, and 12.6% in the transportation students, and 45.3%, 36.0%, 17.4%, and 4.2% in the general public sample, respectively. The students reported more frequent insomnia symptoms and PTSS than the general public sample. In the student group, compared with those without PTSS, those with PTSS reported significantly higher rates of depressive, anxiety, and insomnia symptoms. Two weeks after a plane crash, mental health symptoms are common in the general public and transportation students, with the latter being more likely to have PTSS symptoms. Our findings suggest the importance to identify risk groups when developing interventions after indirect exposure to traumatic events.

Integrated Analysis of miRNA and mRNA Expression Profiles Reveals the Molecular Mechanism of Posttraumatic Stress Disorder and Therapeutic Drugs

Purpose

Post-traumatic stress disorder (PTSD) is a result of trauma exposure and is related to psychological suffering as a long-lasting health issue. Further analysis of the networks and genes involved in PTSD are critical to the molecular mechanisms of PTSD.

Methods

In this study, we aimed to identify key genes and molecular interaction networks involved in the pathogenesis of PTSD by integrating mRNA and miRNA data.

Results

By integrating three high-throughput datasets, 5606 differentially expressed genes (DEGs) were detected, including five differentially expressed miRNAs (DEmiRNAs) and 5525 differentially expressed mRNAs (DEmRNAs). Nineteen upregulated and 46 downregulated DEmRNAs were identified in both GSE64813 and GSE89866 datasets, while five upregulated DEmiRNAs were found in the GSE87768 dataset. Functional annotations of these DEmRNAs indicated that they were mainly enriched in blood coagulation, cell adhesion, platelet activation, and extracellular matrix (ECM)-receptor interaction. Integrated protein-protein and miRNA-protein interaction networks among the DEGs were established with the help of 65 nodes and 121 interactions. Finally, 286 small molecules were obtained based on the Drug-Gene Interaction database (DGIdb). Three genes, prostaglandin-endoperoxide synthase 1 (PTGS1), beta-tubulin gene (TUBB1), and cyclin-dependent kinase inhibitor 1A (CDKN1A), were the most promising targets for PTSD therapy. Additionally, the present study also provided a higher performance diagnostic model for PTSD based on 17 DEmRNAs, which was validated in two independent datasets, GSE109409 and GSE63878.

Conclusion

Our data provides a new molecular aspect that ECM-receptor interaction and the platelet activation process could be the potential molecular mechanism of PTSD, and the genes involved in this process may be promising therapeutic targets. A higher-performance diagnostic model for PTSD has also been identified.

The Impact of Electroacupuncture Early Intervention on the Brain Lipidome in a Mouse Model of Post-traumatic Stress Disorder

The neuroprotective effect of electroacupuncture (EA) treatment has been well studied; growing evidence suggests that changes in lipid composition may be involved in the pathogenesis of post-traumatic stress disorder (PTSD) and may be a target for treatment. However, the influence of early EA intervention on brain lipid composition in patients with PTSD has never been investigated. Using a modified single prolonged stress (mSPS) model in mice, we assessed the anti-PTSD-like effects of early intervention using EA and evaluated changes in lipid composition in the hippocampus and prefrontal cortex (PFC) using a mass spectrometry-based lipidomic approach. mSPS induced changes in lipid composition in the hippocampus, notably in the content of sphingolipids, glycerolipids, and fatty acyls. These lipid changes were more robust than those observed in the PFC. Early intervention with EA after mSPS ameliorated PTSD-like behaviors and partly normalized mSPS-induced lipid changes, notably in the hippocampus. Cumulatively, our data suggest that EA may reverse mSPS-induced PTSD-like behaviors due to region-specific regulation of the brain lipidome, providing new insights into the therapeutic mechanism of EA.

Factors associated with peritraumatic stress symptoms among the frontline healthcare workers during the outbreak of COVID-19 in China

OBJECTIVES

This study aimed to examine the prevalence of peritraumatic stress symptoms (PTSSs), perceived threat, social support and factors contributing to clinically significant PTSS among frontline COVID-19 healthcare workers (HCWs) in China.

DESIGN AND SETTING

An online survey through self-administered questionnaires was conducted from 18 February to 4 March 2020, during the outbreak of COVID-19.

OUTCOMES MEASURES

PTSS was assessed using the post-traumatic stress disorder (PTSD) self-rating scale. Demographic and socioeconomic characteristics, self-reported health, physical/psychological symptoms, perceived threat from frontline work and perceived social support were investigated. Multivariable line regression analysis distinguished factors associated with HCWs' PTSS scores.

RESULTS

A total of 676 (58.1%) HCWs have shown clinically significant high levels of PTSS. Only 441 (37.9%) self-reported good health. Most had physical symptom(s) (915 (78.7%)), psychological symptom(s) (906 (77.9%)), inability to vent emotions (284 (24.4%)), emotional exhaustion (666 (57.3%)) and 1037 (89.2%) needed professional respect. Moreover, social support received was less than expected, and the receipt of psychological services/help scored the lowest (3.11±1.73). Combined psychological and physical symptoms, difficulty in releasing tension and venting emotions timely, fear of infection, emotional exhaustion and depersonalisation are significantly associated with PTSS scores among frontline HCWs. Working ≥8 hours, having the senior professional title, self-reported health, enjoying perfect protection and control measures, economic subsidy and control policy on reducing discriminatory practices are negatively correlated with PTSS scores.

CONCLUSIONS

During the outbreak of COVID-19, frontline HCWs experienced clinically significant high levels of PTSS and heavy workload, and the emergency resulted in their inadequate psychosocial support. If this is left unchecked, HCWs have a higher risk of developing PTSD. Early detection, identification and person-directed, targeted multidisciplinary interventions should be undertaken to address various influencing factors. Comprehensive measures, including setting up emotional release channels, as well as providing psychological and social support intervention for HCWs globally, are highly recommended.

Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy

Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9-15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.

Assessment of earthquake casualties and comparison of accuracy of five injury triage methods: evidence from a retrospective study

OBJECTIVE

The use of an injury triage method among earthquake injury patients can facilitate the reasonable allocation of resources, but the various existing injury triage methods need further confirmation. This study aims to assess the accuracy of several injury triage methods, namely, the Simple Triage and Rapid Treatment (START) technique; CareFlight Injury Triage (CareFlight); Rapid Emergency Medicine Score (REMS); Triage Revised Trauma Score (T-RTS) and Triage Early Warning Score (TEWS), based on their effects on earthquake injury patients.

DESIGN

Data in the Huaxi Earthquake Casualty Database were analysed retrospectively.

SETTING

This study was conducted in China.

PARTICIPANTS

Data on 29 523 earthquake casualties were separately evaluated using the START technique, CareFlight, REMS, T-RTS and TEWS, with these being the five types of injury triage studied.

PRIMARY OUTCOME MEASURE

The receiver operating characteristic (ROC) curves for the five injury triages were calculated based on hospital deaths, injury severity scores greater than 15 points, and whether casualties stayed in the intensive care unit.

RESULTS

The ROC curve areas of the START technique, CareFlight, REMS, T-RTS and TEWS were 0.750, 0.737, 0.835, 0.736 and 0.797, respectively. Among the five injury triages, the most accurate in predicting hospital deaths was REMS, with an average area under the curve (AUC) of 0.835, with this due to the inclusion of more evaluation indicators.

CONCLUSION

All methods had an effect on the triage of earthquake mass casualties. Among them, the REMS injury triage method had the largest AUC of the five triage methods. Except for REMS, no obvious difference was found in the effect of the other four injury triage methods.

Long-term effects of housing damage on survivors' health in rural China: Evidence from a survey 10 Years after the 2008 Wenchuan earthquake

BACKGROUND

Disaster experiences have long-term health effects. However, less is known about the pathways of the association between disaster experiences and people's long-term health. We aimed to examine the long-term (10-year) effect of housing damage in the 2008 Wenchuan earthquake on survivors' health and to explore the pathways of the long-term effect.

METHODS

We used data from a survey conducted in 2018 in rural areas affected by the 2008 Wenchuan earthquake. The survey collected information on housing damage caused by the earthquake from survivors aged 18 years old or above. Our primary outcome was dichotomous self-rated health in 2018. We considered decreased living standards and debt burden as mediators. To examine the long-term effect of housing damage on health, we performed multivariable binary logistic regression models. We also performed mediation analyses using the "KHB-method".

RESULTS

Compared with no/slight damage, serious damage (odds ratio (OR): 1.50, 95% confidence interval (CI): 1.11,2.04) and collapse (OR: 1.57, 95% CI: 1.13,2.18) were associated with a higher risk of poor health. Decreased living standards and debt burden mediated 8.49% and 4.79%, respectively, of the association between serious damage and poor health and 10.64% and 6.10%, respectively, of the association between collapse and poor health.

CONCLUSION

Housing damage in a natural disaster is a long-term risk for survivors' health. Long-term policies and interventions are necessary to protect and promote the health of survivors who experience housing damage. In addition to house reconstruction assistance, policies and interventions can be designed to promote living standards and financial situations to protect survivors' health.

Mental disorder and PTSD in Syria during wartime: a nationwide crisis

BACKGROUND

Syria has experienced war since 2011, leaving over 80% under the poverty line and millions displaced. War and its retaliations have significantly impacted the mental health of Syrians. This study evaluates the post-traumatic stress disorder (PTSD), and the severity of the mental distress caused by war and other factors such as low social support. This study also evaluates other variables and compares the findings with those of multiple studies on Syria and refugees.

METHODS

This is a cross-sectional study that included people who lived in Syria in different governorates. Online surveys were distributed into multiple online groups and included the Kessler 10 (K10) scale which screens for anxiety and depression, the Screen for Posttraumatic Stress Symptoms (SPTSS) tool, the Multidimensional Scale of Perceived Social Support, and questionnaires on demographic and war-related factors.

RESULTS

Our study included 1951 participants, of which, 527 (27.0%) were males and 1538 (78.8%) between the age of 19 and 25. Among participants, 44% had likely severe mental disorder, 27% had both likely severe mental disorder and full PTSD symptoms, 36.9% had full PTSD symptoms, and only 10.8% had neither positive PTSD symptoms nor mental disorder on the K10 scale. Around 23% had low overall support. Half of the responders were internally displaced, and 27.6% were forced to change places of living three times or more due to war. Around 86.6% of the responders believed that the war was the main reason for their mental distress. Those with high SPTSS and K10 scores were found to take more days off from work or school due to negative feelings and having somatic symptoms. Moreover, the number of times changing places of living due to war, educational level, and being distressed by war noise were the most prominent factors for more severe PTSD and mental distress. No differences in PTSD and mental disorder prevalence were noted in participants living in different governorates or among different types of jobs. A strong significant correlation (r = 0.623) was found between SPTSS and K10 scores.

CONCLUSION

The conflict in Syria has left the population at great risk for mental distress which was higher compared to Syrian refugees elsewhere. Many measures with an emphasis on mental health are needed to help the people against a long-term avoidable suffering.

Advances in Treatment of Post-Traumatic Stress Disorder with Chinese Medicine

"Timely, near, and expectation" is the main principle of battlefield rescue for military combat stress reaction (CSR). Post-traumatic stress disorder (PTSD) is the most common form of CSR and a long-term persistent mental disorder that is caused by unusual threatening or catastrophic psychological trauma. Chinese medicine (CM) has abundant resources, is simple, easy to master, with few side effects. This article summarizes the cellular and animal experimental mechanisms of CM treatment on PTSD, suggesting that traditional Chinese herbs and acupuncture can protect brain functional areas, and adjust hypothalamus-pituitary-adrenal axis. Traditional Chinese herbs and acupuncture have shown good anti-stress efficacy and fewer side effects in clinical application, which may improve the CSR in the battlefield.

A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People

Post-traumatic stress disorder (PTSD) is common among homeless people and is associated with an increased risk of mortality from suicide, medical causes, and drug-related problems. However, there are no previous systematic review and meta-analysis studies that reported the consolidated magnitude of PTSD among homeless people. A literature search was conducted on PubMed, Embase, and Scopus to discover pertinent studies that determined the prevalence of PTSD among the homeless. Articles were evaluated by titles, abstracts, and full-text. Comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis were performed and Cochran's Q- and the I² test were used to assess heterogeneity. The evidence of publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots. From the total, 19 studies with 20,364 participants across seven countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence of PTSD among homeless people was 27.38% (95% CI; 21.95-33.57). In our subgroup analysis, we found that the prevalence of PTSD was considerably high as measured by the screening instrument (35.93%) than the diagnostic instrument (23.57% %). The prevalence of PTSD among homeless showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. This review showed that the pooled prevalence estimate of PTSD among homeless peoples was remarkably high (27.38%). Early screening and treatment of PTSD among homeless peoples are warranted to alleviate suffering.

The role of trauma experiences, personality traits, and genotype in maintaining posttraumatic stress disorder symptoms among child survivors of the Wenchuan earthquake

BACKGROUND

Posttraumatic stress disorder (PTSD) is the most prevalent type of psychiatric disorder among children after an earthquake. This study investigated the role of trauma experiences, personality traits, and genotype in the maintenance of PTSD symptoms.

METHODS

In a previous large-scale epidemiological investigation 1 year after the Wenchuan earthquake, 215 children with PTSD symptoms were selected at random with their blood samples collected. All of them were followed up, and their PTSD symptoms were assessed 3 years later. The adolescent version of the UCLA PTSD Reaction Index, the earthquake exposure scale, and the Junior Eysenck Personality Questionnaire were used to determine PTSD symptoms, trauma experiences, and personality traits, respectively. We sequenced candidate genes involved in the regulation of long-term potentiation via NMDA-type receptors to identify the related SNP variations.

RESULTS

Being trapped for a longer period of time, feeling one's own or a family member's life to be in danger, losing a close family member or friend, extraversion, neuroticism, TrkB, G72 and CNTF were found to be associated with the maintenance of PTSD symptoms.

CONCLUSIONS

Experiences, personality traits, and genotype influenced the maintenance of PTSD in child survivors who were considered to be followed up without medicine. This result could help to identify potential targets for treatment and promote the rational allocation of medical resources.

The Usefulness of Brief Telephonic Intervention After a Nuclear Crisis: Long-Term Community-Based Support for Fukushima Evacuees

The Fukushima Daiichi Nuclear Power Station accident in 2011 produced over 100000 evacuees. In order to deal with an increased need of mental health care, brief, transdiagnostic Telephonic Interventions (TI) have been provided for those at risk of different mental health problems identified based on results of the Mental Health and Lifestyle Survey (MHLS). This study aimed to examine usefulness of TI with focusing on evacuees' subjective estimation assessed in individual follow-up interviews. The sample comprised 484 persons who had been evacuated from 13 municipalities in Fukushima Prefecture to 8 safer regions in and out of Fukushima. We conducted semi-structured interviews for participants receiving TI (intervention group) and those not receiving TI despite being identified as high risk (non-intervention group). The intervention group was older, had a higher proportion of self-reported mental illness, and higher unemployment compared with the non-intervention group. The satisfaction proportion of those who underwent TI was as high as 74.6%. Satisfaction was significantly associated with advance knowledge of TI availability (OR = 3.00, 95% CI: 1.59-5.64), and advice on health-related practices (OR = 2.15, 95% CI: 1.12-4.13). Thus, TI is considered to be feasible and useful for public health management practices in major disasters.

Health-Related Rehabilitation after the 2008 Great Wenchuan Earthquake in China: A Ten Year Retrospective Systematic Review

Being one of the world’s seismically hazard-prone countries, the People’s Republic of China (PRC) witnessed an 8.0-magnitude earthquake on May 12th 2008—which was reported as one of the most destructive disasters since its founding. Following this earthquake, rehabilitation was greatly required for survivors to enable them to achieve and maintain optimal independence; functioning; full physical, mental and social ability; inclusion; and participation in all aspects of life and environments. We conducted a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to retrospectively identify, in five English databases/sources, the existing evidence about the Health-Related Rehabilitation (HRR) that was rendered to the survivors of the 2008 Wenchuan earthquake between 2008 and 2018. Only 11 studies out of 828 initial studies retrieved were included in our study and reported the survivors of the 2008 Wenchuan earthquake to have been aged between 10.5 and 55.7, and predominantly diagnosed with posttraumatic stress disorders. Their HRR was mainly premised on physical and physiological therapies, as well as traditional Chinese medicine and digital technologies. Although all HRR interventions used were reported to be effective, none was identified as much more effective than the others in the post-earthquake era —which calls for more robust research to build upon our systematic review.

Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study

Despite the occurrence of several earthquakes, only a few studies were conducted in Italy on the psychological impact in children and adolescents, with data mostly collected within one year after the disaster. This cross-sectional study aimed at exploring the prevalence of both post-traumatic stress disorder (PTSD) and emotional/behavioral difficulties, as well as at identifying their main predictors, among youths 2 years after the earthquake that hit Northern Italy in 2012. 682 children and adolescents (9-14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The prevalence of a likely PTSD in the earthquake zone was 1.9% (4.4% near the epicenter) and the total PTSD score in the affected area was significantly higher than in the control zone. 14.9% of youths living in the earthquake zone had a borderline/abnormal SDQ total difficulties score and 87.5% of youth with a likely PTSD also had a SDQ total score in the borderline/abnormal range. Regression analysis showed that the number of lifetime traumatic events (e.g., death of a relative) was the best predictor of children/adolescents psychological difficulties 2 years after the earthquake, followed by severity of exposure (personal injuries and losses) and parental psychopathology. Despite some limitations, this study highlights that youths may exhibit PTSD symptoms years after disasters, often in comorbidity with behavioral/emotional difficulties, stressing the need for long-term surveillance and interventions in exposed populations.

Prevalence and Influencing Factors of Post-Traumatic Stress Disorder Among Survivors in the Hard-Hit Areas Ten Years After the Wenchuan Earthquake: A Cross-Sectional Study

BACKGROUND

Post-traumatic stress disorder (PTSD) is common psychological distress after natural disasters, which is persistent. Chronic PTSD leads to a heavy disease burden. The purpose of this study is to explore the prevalence and influencing factors of chronic PTSD among survivors in the hard-hit areas ten years after the Wenchuan earthquake.

MATERIALS AND METHODS

A cross-sectional survey was conducted on residents aged 16 or above in hard-hit areas through a multi-stage sampling approach ten years after the Wenchuan earthquake. The items of the questionnaire included demographic characteristics and earthquake exposure factors, and the PTSD Checklist-Civilian Version (PCL-C) was used to evaluate the PTSD of the respondents.

RESULTS

A total of 1039 complete questionnaires were obtained. The median age of 1039 respondents was 60 years, 63.2% of whom were female, 70.2% were illiterate or had received primary education, and 58% had an annual household income of less than 20,000 yuan (US$ 2871.3). The rate of PTSD was 9.1% (95/1039). After controlling for confounding factors, it was found that higher income level and education level, and moving to concentrated rural settlement (CRS) after the earthquake might be protective factors for the long-term mental health of survivors in the hard-hit areas, and the loss of immediate families in the earthquake was an important risk factor.

CONCLUSION

Even though ten years have passed since the Wenchuan earthquake, the survivors in the hard-hit areas still have a serious mental disorder. The local government and health-care institutions should take appropriate measures to improve the mental health of residents.

Neural Correlates of Facial Expression Recognition in Earthquake Witnesses

Major adverse events, like an earthquake, trigger different kinds of emotional dysfunctions or psychiatric disorders in the exposed subjects. Recent literature has also shown that exposure to natural disasters can increase threat detection. In particular, we previously found a selective enhancement in the ability to read emotional facial expressions in L’Aquila earthquake witnesses, suggesting hypervigilance to stimuli signaling a threat. In light of previous neuroimaging data showing that trauma exposure is related to derangement of resting-state brain activity, in the present study we investigated the neurofunctional changes related to the recognition of emotional faces in L’Aquila earthquake witnesses. Specifically, we tested the relationships between accuracy in recognizing facial expressions and activity of the visual network (VN) and of the default-mode network (DMN). Resting-state functional connectivity (FC) with the main hub of the VN (primary, ventral, right-dorsal, and left-dorsal visual cortices) and DMN (posterior cingulate/precuneus, medial prefrontal, and right and left inferior parietal cortices) was investigated through a seed-based functional magnetic resonance imaging (fMRI) analysis in both earthquake-exposed subjects and non-exposed persons who did not live in an earthquake-affected area. The results showed that, in earthquake-exposed subjects, there is a significant reduction in the correlation between accuracy in recognizing facial expressions and the FC of the dorsal seed of the VN with the right inferior occipito-temporal cortex and the left lateral temporal cortex, and of two parietal seeds of DMN, i.e., lower parietal and medial prefrontal cortex, with the precuneus bilaterally. These findings suggest that a functional modification of brain systems involved in detecting and interpreting emotional faces may represent the neurophysiological basis of the specific “emotional expertise” observed in the earthquake witnesses.

Identification of Key Genes and Pathways in Post-traumatic Stress Disorder Using Microarray Analysis

Introduction: Post-traumatic stress disorder (PTSD) is characterized by impaired fear extinction, excessive anxiety, and depression. However, the potential pathogenesis and cause of PTSD are not fully understood. Hence, the purpose of this study was to identify key genes and pathway involved in PTSD and reveal underlying molecular mechanisms by using bioinformatics analysis. Methods: The mRNA microarray expression profile dataset was retrieved and downloaded from the Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) were screened using GEO2R. Gene ontology (GO) was used for gene function annotations and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway was performed for enrichment analysis. Subsequently, protein-protein interaction (PPI) network and module analysis by the plugin MCODE were mapped by Cytoscape software. Finally, these key genes were verified in stress-exposed models by Real-Time quantitative (qRT-PCR). In addition, we performed text mining among the key genes and pathway with PTSD by using COREMINE. Results: A total of 1004 DEGs were identified. Gene functional annotations and enrichment analysis indicated that the most associated pathway was closely related to the Wnt signaling pathway. Using PPI network and module analysis, we identified a group of "seed" genes. These genes were further verified by qRT-PCR. In addition, text mining indicated that the altered CYP1A2, SYT1, and NLGN1 affecting PTSD might work via the Wnt signaling pathway. Conclusion: By using bioinformatics analysis, we identified a number of genes and relevant pathway which may represent key mechanisms associated with PTSD. However, these findings require verification in future experimental studies.

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.

Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake

Background: Many studies have reported the comorbidity of posttraumatic stress disorder (PTSD) and depression in children. However, the underlying relationship between PTSD and depression remains unclear. Objective: This study examines the relationship between PTSD and depressive symptoms in children who survived the Wenchuan earthquake in China. Methods: In total, 301 children were assessed at four months and then followed up at 29, 40 and 52 months after the disaster. The ages of the children ranged from 9.6-14.6 years old, and the sample included 157 males and 144 females. The children were assessed by using the University of California at Los Angeles PTSD reaction index for DSM-IV for PTSD symptoms and the Children's Depression Inventory for depressive symptoms. Results: Comorbid PTSD and depressive symptoms were prevalent in 4.0, 3.3, 3.7 and 5.1% of the participants at times 1, 2, 3 and 4, respectively. The cross-lagged analysis indicated that PTSD symptoms at time 1 predicted depressive symptoms at time 2; depressive symptoms at time 1 predicted PTSD symptoms at time 2; depressive symptoms at time 2 predicted PTSD symptoms at time 3; and depressive symptoms at time 3 predicted PTSD symptoms at time 4. The findings also showed that being female, poor parental relationships and trauma exposure were risk factors for PTSD or depressive symptoms. Conclusions: The results suggest that the causal relationship between PTSD and depressive symptoms changes over time; the effects of PTSD symptoms tend to decrease, while those of depressive symptoms tend to increase. Two stages of the relationship between PTSD and depressive symptoms were observed, namely, that PTSD and depressive symptoms first influenced each other and then that depressive symptoms predicted PTSD. The results of our study also suggest that females with poor parental relationships and a high degree of trauma exposure are more likely to require intervention.

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

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

Longitudinal interplays of estrogen receptor alpha gene rs9340799 with social-environmental factors on post-traumatic stress disorder in Chinese Han adolescents after Wenchuan earthquake

Indirect evidences suggested associations of estrogen receptor alpha (ESR1) with post-traumatic stress disorder (PTSD). However, the relationship between rs9340799 on ESR1 gene and PTSD has not been reported yet. The present study was to explore the longitudinal changes of prevalence and severity of PTSD in adolescents with different genotypes of rs9340799 after the 2008 Wenchuan earthquake. Social-environmental factors were collected by questionnaires in 465 high school students. Variants of rs9340799 were determined by polymerase chain reaction-restriction fragment length polymorphism analyses and verified by DNA sequencing. PTSD symptoms were assessed by PTSD Checklist-Civilian Version (PCL-C) at 6, 12, and 18 months after the earthquake. The female AA homozygotes had a trend of higher prevalence of PTSD and significantly higher PCL-C scores than the female G allele carriers at 6 months after the earthquake. The female students had higher prevalence of PTSD and higher PCL-C scores than the male subjects at 6 months in the AA homozygotes, but not in the G allele carriers. Consecutive decreases in PCL-C scores were observed only in the female AA homozygotes. Only in the female, the AA genotype was the risk factor and predictor of PCL-C scores at 6 months. Potential factors of PTSD prevalence and predictors of PCL-C scores were different between the AA homozygotes and G allele carriers at different time during the follow-up. These results suggest gene-environment interactions may occur among rs9340799 and social-environmental factors, and influence the development and natural rehabilitation of PTSD in the course after stressed by the earthquake.

Posttraumatic stress disorder symptoms in parents and adolescents after the Wenchuan earthquake: A longitudinal actor-partner interdependence model

BACKGROUND

Previous research has examined the association between parents' and children's posttraumatic stress disorder symptoms (PTSS) after a variety of traumatic events. However, longitudinal parent-child dyadic studies are scarce.

METHODS

Independent self-reports were collected from parent-adolescent dyads (n = 688) after the 2008 Wenchuan earthquake. Adolescents (Mean = 15.22 years; 61.63% female) and one of their parents (Mean = 41.04 years; 58.14% female) each reported on their PTSS at 12 (T_12m) and 18 months (T_18m) following the earthquake. Longitudinal actor-partner interdependence models (APIMs) were used to examine PTSS within dyads.

RESULTS

The prevalence rates of probable PTSD at T_12m and T_18m were 18.90% and 11.92% in adolescents; as well as 22.09% and 15.12% in parents, showing a significant decline over time. After adjusted for earthquake exposure, both maternal and paternal PTSS at T_12m prospectively predicted adolescent girls' and boys' PTSS at T_18m (mother to daughter: β = 0.13; mother to son: β = 0.17; father to daughter: β = 0.17; father to son: β = 0.33), while adolescent girls' and boys' PTSS at T_12m only predicted maternal PTSS at T_18m (daughter to mother: β = 0.20; son to mother: β = 0.20), but not paternal PTSS at T_18m.

LIMITATIONS

Self-reported measures other than clinical reviews were used to collect data.

CONCLUSIONS

This study highlights the mutual impacts of adolescent and parental (especially maternal) PTSS after a disaster. Psychological prevention and intervention for adolescent disaster survivors should adopt a whole family approach.

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.

The Chinese herbal formula Free and Easy Wanderer ameliorates oxidative stress through KEAP1-NRF2/HO-1 pathway

Posttraumatic stress disorder (PTSD) gains a lot of attention due to high prevalence and strong psychological upset, but the etiology remains undefined and effective treatment is quite limited. Growing studies demonstrated the involvement of oxidative stress in various psychiatry diseases, suggesting anti-oxidation therapy might be a strategy for PTSD treatment. Free and Easy Wanderer (FAEW) is a poly-herbal drug clinically used in China for hundreds of years in the treatment of psychiatric disorder. We hypothesized that FAEW exerts clinical effects through the activity against oxidative stress with fluoxetine as antidepressant control drug. Our results revealed that FAEW significantly reduced both endogenous and H₂O₂-induced exogenous ROS levels in the human glioblastoma T98G and neuroblastoma SH-SY5Y cell lines. Transcriptome-wide microarray analysis indicated NRF2/HO-1 as the common target of FAEW and fluoxetine. Western blotting assay proved that the two drugs promoted NRF2 release from KEAP1 in the cytoplasm and translocation to the nuclei in a KEAP1-dependent manner, the expression of the protein HO-1 increased accordingly, suggesting the participation of KEAP1-NRF2/HO-1 pathway. The chemical constituents of FAEW (i.e. paeoniflorin, baicalin) bound to KEAP1 in silico, which hence might be the effective substances of FAEW. In conclusion, FAEW counteracted H₂O₂-induced oxidative stress through KEAP1-NRF2/HO-1 pathway.

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.

Identification of NF-κB as Determinant of Posttraumatic Stress Disorder and Its Inhibition by the Chinese Herbal Remedy Free and Easy Wanderer

Posttraumatic stress disorder (PTSD) is a mental disorder developing after exposure to traumatic events. Although psychotherapy reveals some therapeutic effectiveness, clinically sustainable cure is still uncertain. Some Chinese herbal formulae are reported to work well clinically against mental diseases in Asian countries, but the safety and their mode of action are still unclear. In this study, we investigated the mechanisms of Chinese remedy free and easy wanderer (FAEW) on PTSD. We used a reverse pharmacology approach combining clinical data to search for mechanisms of PTSD with subsequent in vitro verification and bioinformatics techniques as follows: (1) by analyzing microarray-based transcriptome-wide mRNA expression profiling of PTSD patients; (2) by investigating the effect of FAEW and the antidepressant control drug fluoxetine on the transcription factor NF-κB using reporter cell assays and western blotting; (3) by performing molecular docking and literature data mining based on phytochemical constituents of FAEW. The results suggest an involvement of inflammatory processes mediated through NF-κB in the progression of PTSD. FAEW was non-cytotoxic in vitro and inhibited NF-κB activity and p65 protein expression. FAEW's anti-inflammatory compounds, i.e., paeoniflorin, isoliquiritin, isoliquiritin apioside and ononin were evaluated for binding to IκK and p65-RelA in a molecular docking approach. Paeoniflorin, albiflorin, baicalin, isoliquiritin and liquiritin have been reported to relieve depression in vivo or in clinical trials, which might be the active ingredients for FAEW against PTSD.