What are the determinants of post-traumatic stress disorder: age, gender, ethnicity or other? Evidence from 2008 Wenchuan earthquake.

OBJECTIVE To estimate the prevalence of post-traumatic stress disorder (PTSD) and assess determinants related to PTSD symptoms among adult earthquake survivors after the 2008 Wenchuan earthquake in China. STUDY DESIGN Cross-sectional multicluster sample surveys with data collected from four counties. METHODS Surveys were conducted separately in four counties in Sichuan Province, with a total of 2004 respondents. Beichuan County and Dujiangyan City were damaged more severely than Yaan County and Langzhong County during the earthquake. In total, 1890 households were represented, with a mean of 2.2 respondents per household. Data were collected using structured interviews, and the Harvard Trauma Questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were used to diagnose PTSD. RESULTS The prevalence rates of suspected PTSD were 47.3% (n = 436) in heavily damaged areas and 10.4% (n = 93) in moderately damaged areas. The prevalence rates of PTSD symptoms among elderly, middle aged and young adults were 55.8%, 50.2% and 28.6% (P = 0.001), respectively, in heavily damaged areas. Older age, female gender, unmarried/divorced/widowed, ethnic minority, death of family member, no household income and damaged household were independent risk factors for PTSD symptoms in heavily damaged areas. CONCLUSION Interventions designed to reduce PTSD among populations affected by the 2008 earthquake should focus on people without household incomes, those with damaged households and those who experienced the death of a family member. Effective, sustainable and culturally sensitive psychosocial interventions and mental health services are required, and attention should be directed to survivors who experienced the death of a family member, women and older adults following the devastating natural disaster. Governments should support income-generating activities and improve living conditions. Trained field personnel can assist with PTSD assessments and referrals, and existing rural healthcare services can be used to provide treatment for common psychiatric disorders.

[1]  C. Gotway,et al.  Mental health problems among adults in tsunami-affected areas in southern Thailand. , 2006, JAMA.

[2]  M. Fredrikson,et al.  Trauma exposure and post‐traumatic stress disorder in the general population , 2005, Acta psychiatrica Scandinavica.

[3]  N. Krause.  Exploring the impact of a natural disaster on the health and psychological well-being of older adults. , 1987, Journal of human stress.

[4]  I. Failde,et al.  Gender differences and determinants of health related quality of life in coronary patients: a follow-up study , 2011, BMC cardiovascular disorders.

[5]  Wenhua Tian,et al.  Are the elderly more vulnerable to psychological impact of natural disaster? A population-based survey of adult survivors of the 2008 Sichuan earthquake , 2010, BMC public health.

[6]  L. Fairbanks,et al.  Post-traumatic Stress Reactions in Children After the 1988 Armenian Earthquake , 1993, British Journal of Psychiatry.

[7]  P. Udomratn.  Mental health and the psychosocial consequences of natural disasters in Asia , 2008, International review of psychiatry.

[8]  F H Norris,et al.  A test of the social support deterioration model in the context of natural disaster. , 1993, Journal of personality and social psychology.

[9]  S. Galea,et al.  The epidemiology of post-traumatic stress disorder after disasters. , 2005, Epidemiologic reviews.

[10]  U. John,et al.  Trauma and posttraumatic stress disorder in the elderly: findings from a German community study. , 2008, The Journal of clinical psychiatry.

[11]  E. Cherniack.  The impact of natural disasters on the elderly. , 2008, American journal of disaster medicine.

[12]  P. Kun,et al.  Public health status and influence factors after 2008 Wenchuan earthquake among survivors in Sichuan province, China: cross-sectional trial. , 2010, Public health.

[13]  Vaughan J. Carr,et al.  THE PSYCHOSOCIAL IMPACT OF AN EARTHQUAKE ON THE ELDERLY , 1996 .

[14]  E. Brähler,et al.  Posttraumatische Belastungsstörungen in Deutschland , 2008, Der Nervenarzt.

[15]  Aizhong Liu,et al.  An Epidemiologic Study of Posttraumatic Stress Disorder in Flood Victims in Hunan China , 2006, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[16]  Pinchen Yang,et al.  Posttraumatic stress disorder among adolescent earthquake victims in Taiwan. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[17]  L. Bourque,et al.  Psychological Distress Following Urban Earthquakes in California , 2002, Prehospital and Disaster Medicine.

[18]  Tao Li,et al.  Risk indicators for post-traumatic stress disorder in adolescents exposed to the 5.12 Wenchuan earthquake in China , 2011, Psychiatry Research.

[19]  R. E. Gardner,et al.  Physical Function and Quality of Life in Older Adults: Sex Differences , 2005, Southern medical journal.

[20]  I. Levav,et al.  Prevalence, risk factors and aging vulnerability for psychopathology following a natural disaster in a developing country , 2005, International journal of geriatric psychiatry.

[21]  C. Brewin,et al.  Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. , 2007, The American journal of psychiatry.

[22]  J. Fairbank,et al.  The Prevalence of Posttraumatic Stress Disorder Among American Indian Vietnam Veterans: Disparities and Context , 2002, Journal of traumatic stress.

[23]  C. Kılıç,et al.  Prevalence of Posttraumatic Stress Disorder and Comorbid Depression in Earthquake Survivors in Turkey: An Epidemiological Study , 2004, Journal of traumatic stress.

[24]  D. Wingard,et al.  Gender differences in health-related quality of life. , 1991, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[25]  L. Fairbanks,et al.  Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia. , 1994, The American journal of psychiatry.

[26]  S. Saxena,et al.  Mental Health in the Aftermath of Disasters: Consensus and Controversy , 2003, The Journal of nervous and mental disease.

[27]  Lan Yao,et al.  Prevalence and risk factors for posttraumatic stress disorder: a cross‐sectional study among survivors of the Wenchuan 2008 earthquake in China , 2009, Depression and anxiety.

[28]  Lan Yao,et al.  Prevalence of post-traumatic stress disorder in Sichuan Province, China after the 2008 Wenchuan earthquake. , 2009, Public health.

[29]  B. L. Cardozo,et al.  Mental health, social functioning, and disability in postwar Afghanistan. , 2004, JAMA.

[30]  S. Becker.  Psychosocial care for adult and child survivors of the tsunami disaster in India. , 2007, Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc.

[31]  A. Goenjian,et al.  Relocation after a disaster: posttraumatic stress disorder in Armenia after the earthquake. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[32]  M. Massagli,et al.  Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. , 2001, JAMA.

[33]  M. B. Rothman,et al.  Planning for and Responding to Special Needs of Elders in Natural Disasters , 2007 .

[34]  L. Berkman,et al.  Gender differences in the comparison of self-reported disability and performance measures. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[35]  J. Beck,et al.  Posttraumatic stress disorder in older adults: a conceptual review. , 2000, Journal of anxiety disorders.

[36]  J. Takaki,et al.  Health impact of disaster‐related stress on pregnant women living in the affected area of the Noto Peninsula earthquake in Japan , 2009, Psychiatry and clinical neurosciences.

[37]  Yunhwan Lee,et al.  Trauma experience of North Korean refugees in China. , 2001, American journal of preventive medicine.

[38]  B. Q. Zhang,et al.  Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China. , 2011, Journal of traumatic stress.

[39]  R. Punamäki,et al.  The role of peritraumatic dissociation and gender in the association between trauma and mental health in a Palestinian community sample. , 2005, The American journal of psychiatry.

[40]  D. Summerfield,et al.  MENTAL WELL-BEING IN SETTINGS OF ‘COMPLEX EMERGENCY’: AN OVERVIEW , 2004, Journal of Biosocial Science.

[41]  D. Bhugra,et al.  Mental health, psychosocial support and the tsunami , 2006, International review of psychiatry.

[42]  Hung-Chi Wu,et al.  Epidemiologic psychiatric studies on post‐disaster impact among Chi‐Chi earthquake survivors in Yu‐Chi, Taiwan , 2007, Psychiatry and clinical neurosciences.

[43]  R. Mollica,et al.  The Harvard Trauma Questionnaire: Validating a Cross‐Cultural Instrument for Measuring Torture, Trauma, and Posttraumatic Stress Disorder in Indochinese Refugees , 1992, The Journal of nervous and mental disease.

[44]  J. Rodenburg,et al.  Posttraumatic Stress Symptoms in Refugees: Assessments with the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist–25 in Different Languages , 2001, Psychological reports.

[45]  L. Gao,et al.  Longitudinal study of earthquake-related PTSD in a randomly selected community sample in north China. , 2000, The American journal of psychiatry.

[46]  B. L. Cardozo,et al.  Mental health in complex emergencies , 2004, The Lancet.

[47]  D. Zatzick,et al.  Ethnic/Racial Diversity and Posttraumatic Distress in the Acute Care Medical Setting , 2008, Psychiatry.