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      Prevalence of PTSD and Depression among Junior Middle School Students in a Rural Town Far from the Epicenter of the Wenchuan Earthquake in China

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          Abstract

          Context

          On May12 th 2008, a devastating earthquake measuring 8.0 on the Richter scale, struck Wenchuan county and surrounding areas in China. The prevalence of mental illness among children and adolescents in a rural town far from the earthquake epicenter is unknown.

          Objective

          To assess the prevalence of posttraumatic stress disorder (PTSD) and depression among junior middle school students in a rural town Ningqiang county, 327 km from the earthquake epicenter.

          Design, Setting, and Participants

          A population-based mental health survey was conducted in March, 2009.

          Main Outcome Measure

          Survey Self-designed General Condition Survey Scale, Children's Revised Impact of Event Scale (CRIES-13), and the Depression Self-rating Scale for Children (DSRSC) were used to sample 1,841 junior middle school students in Ningqiang county, ten months after the Wenchuan earthquake.

          Results

          The prevalence rate of a high-risk for PTSD was 28.4%, with 32.7% among females, 23.8% among males (female vs. male, p<0.001), 38.6% in the severe exposure group and 24.3% in the mild exposure group (severe vs. mild exposure, p<0.001). For depressive symptoms, the overall prevalence was 19.5%, with 24.0% among females, 14.7% among males, 24.5% in the severe exposure group and 17.5% in the mild exposure group (female vs. male, p<0.001; severe vs. mild exposure, p<0.001, respectively). In multivariate analysis, factors such as “having felt despair”, or “danger” and “having own house destroyed or damaged” were significantly associated with PTSD symptoms. Female gender and delayed evacuation in females, and earthquake related experiences in males were significantly associated with depression.

          Conclusion

          Traumatic events experienced during the earthquake were significantly associated with symptoms of PTSD and depression in children and adolescents, ten months after the Wenchuan earthquake. These data highlight a need for mental health services for children and adolescents in rural areas, far from earthquake epicenters.

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          Most cited references34

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          Children and disaster: age, gender, and parental effects on PTSD symptoms.

          Psychiatric reports of 179 children aged 2 to 15 who were exposed to the Buffalo Creek dam collapse in 1972 were rated for post-traumatic stress disorder (PTSD) symptoms 2 years after the disaster. Age and gender effects and the impact of the level of exposure and parental functioning were examined according to a conceptual model addressing factors contributing to adaptation to a traumatic event. Results showed fewer PTSD symptoms in the youngest age group and higher symptom levels for girls than boys. Approximately 37% of the children were given a "probable" diagnosis of PTSD. Multiple regression analysis showed that life threat, gender, parental psychopathology, and an irritable and/or depressed family atmosphere all contributed to the prediction of PTSD symptomatology in the children.
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            Post-traumatic stress reactions in children after the 1988 Armenian earthquake.

            One and a half years after the devastating earthquake in Armenia in 1988, 231 children from three cities at increasing distances from the epicentre were randomly screened in their schools to determine the frequency and severity of post-traumatic stress reactions, using the Children's Post-traumatic Stress Disorder Reaction Index (CPTSD-RI). A systematic clinical assessment of PTSD based on DSM-III-R criteria was also conducted on approximately half of this sample. A high CPTSD-RI score was strongly correlated with a clinical diagnosis of PTSD. A strong positive correlation was found between proximity to the epicentre and overall severity of post-traumatic stress reaction, as well as severity of core component symptoms of PTSD. High rates of chronic, severe post-traumatic stress reactions were found among children in the two most damaged cities, Spitak and Gumri. Analyses controlling for exposure revealed that girls reported more persistent fears than boys. These findings indicate that after catastrophic natural disaster, post-traumatic reactions in children may reach epidemic proportions, remain high for a prolonged period, and jeopardise the well-being of the child population of a large region. Systematic screening of children for PTSD can provide critical information for a rational public mental health programme after such a disaster.
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              Psychiatric comorbidity in children after the 1988 earthquake in Armenia.

              To determine current rates of posttraumatic stress disorder (PTSD), depressive disorder, and separation anxiety disorder (SAD) among children 1 1/2 years after the 1988 earthquake in Armenia; to determine current rates of comorbid PTSD and depressive disorder; and to assess the contribution of exposure, gender, loss of family members, and loss of residence. Two hundred eighteen school-age children from three cities at increasing distances from the epicenter were evaluated using the Child Posttraumatic Stress Disorder Reaction Index, the Depression Self-Rating Scale, and the section on SAD from the Diagnostic Interview for Children and Adolescents. On the basis of these evaluations, high rates of current PTSD, depressive disorder, and their co-occurrence were found among victims residing in the two heavily impacted cities. SAD was comparatively less frequent, although symptoms of SAD had been pervasive throughout the region. Severity of posttraumatic stress and depressive reactions were highly correlated. Extent of loss of family members was independently correlated with each. After a catastrophic natural disaster, children are at risk for comorbid PTSD and secondary depression. Based on the findings, an interactive model is proposed of postdisaster psychopathology. Early clinical intervention is recommended to prevent chronic posttraumatic stress reactions and secondary depression.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                23 July 2012
                : 7
                : 7
                : e41665
                Affiliations
                [1 ]Department of Psychiatry, First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
                [2 ]Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
                [3 ]Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, Chiba, Japan
                Rikagaku Kenkyūsho Brain Science Institute, Japan
                Author notes

                Conceived and designed the experiments: XCM XLS YH CGG. Performed the experiments: WW WF XCM CGG. Analyzed the data: WW JW XCM KH CGG. Contributed reagents/materials/analysis tools: WW JW XCM KH CGG. Wrote the paper: WW JW XCM KH CGG.

                Article
                PONE-D-12-15203
                10.1371/journal.pone.0041665
                3402444
                22911838
                2f707e3e-731a-4a41-9b9e-d1b7084a267b
                Wang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 17 May 2012
                : 22 June 2012
                Page count
                Pages: 10
                Categories
                Research Article
                Medicine
                Epidemiology
                Environmental Epidemiology
                Survey Methods
                Global Health
                Mental Health
                Psychiatry
                Mood Disorders
                Psychology
                Psychological Stress
                Pediatrics
                Adolescent Medicine
                Public Health
                Health Screening
                Social and Behavioral Sciences
                Psychology
                Psychological Stress

                Uncategorized
                Uncategorized

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