Tubao Yang

An Epidemiologic Study of Posttraumatic Stress Disorder in Flood Victims in Hunan China

Objective: To estimate the occurrence and to assess the determinants of posttraumatic stress disorder (PTSD) in flood victims. Method: We carried out a retrospective study to examine the occurrence and the determinants of PTSD in victims of flood in 1998 and 1999 in Hunan, China. We used multistage sampling to select the subjects from the flood areas, and we ascertained PTSD according to DSM-IV criteria. Data were collected in face-to-face interviews carried out by experienced research assistants using a preconstructed questionnaire. We used a multiple logistic regression model to analyze the data. Results: A total of 33 340 subjects (86.0% of the selected subjects, aged 7 years or over) in the study villages were interviewed. Among them, 2875 (8.6%) had symptoms that met the diagnostic criteria for PTSD. Significant risk factors for PTSD included female sex (odds ratio [OR] 1.12; 95% confidence interval [CI], 1.04 to 1.21), older age (age 18 to 59 years OR 2.28; 95%CI, 2.02 to 2.57, and age > 60 years OR 2.42; 95%CI, 2.05 to 2.85), flood type (collapsed embankment OR 1.84; 95%CI, 1.64 to 2.05, and flash flood OR 3.12; 95%CI, 2.76 to 3.52), and flood severity (intermediate OR 4.05; 95%CI, 3.55 to 4.62, and severe OR 2.98; 95%CI, 2.60 to 3.41). Conclusions: PTSD is a common mental disorder in flood victims, which implies the need for improved health services, especially mental health services, for this population.

A study on the relationship between posttraumatic stress disorder in flood victim parents and children in Hunan, China

Objective: To explore the relationship between posttraumatic stress disorder (PTSD) in flood victim parents and children in Hunan, China. Methods: Using the method of multistage cluster random sampling, we conducted a retrospective investigation on 3,698 families in Hunan, China who suffered from flooding in 1998. Investigators held face-to-face interviews with the parents and children of the families. The diagnosis of PTSD was made according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The comparison of rate of PTSD positive in the groups of children with different characteristics was done by chi-square test. In the evaluation of the impact of parent PTSD on PTSD in their children, we used a multivariable logistic regression model to re-estimate the adjusted Odds Ratio and its confidence interval. We did this after the possible confounding variables were adjusted for. Additionally, the Odds Ratio and its confidence interval were estimated under the condition of a single variable. Results: A total of 4,327 children and the parents of 3,292 families were included for analysis; 203 (4.7%) of 4,327 children and 740 (11.2%) of 6,584 parents were diagnosed with PTSD. We found that the PTSD positive rate is significantly higher in the children with disaster-related experience. The rate of beating their children in PTSD positive fathers (54.9%) was higher than that of PTSD negative fathers (51.2%). No correlation was found between mothers’ PTSD and beating their children. The risk of developing PTSD is higher for children living in the families with PTSD parents. Conclusion: The rate of PTSD in 7–14-year-old children is 4.7% in areas in Hunan, China, who suffered from flooding in 1998. The possibility for children to develop PTSD is increased in families with PTSD parents.

Prevalence and Determinants of Chronic Post-Traumatic Stress Disorder After Floods

OBJECTIVE To explore the prevalence and determinants of chronic post-traumatic stress disorder (PTSD) among flood victims. METHODS A cross-sectional survey was carried out in 2014 among individuals who had experienced the 1998 floods and had been diagnosed with PTSD in 1999 in Hunan, China. Cluster sampling was used to select subjects from the areas that had been surveyed in 1999. PTSD was diagnosed according to DSM-IV criteria, social support was measured according to a Social Support Rating Scale, coping style was measured according to a Simplified Coping Style Questionnaire, and personality was measured by use of the revised Eysenck Personality Questionnaire Short Scale for Chinese. Data were collected through face-to-face interviews by use of a structured questionnaire. Multivariate logistic regression analysis was used to reveal the determinants of chronic PTSD. RESULTS A total of 123 subjects were interviewed, 17 of whom (14.4%) were diagnosed with chronic PTSD. Chronic PTSD was significantly associated with disaster stressors (odds ratio [OR]: 1.74; 95% confidence interval [CI]: 1.22-2.47), nervousness (OR: 1.09; 95% CI: 1.01-1.17), and social support (OR: 0.85; 95 CI%: 0.74-0.98). CONCLUSIONS Chronic PTSD in flood victims is significantly associated with disaster stressors, nervousness, and social support. These factors may play important roles in identifying persons at high risk of chronic PTSD.

Association between Posttraumatic Stress Disorder and Preflood Behavioral Characteristics among Children Aged 7-15 Years in Hunan, China

Objective: To explore the relationship between posttraumatic stress disorder (PTSD) and preflood behavioral characteristics among children aged 7–15 years in Hunan, China. Subjects and Methods: In 2000, a retrospective study was carried out among children who had been exposed to the 1998 floods in Hunan. A multistage sampling method was used to select subjects from the flood-affected areas. A structured questionnaire administered to the children selected was used to diagnose PTSD based on the DSM-IV criteria. A parent questionnaire was used to measure preflood behavioral characteristics related to health, behavioral, and habit problems. The association between PTSD and preflood behavioral characteristics was assessed using χ2-tests and multivariate logistic regression. Results: A total of 7,038 children from 13,450 households, aged 7–15 years, were investigated. The overall prevalence of PTSD was 2.05%. Generally, the PTSD-positive rate increased with increasing scores for behavioral characteristics. Conclusion: Preflood behavioral characteristics are an important factor influencing the prevalence of PTSD among children exposed to floods. It is therefore necessary to give special attention to children with behavioral problems in order to reduce the psychological impact of floods.

A short DSM-IV screening scale to detect posttraumatic stress disorder after a natural disaster in a Chinese population.

The objective of the study was to construct a short screening scale for posttraumatic stress disorder (PTSD). We used data from our previous study on PTSD among flood victims in 1998 and 1999 in Hunan, China, which was a representative population sample of 27,267 subjects from 16 to 94 years old. Multistage sampling was used to select the subjects from the flood areas and PTSD was ascertained with the Diagnostic and Statistical Manual of Mental Disorders: 4th Edition (DSM-IV). We randomly assigned 80% (n=21,762) of study subjects to construct the screening scale (construct model) and the remaining 20% (n=5505) to test the model. Logistic regression analysis and receiver operating characteristic analysis were used to select a subset of items (symptoms) from the full scale that would effectively predict PTSD. A seven-symptom screening scale for PTSD was selected. A score of 3 or more on this scale was used to define positive cases of PTSD, with a sensitivity of 87.9%, specificity of 97.9%, positive predictive value of 81.3%, and negative predictive value of 98.7%. The short screening scale developed in this study is highly valid, reliable, and predictable. It is an efficient tool to screen PTSD in epidemiological and clinical studies.