Xiulan Zhang

Posttraumatic stress disorder symptoms among adult survivors of the 2008 Sichuan earthquake in China

This study examined the estimated prevalence rate of posttraumatic stress disorder (PTSD) symptoms and associated risk factors among Chinese adult survivors 7 to 8 months after the 2008 Sichuan earthquake. The sample was recruited from 2 areas close to the epicenter but of different distances. The estimated rate of PTSD symptoms was 55.6% and 26.4% respectively in the two areas. Loss of a child was a strong predictive factor for PTSD symptoms for the parents. Other predictive factors included female gender, loss of a parent, loss of friends or neighbors, residential house damage or collapse, and proximity to the epicenter. Effective and sustainable mental health services are needed and should be directed particularly to bereaved survivors.

Symptoms of posttraumatic stress disorder and depression among bereaved and non-bereaved survivors following the 2008 Sichuan earthquake

Many studies have suggested that unexpected death of a loved one is an important risk factor of posttraumatic stress disorder (PTSD) and depression among disaster survivors, but few have examined the magnitude of psychiatric morbidities among bereaved survivors. This study examined the prevalence rates of clinically significant PTSD and depressive symptoms and their associated risk factors among Chinese adult survivors following the 2008 Sichuan earthquake. Two hundred and fifty-one bereaved adults were compared with 1474 non-bereaved adult survivors. The estimated rates of PTSD and depressive symptoms were 65.6% and 64.8% for those who lost first-degree family members, 34.1% and 45.5% for those who lost second-degree relatives, and 27.1% and 37.5% for non-bereaved survivors respectively. Loss of a child was a significant predictor of psychopathological symptoms. The results suggested that effective and sustainable mental health services were required, especially for bereaved single-child parents.

The impact of the catastrophic earthquake in China's Sichuan province on the mental health of pregnant women

BACKGROUND On May 12, 2008, a magnitude 8.0 earthquake struck Chinas southwestern Sichuan province. Recent studies have identified mental health problems among the survivors, but little is known about the impact of the Sichuan earthquake on the mental health of pregnant women in the area. The main objective was to assess the impact of the Sichuan earthquake on the mental health of pregnant women in earthquake stricken areas. METHODS During November 2009 and January 2010, 311 pregnant women were interviewed. Symptoms of PTSD were measured using IES-R, while symptoms of antenatal depression were measured using EPDS. RESULTS The prevalence rate of PTSD symptoms was 12.2% (95% CI, 9.0-16.4). The rate of major depression was 40.8% (95% CI, 35.5-46.4). Living through an earthquake has been significantly correlated with PTSD but no significant correlation has been found with depression. The perceived stresses of pregnancy are significantly correlated with both depression and PTSD. LIMITATIONS Lack of long term follow up data and comparison group from non earthquake struck area. CONCLUSIONS 18 months after the Sichuan earthquake, the incidence of depression and PTSD were still quite high among pregnant women in the earthquake stricken areas. Depression was more common than PTSD. Living through an earthquake has been significantly correlated with PTSD but not with depression.

Longitudinal study of rural health workforce in five counties in China: research design and baseline description

BackgroundThe village doctors have served rural residents for many decades in China, and their role in rural health system has been highly praised in the world; unfortunately, less attention has been paid to the health workforce during the ambitious healthcare reform in recent years. Therefore, we conducted a longitudinal study to explore the current situation and track the future evolution of the rural healthcare workforce.MethodsThe self-administered structured Village Clinic Questionnaire and Village Doctor Questionnaire, which were modified from the official questionnaires of the Ministry of Health, were constructed after three focus groups, in-depth interviews in Hebei Province, and a pilot survey in Sichuan Province. Using a stratified multistage cluster sampling process, we gathered baseline data for a longitudinal survey of village doctors, village clinics from Changshu County, Liyang County, Yongchuan District, Mianzhu County, and Jingning County in China in 2011. Well-trained interviewers and strict procedures were employed to ensure the quality of this survey. Descriptive and correlation analyses were performed with Stata 12.0.ResultsAfter four months of surveying, 1,982 Village Doctor Questionnaires were collected, and the response rate was 88.1%. There were 1,507 (76.0%) male and 475 (24.0%) female doctors, with an average age of 51.3 years. The majority of village doctors (58.5%) practiced both western medicine and Traditional Chinese Medicine, and 91.2% of the doctors received their education below college level. Their practice methods were not correlated with education level (P = 0.43), but closely related to the way they obtained their highest degree (that is, prior to starting work or as on-the-job training) (P < 0.01). The mean income of the village doctors was 1,817 (95% CI 1,733 to 1,900) RMB per month in 2011; only 757 (41.3%) doctors had pensions, and the self-reported expected pension was 1,965 RMB per month.ConclusionsVillage doctors in rural China are facing critical challenges, including aging, gender imbalance, low education, and a lack of social protection. This study may be beneficial for making better policies for the development of the health workforce and China’s healthcare reform.

Employment status and self-rated health in north-western China

OBJECTIVE Despite a growing economy, unemployment remains a severe socio-economic problem in China. This study aimed to examine whether risk of self-rated poor health is related to employment status, and if any such relationship varies across sociodemographic groups. STUDY DESIGN A cross-sectional analysis in a random sample survey conducted in three north-western Chinese cities in 2005. METHODS Subjects were 7796 adults aged 20-59 years who reported being either employed or unemployed but actively seeking work. Multinomial generalized estimating equation models were performed for ordered logistic regression to estimate the relative risk of self-reporting poor health on an ordinal five-point scale with regard to employment status. RESULTS Unemployment was associated with self-rated poor health (odds ratio 1.4, 95% confidence interval 1.25-1.55). This association was stronger for people who resided in Xining, were older, frequently consumed alcohol and possessed a strong social network. Likelihood of self-rated poor health increased with duration of unemployment up to 5 years, but then decreased. CONCLUSION This study found that unemployment is detrimental to health, and that the relationship is modified by certain personality characteristics and social factors. An optimal strategy would incorporate such heterogeneity into Chinese programmes aimed at alleviating poor health among the unemployed.

Pathways to psychiatric care in urban north China: a general hospital based study.

BackgroundPathway studies highlight the help-seeking behaviors of patients with physical and mental illnesses. A number of studies in this field have been completed in various parts of the world. The purpose of this study is to explore the characteristics of the help-seeking pathways of patients with mental illness from urban north China at Mental Health Professional (MHP).MethodsThe pathway diagrams, which accounted for more than five percent of patients, were documented for 441 subjects using the translated version of the World Health Organization (WHO) pathway encounter form. The patterns and durations of care-seeking were analyzed in different diagnostic groups. The χ2-test and the Mann-Whitney U test were employed, as needed.ResultsRespondents visited the MHP through a variety of pathways. Approximately three-quarters of the patients took an indirect pathway (74.8% vs 25.2%, χ2 = 108.8, p < 0.0001), and on average, each patient consulted 3.4 caregivers. The vast majority of patients first visited local tertiary general hospitals (56.4% vs 4.1%, χ2 = 138.3, p < 0.0001) or local secondary general hospitals (24.8% vs 4.1%, χ2 = 40.96, p < 0.0001). However, only 9.6% of patients were diagnosed with mental disorders for the patients who first visited non-psychiatric hospitals. Of the patients who first contacted with psychiatry hospital, 55.6% received a professional diagnosis and finally reached the MHP because of the poor treatment or high-cost medical care.ConclusionsThe majority of patients seek other pathways than to go to MHP directly and this may be due to stigma, and/or lack of knowledge. The study gives emphasis on the importance of improving skills and knowledge that will facilitate the recognition of psychiatric disorders in the community health centers, the general hospitals system and by private practitioners. The pathway described by this study may be helpful while preparing mental health programs in the future.

Aging village doctors in five counties in rural China: situation and implications

BackgroundThe aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former “barefoot doctors”) who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors’ aging situation and its implications in rural China.MethodsThe data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0.ResultsThe average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts.ConclusionsAging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.

The role of basic health insurance on depression: an epidemiological cohort study of a randomized community sample in northwest China.

BackgroundLittle research has focused on the relationship between health insurance and mental health in the community. The objective of this study is to determine how the basic health insurance system influences depression in Northwest China.MethodsParticipants were selected from 32 communities in two northwestern Chinese cities through a three-stage random sampling. Three waves of interviews were completed in April 2006, December 2006, and January 2008. The baseline survey was completed by 4,079 participants. Subsequently, 2,220 participants completed the first follow-up, and 1,888 completed the second follow-up. Depression symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D).ResultsA total of 40.0% of participants had at least one form of health insurance. The percentages of participants with severe depressive symptoms in the three waves were 21.7%, 22.0%, and 17.6%. Depressive symptoms were found to be more severe among participants without health insurance in the follow-up surveys. After adjusting for confounders, participants without health insurance were found to experience a higher risk of developing severe depressive symptoms than participants with health insurance (7 months: OR, 1.40; 95% CI, 1.09-1.82; p = 0.01; 20 months: OR, 1.89; 95% CI, 1.37-2.61; p < 0.001).ConclusionA lack of basic health insurance can dramatically increase the risk of depression based on northwestern Chinese community samples.

Prevalence and determinants of depression among survivors 8 months after the Wenchuan earthquake.

Abstract The current study assessed the estimated rate of depression and associated risk factors among survivors 8 months after the 2008 Wenchuan earthquake in China. A stratified random sample of 1514 participants was recruited from all temporary camp communities in a county town 45 km away from the epicenter. The estimated rate of depression was 35.7%. The severity of depressive symptoms was significantly associated with female sex, perceived livelihood security, loss of a family member, residential house damage or collapse, and not living in an urban area, whereas married status is a protector against depressive symptoms. The results suggest that community-based effective, sustainable, and culturally sensitive interventions and services are warranted and should be directed to the groups at high risk for mental health problems.

Depression and its risk factors among pregnant women in 2008 Sichuan earthquake area and non-earthquake struck area in China

BACKGROUND On May 12, 2008, a powerful 8.0 magnitude earthquake struck Chinas Sichuan province. While some studies have assessed the mental and physical wellbeing of disaster victims, few have examined the long-term impact of natural disasters on pregnant womens mental health. As such, this study aims to assess whether the Sichuan earthquake continues to negatively affect womens mental health, 4 years since its occurrence. In addition, predictive and protective risk factors of depressive symptoms among pregnant women were also identified. METHODS From June 2012 to October 2012, 520 pregnant women were interviewed, of whom 253 were from an earthquake struck area and 267 were from a non-earthquake struck area. Symptoms of antenatal depression were measured using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff of≥10. RESULTS The prevalence rate of depression among pregnant women in the earthquake area was 34.5% (95% CI, 28.9-40.6), while the rate in the non-earthquake area was 39.6% (95% CI, 33.9-45.5). The perceived stresses associated with pregnancy and social support from husbands are significantly correlated with antenatal depression. LIMITATIONS Lack of diagnosis for antenatal depression and it is a self-report evaluation. CONCLUSIONS This study found that the Sichuan earthquake does not necessarily have a long-lasting effect on pregnant women who were once victims of the disaster. It was found that pregnant women who experience high levels of pressures from the pregnancy and receive medium support from husbands are more susceptible to experience antenatal depression than pregnant women who perceive higher levels of support from husbands.