Long term impact of Wenchuan earthquake on population mental and behavioral disorders in heavily-stricken areas: An ecological study based on big data.

BACKGROUND: This study aimed to explore and evaluate the development trends and differential changes in the prevalence of mental and behavioral disorders among the earthquake survivors in exposure groups (highly hard-hit areas) and control groups (general disaster areas) from 2015 to 2019, as well as to investigate the potential influencing factors. METHODS: Data was obtained from the Sichuan Health Information System and the Sichuan Health Yearbook, the prevalence of the exposure group and the control group were calculated, the difference between the two groups was evaluated using the prevalence rate ratio, and a fixed effect model was developed to investigate the potential influencing factors of the prevalence. RESULTS: The prevalence by gender and age in the exposure group was always greater than those in the control group (RR>1), although the disparity between the two proceeded to diminish with time. The urbanization rate (ß = 0.0448, P < 0.05) and disaster area levels (ß = 0.0104, P < 0.05) were risk factors for the prevalence of mental and behavioral disorders. LIMITATIONS: The study only collected data at the group level following the Wenchuan earthquake. Consequently, the findings are only applicable at the group level. Furthermore, diagnostic criteria for various types of mental and behavioral disorders diseases were not provided. CONCLUSIONS: The earthquake has a significant long-term impact on mental health. It is necessary to continuously monitor the mental health of Wenchuan earthquake survivors and take appropriate post-disaster intervention measures.

PTSD, FOMO and fake news beliefs: a cross-sectional study of Wenchuan earthquake survivors.

BACKGROUND: Post-traumatic stress disorder (PTSD) sufferers show problematic patterns of Internet use such as fear of missing out (FOMO) and sharing misinformation and fake news. This study aimed to investigate these associations in survivors of the 2008 earthquake in Wenchuan, China. METHODS: A self-reported survey was completed by 356 survivors of the Wenchuan earthquake. A mediated structural equation model was constructed to test a proposed pattern of associations with FOMO as a mediator of the relationship between PTSD symptoms and belief in fake news, as well as moderators of this pathway. RESULTS: PTSD was directly associated with believing fake news (ß = 0.444, p < .001) and with FOMO (ß = 0.347, p < .001). FOMO mediated the association between PTSD and fake news belief (ß = 0.373, p < .001). Age moderated the direct (ß = 0.148, t = 3.097, p = .002) and indirect (ß = 0.145, t = 3.122, p = .002) pathways, with effects more pronounced with increasing age. Gender was also a moderator, with the indirect effect present in females but not in males (ß = 0.281, t = 6.737, p < .001). CONCLUSION: Those with higher PTSD symptoms are more likely to believe fake news and this is partly explained by FOMO. This effect is present in females and not males and is stronger in older people. Findings extend knowledge of the role of psychological variables in problematic Internet use among those with PTSD.

Chinese College Students' Death Cognition and its Long-Term Changes After Wenchuan Earthquake.

This study explores the cognitive structure of death and long-term changes of death cognition after catastrophes for Chinese college students. Two months before Wenchuan earthquake, a week after, a year after, and ten years after, a total of 1507 participants' associated words of death were collected, after clustering high-frequency words' similarity coefficients, results showed that death was represented by four advanced clusters: death contact, death anxiety and its reminders, deathafter, and defense mechanism; a week after earthquake, death anxiety and its reminders, defense mechanism were activated; a year after, death contact, afterdeath were appreciated, death anxiety and its reminders, defense mechanism were underappreciated, this phenomenon still existed even ten years later, which suggests that the earthquake permanently changed their death cognition, and this change stabilized one year later. In addition, this paper provides an effective method to uncover cognitive structure of one certain concept.

Well-being Effects of Natural Disasters: Evidence from China's Wenchuan Earthquake.

This study finds that the Wenchuan earthquake in 2008, one of China's most catastrophic earthquakes, substantially decreased victims' subjective well-being even after incorporating the offsetting effects of post-disaster relief programs. This net well-being impact lasted for nearly 10 years and was on average equivalent to a loss of 67% of the average equivalized household income. Although the post-disaster measures largely restored income, health, and employment, they failed to prevent well-being losses due to family dissolution, as reflected in the higher rates of divorce and widowhood after the earthquake. We find that rural populations, older adults, the less educated, and residents without social insurance were more vulnerable to the earthquake shock. This study uses six waves of a nationally representative dataset of China and a difference-in-differences approach to identify the short- and long-term causal well-being effects of the Wenchuan earthquake. Deeper analyses on mechanisms and heterogeneity suggest that post-disaster policies should focus more on aspects beyond economic factors and on the well-being of disadvantaged populations in particular. Supplementary Information: The online version contains supplementary material available at 10.1007/s10902-022-00609-z.

How Maternal Trauma Exposure Contributed to Children's Depressive Symptoms following the Wenchuan Earthquake: A Multiple Mediation Model Study.

Although well-established literature has indicated the burden of mental health among victims after the Wenchuan earthquake, no research has focused on the mental health of mothers and their children who experienced the earthquake and were pregnant during or shortly after it. This study investigates the relationship between maternal trauma exposure (TE) and children's depressive symptoms after the Wenchuan earthquake and explores the risk and protective factors underlying this relationship. A sample of 547 mother-child dyads, in which the mother experienced the Wenchuan earthquake, was used to assess maternal depressive symptoms, maternal TE, children's depressive symptoms, children's perceived impact of the earthquake and maternal posttraumatic growth (PTG). The results showed that maternal TE had two significant one-step indirect associations with children's depressive symptoms (through children's perceived impact of the earthquake and maternal PTG) and one two-step indirect association with children's depressive symptoms (through maternal depressive symptoms via children's perceived impact of the earthquake). The results indicated that maternal depressive symptoms, children's perceived impact of the earthquake and maternal PTG mediated the association between maternal TE and children's depressive symptoms. These findings highlight the importance of mothers in supporting the mental health of these children. Maternal depressive symptoms and PTG, two posttraumatic outcomes, played positive and negative roles in the intergenerational transmission of trauma. Thus, post-disaster interventions should reduce the maternal transmission of trauma-related information and improve maternal PTG to support children's mental health.

To stay or to move? Investigation on residents' migration intention under frequent secondary disasters in Wenchuan earthquake-stricken area.

The deterioration of the living environment caused by the earthquake is the main migration motivation of residents in the area of the secondary earthquake disaster, and their migration intention is one of the most important factors affecting residents' happiness. This paper uses 957 effective survey samples from 12 secondary geological disaster areas after the Wenchuan earthquake to research the migration intention of residents and its influencing factors. It can be found that 45.2% of residents are willing to migrate, which means they have an instinctive reaction to profit-seeking and harm-avoiding, but it has not become a realistic choice. Investigation facts and research results show that the instinctive response of profit-seeking and harm-avoiding drives residents to make different choices. The migration of residents in areas where secondary geological disasters occur is affected not only by disasters such as debris flow, landslides, and collapse, but also by many factors such as life convenience, family income, expectations for future life, gender, education level, psychological feeling. The improved life and the optimization of the economic conditions brought about by the success of post-disaster reconstruction have made the vast majority of people more confident in the future of the disaster-stricken areas, which made most people choose to stay in those areas. This paper will provide policy suggestions for residents' migration and the reconstruction of the local social governance system in secondary geological disaster areas, which is helpful to improve ecological livability and residents' happiness in the Wenchuan earthquake-stricken area.

Rural Post-Earthquake Resettlement Mode Choices: Empirical Case Studies of Sichuan, China.

Earthquakes occur frequently in rural areas of Sichuan, China, causing huge damage and high mortality. The built environment plays a significant role in providing residents with safe and resilient settlements in such areas. There is yet little research on how rural families in developing countries cope with geological disasters like earthquakes, and how built environmental factors would influence their resettlement choices which would directly affect their quality of life afterward. Urban planning activities should be accompanied by these insights to design and create human-centric resettlements accordingly. In this study, the resettlement choices after three major earthquakes in Sichuan were studied for this reason. Random sampling and face-to-face questionnaire surveys were combined with factor analysis and binary logistic regression to understand the resettlement modes desired by the residents and the influencing factors. The results show that residents who have lived in their current places long and whose houses were not built recently are more likely to choose the in-situ resettlement. Accessibility to employment and public services has a significant impact on residents' choice of in-situ resettlement or reallocated resettlement, and so does the previous resettlement experience. The research results can provide useful suggestions for Chinese rural area post-earthquake resettlement planning following a human-centric approach with empirical data.

Spatial-Temporal Evolution and Driving Forces of NDVI in China's Giant Panda National Park.

Identifying the ecological evolution trends and vegetation driving mechanisms of giant panda national parks can help to improve the protection of giant panda habitats. Based on the research background of different geomorphological zoning, we selected the MODIS NDVI data from 2000 to 2020 to analyze the NDVI trends using a univariate linear model. A partial correlation analysis and multiple correlation analysis were used to reveal the influence of temperature and precipitation on NDVI trends. Fourteen factors related to meteorological factors, topographic factors, geological activities, and human activities were selected, and the Geographically Weighted Regression model was used to study the mechanisms driving NDVI change. The results were as follows: (1) The NDVI value of Giant Panda National Park has fluctuated and increased in the past 21 years, with an annual growth rate of 4.7%/yr. Affected by the Wenchuan earthquake in 2008, the NDVI value fluctuated greatly from 2008 to 2012, and reached its peak in 2018. (2) The NDVI in 94% of the study area improved, and the most significant improvement areas were mainly distributed in the northern and southern regions of Southwest Subalpine and Middle Mountain and the Xiaoxiangling area. Affected by the distribution of fault zones and their local activities, vegetation degradation was concentrated in the Dujiangyan-Anzhou area of Hengduan Mountain Alpine Canyon. (3) The Geographically Weighted Regression analysis showed that natural factors were dominant, with climate and elevation having a double-factor enhancement effect, the peak acceleration of ground motion and fault zone having a superimposed effect, and river density and slope having a double effect, all of which had a significant impact on the NDVI value of the surrounding area. To optimize the ecological security pattern of the Giant Panda National Park, we recommended strengthening the construction of ecological security projects through monitoring meteorological changes, preventing, and controlling geo-hazards, and optimizing the layout and intensity of human activities.

Six-year changes of posttraumatic stress symptoms and depressive symptoms among Chinese earthquake survivors: A network analysis.

BACKGROUND: The risk factors of Posttraumatic Stress Symptoms (PTSS) and depressive symptoms have been well-established, but whether the network structure of their symptoms changes over time remains unclear. This study aims to examine the six-year changes of network structure of PTSS and depressive symptoms among Wenchuan earthquake adult survivors in China. METHODS: In this pooled cross-sectional study, respondents were sampled from the same population at each of the five waves (N = 1343, 1205, 1177, 1376, and 1339). The network structure of them was investigated using network analyses. RESULTS: The study shows network connections stable across waves were the positive connections between hyperarousal and intrusions, hyperarousal and somatic symptoms, and two dimensions of positive effects. Stable negative connections were those between depressed affects and positive effects, avoidance and depressed affects, avoidance with interpersonal symptoms and avoidance with somatic symptoms. Across waves, fearful emotion consistently was the strongest bridge symptom connecting with PTSS symptoms. However, for PTSS the strongest bridge symptom varied across time as it was avoidance in wave 1 but were hyperarousal in other four waves. LIMITATIONS: This study was based on a pooled cross-sectional survey, which inhibits conclusions regarding causal influences between symptoms at the individual patient level. CONCLUSIONS: The network structure of PTSS and depressive symptoms was partly stable, yet also varied across survey waves. Core symptom clusters for PTSS and depressive symptoms were avoidance and depressed affect, respectively. The central role of these clusters in PTSS and depressive symptoms has important implications to future psychiatric programs.

Using network analysis to explore the key bridge symptoms between posttraumatic stress symptoms and posttraumatic growth among survivors 10 years after the Wenchuan earthquake in China.

Despite previous research has illustrated there is high-coexistence between posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in the aftermath of traumatic events, few studies have conceptualized the coexistence mechanism of the two psychological phenomena. Using the network analysis, this study aimed to identify the key bridge symptoms and compare sex differences between PTSD symptoms and PTG elements in survivors 10 years after the Wenchuan earthquake in China. A total of 744 survivors 10 years after the Wenchuan earthquake in China completed self-reported questionnaires on demographics, PTSD symptoms (4-item of Posttraumatic Stress Disorder Checklist), and PTG (10-item of Posttraumatic Growth Inventory). Network analysis was used to identify the network structure of PTSD symptoms and elements of PTG, along with bridge symptoms. Additionally, sex differences in the network structure were compared by the Network Comparison Test. Results revealed that the network of PTSD symptoms and elements of PTG was robust to stability and accuracy tests. The key bridge symptoms in the network were "Stronger religious faith", "Changed priorities", and "Easily startled". There were significant differences in network global strength across sex, and network structure across the severity of property loss other than house damage. Future interventions targeting the three key bridge symptoms are expected to relieve the severity of PTSD and promote growth following exposure to traumatic events.

Community Disaster Resilience and Risk Perception in Earthquake-Stricken Areas of China.

OBJECTIVE: The purpose of this study is to further deepen our understanding of the relationship between community resilience and disaster risk perception of residents, so as to provide beneficial enlightenment for the construction of community resilience disaster prevention system and disaster risk management. METHODS: This study surveyed 327 rural households in four counties of Sichuan Province, China, that were affected by the Wenchuan and Lushan earthquakes. Community disaster resilience was divided into five dimensions: connection and caring, resources, transformative potential, disaster management, and information and communication. Residents' disaster risk perception was divided into three dimensions: possibility, threat, and worry. This study analyzed the characteristics of community disaster resilience and residents' disaster risk perceptions. Ordinary least squares (OLS) methods were used to explore the correlations between these factors. RESULTS: The results show that (1) Residents' overall disaster risk perception was at a moderate level, and the community's overall disaster resilience were above the moderate level. (2) Community connection and caring has a positive significant correlation with the possibility perception of disaster occurrence; transformative potential has a negative significant correlation with the possibility perception of disaster occurrence; the overall community disaster resilience has negative significant correlations with the possibility and the overall residents' perception of disaster risk occurrence. CONCLUSIONS: The implication for the local government is that the government should appropriately increase its contact with external institutions/organizations, especially some Non-Governmental Organization, to strengthen the resilience and disaster prevention capacity of the community. Establish and improve information and communication networks to ensure the timely and effective transmission of effective disaster information, and strengthen the supervision of the dissemination of false information to reduce the losses caused by false information to residents. Attention should be paid to psychological counseling for people in disaster-hit areas to reduce the psychological trauma of the disaster.

Valuable Clues for DCNN-Based Landslide Detection from a Comparative Assessment in the Wenchuan Earthquake Area.

Landslide inventories could provide fundamental data for analyzing the causative factors and deformation mechanisms of landslide events. Considering that it is still hard to detect landslides automatically from remote sensing images, endeavors have been carried out to explore the potential of DCNNs on landslide detection, and obtained better performance than shallow machine learning methods. However, there is often confusion as to which structure, layer number, and sample size are better for a project. To fill this gap, this study conducted a comparative test on typical models for landside detection in the Wenchuan earthquake area, where about 200,000 secondary landslides were available. Multiple structures and layer numbers, including VGG16, VGG19, ResNet50, ResNet101, DenseNet120, DenseNet201, UNet-, UNet+, and ResUNet were investigated with different sample numbers (100, 1000, and 10,000). Results indicate that VGG models have the highest precision (about 0.9) but the lowest recall (below 0.76); ResNet models display the lowest precision (below 0.86) and a high recall (about 0.85); DenseNet models obtain moderate precision (below 0.88) and recall (about 0.8); while UNet+ also achieves moderate precision (0.8) and recall (0.84). Generally, a larger sample set can lead to better performance for VGG, ResNet, and DenseNet, and deeper layers could improve the detection results for ResNet and DenseNet. This study provides valuable clues for designing models' type, layers, and sample set, based on tests with a large number of samples.

Gender differences in trajectories of mental health symptoms among Chinese earthquake survivors.

BACKGROUND: Posttraumatic stress symptoms and depressive symptoms are prevalent after natural disasters. However, in a Chinese trauma context, little research examined the long-term trajectories of these two symptoms with a gender perspective. METHODS: Data came from an 8-year longitudinal survey of 3522 Wenchuan earthquake adult survivors. We used multilevel growth-curve models to investigate the trajectories of PTSS and depressive symptoms; adopted conditional growth-curve models to explore the gender differences in trajectories together with gendered factors associated with mental health symptoms; conducted Chow tests to examine the significance of gender differences. Standardized coefficients, P values, and effect sizes were reported. RESULTS: With covariates controlled, both linear (ß = -1.33, p < 0.001, Cohen's d = 0.79) and quadratic effects (ß = 1.03, p < 0.001, Cohen's d = 0.59) of time were significant in PTSS trajectory, whereas quadratic effect (ß = 0.27, p < 0.001, Cohen's d = 0.14) in the declining depressive trajectory was clinically nonsignificant. Compared with men, women are at higher risk of PTSS (ß = 0.12, p < 0.001, Cohen's d = 0.21) and depressive symptoms (ß = 0.10, p < 0.001, Cohen's d = 0.20), but also with a faster-declining rate in PTSS within first five years after the disaster. No gender difference was found regarding depressive trajectory. Additionally, poor education and income associate with more PTSS in women, while sickness predicts severer depression in women and more PTSS in men. CONCLUSIONS: This study proposes a gendered U-shape trajectory for PTSS and a declining depressive trajectory without gender difference. The findings of this study shed light on mental health intervention in future natural disasters.

Trajectories of mental health symptoms predict long-term quality of life among Wenchuan adolescent survivors: A 10-year follow-up study.

PURPOSE: Previous studies usually examine the associations between psychological distresses and quality of life (QOL) with a variable-centred approach, while little is known about the effect of the individual variance in time-varying changes of psychological distresses on QOL. Therefore, this study aimed to examine whether individual variance in psychological distresses during the early phases post-earthquake would develop different QOL's levels among adolescent survivors 10-year after the Wenchuan earthquake. METHODS: Data were extracted from the Wenchuan Earthquake Adolescent Health Cohort Study. The current study included 744 adolescent survivors who effectively completed surveys at 6 months, 24 months, and 10 years after the earthquake. Self-report questionnaires were administered to collect information on socio-demographic characteristics, earthquake exposure, life events, anxiety symptoms, depressive symptoms, posttraumatic stress symptoms (PTSS), and QOL. Data were analysed using hierarchical multiple regression. RESULTS: Trajectories of psychological distresses were classified as follow: resistance (anxiety 40.73%; depression 54.70%; PTSS 74.46%), recovery (anxiety 17.20%; depression 9.27%; PTSS 10.35%), delayed dysfunction (anxiety 10.35%; depression 18.15%; PTSS 6.18%), and chronicity (anxiety 31.72%; depression 17.88%; PTSS 9.01%). After controlling covariates, hierarchical multiple regression only revealed that the anxiety trajectory with delayed dysfunction remained significantly predictive for four domains of QOL (physical health, psychological health, social relationships, and environment). CONCLUSION: The current study highlights the importance of focusing on the variations in trajectories of anxiety symptoms among disaster survivors and providing individualized mental health services to improve survivors' QOL.

Influence of post-traumatic status on health-related quality of life among survivors 10 years after the Wenchuan earthquake in China.

BACKGROUND: China is a country with frequent earthquakes. Beichuan was the epicenter of what was later called the Wenchuan earthquake, which caused nearly 80% of the houses in the area to collapse, with 8,605 people killed and 9,693 people missing. The aim of our study was to explore the prevalence of post-traumatic stress disorder (PTSD) and its influence on health-related quality of life (HRQOL) among the survivors 10 years after the 2008 Wenchuan earthquake in China. METHODS: A total of 610 survivors from Leigu town in Beichuan County were investigated by a systematic sampling method. Post-traumatic status, HRQOL, and demographic sources were measured by the PTSD Checklist Civilian Version (PCL-C), 36-item Health Survey Short Form (SF-36), and self-questionnaire, respectively. RESULTS: Ten years after the Wenchuan earthquake, the prevalence of PTSD for survivors was 1.6%. There were significant negative correlations between survivors' SF-36 scores and the scores of PCL-C. Higher scores in post-traumatic status were associated with a higher rate of poor physical HRQOL, which was lower than the mean score [adjusted odds ratio (OR) 1/4 0.96 per SD increase, P 1/4 0.001] and mental HRQOL (adjusted OR 1/4 0.93 per SD increase, P 1/4 0.001). The independent contribution of post-traumatic status to the risk for poor physical and mental HRQOL was 4.9% and 18.7% respectively. CONCLUSIONS: As time has elapsed, the incidence of PTSD has gradually declined after the Wenchuan earthquake. Post-traumatic status was found to influence the health related quality of life of survivors.

Risk factors of post-traumatic stress disorder 10 years after Wenchuan earthquake: a population-based case-control study.

AIMS: To investigate the prevalence of post-traumatic stress disorder (PTSD) symptoms in the hard-hit areas 10 years after the Wenchuan earthquake, and explore the risk factors of long-term PTSD among Wenchuan earthquake survivors. METHODS: A matched case-control study was conducted. The involving participants were from the hard-hit areas 10 years after the Wenchuan earthquake. The collected information includes demographic characteristics, socioeconomic status, behaviour habits, earthquake exposure, perceived social support, physical health and mental health. Mental health status was measured using the PTSD Checklist-Civilian Version (PCL-C). Respondents with PCL-C score ⩾38 were classified as cases, and then the cases and controls were matched based on age (±3 years) and community location according to a ratio of 1:3. RESULTS: We obtained 86 cases and 258 controls. After controlling for confounding factors, it was found that lower income (OR 2.42; 95% CI 1.16-5.03), chronic diseases (OR 3.00; 95% CI 1.31-6.88) and death of immediate families in the earthquake (OR 7.30; 95% CI 2.36-22.57) were significantly associated with long-term PTSD symptoms. CONCLUSION: Even 10 years after the Wenchuan earthquake, the survivors in the hard-hit areas still suffered from severe mental trauma. Low income, chronic diseases and death of immediate families in the earthquakes are significantly associated with long-term PTSD symptoms. Interventions by local governments and health institutions to address these risk factors should be undertaken to promote the health of survivors.

Paired assistance policy and recovery from the 2008 Wenchuan earthquake: a network perspective.

The role of the paired assistance policy (PAP) in facilitating recovery after the Wenchuan earthquake in China on 12 May 2008 is best analysed from a network perspective. This paper makes five assumptions to explore the relationship, and then draws on three additional cases to examine them. The key findings support all five assumptions. First, the interactions of authority compliance initiated the PAP, and second, the interactions of resource input significantly contributed to rapid reconstruction following the earthquake. Third, the interactions of knowledge transfer supported social system recovery, and fourth, the interactions of benefit reciprocity laid the foundation for sustainable recovery. Fifth, by contrast, the interactions of performance comparison caused suboptimal overfunding of particular public infrastructure projects and reduced local self-reliance to some extent. Finally, suggestions are made to improve the policy implications of extending the use of the PAP in other administrative contexts. The PAP could become an even more important policy device in the future.

Post-traumatic growth among 5195 adolescents at 8.5 years after exposure to the Wenchuan earthquake: Roles of post-traumatic stress disorder and self-esteem.

We evaluated the level of post-traumatic growth in a large sample of Chinese adolescent earthquake survivors (n = 5195) and relationships among self-esteem, post-traumatic stress disorder, and post-traumatic growth. This cross-sectional study indicated that the prevalence of post-traumatic growth among adolescent survivors was 14.8 percent. Post-traumatic growth was independently associated with self-esteem, severity of exposures, and avoidance facets of post-traumatic stress disorder. Post-traumatic stress disorder was found to be partially mediated by self-esteem on post-traumatic growth; and post-traumatic stress disorder was also a mediator between earthquake exposure and post-traumatic growth. This study suggests that future longitudinal research and clinical practice should test whether promoting self-esteem can enhance post-traumatic stress disorder treatment.

ICD-11 Posttraumatic Stress Disorder and Complex PTSD Among Hospital Medical Workers in China: Impacts of Wenchuan Earthquake Exposure, Workplaces, and Sociodemographic Factors.

BACKGROUND: Previous studies address posttraumatic stress disorder (PTSD) following disasters as a public health issue. However, few studies investigate the long-term effect of disaster exposure on PTSD among hospital medical workers (HMWs). OBJECTIVES: This study aimed to study the prevalence of ICD-11 PTSD and complex PTSD (CPTSD) among exposed and non-exposed HMWs 11 years after the Wenchuan earthquake in China, to identify the factors associated with PTSD and CPTSD scores, and to examine the factor structures of PTSD and CPTSD models. METHODS: A cross-sectional study was conducted using a self-administered online questionnaire. Two thousand fifty-nine valid samples were collected from four hospitals in 2019. Descriptive statistical analysis, multivariate regression models, and confirmatory factor analysis (CFA) were performed. RESULTS: The prevalence of PTSD and CPTSD was 0.58 and 0.34%, respectively. The unexposed group reported higher PTSD and CPTSD scores than the exposed group. The type of workplace and marital status were significantly associated with the PTSD and CPTSD scores of HMWs. The CFA results indicate that both the correlated first-order model and the correlated two-layer model were a good fit to explain the structure of PTSD and CPTSD. CONCLUSION: These findings suggest that few HMWs who were exposed to the Wenchuan earthquake suffered from PTSD or CPTSD 11 years following the disaster. However, psychological support was still necessary for all HMWs, especially for unmarried HMWs who were Working in smaller hospitals. Further research is required to analyze mental health status using ICD-11 PTSD and CPTSD to provide ongoing evidence to help HWMs cope effectively with the challenges of future disasters.

Consistencies and differences in posttraumatic stress disorder and depression trajectories from the Wenchuan earthquake among children over a 4-year period.

BACKGROUND: Posttraumatic stress disorder (PTSD) and depression are the most prevalent mental disorders following disasters, and they often co-occur. The current study investigated trajectories of PTSD and depression among children after exposure to the Wenchuan earthquake and identified factors associated with PTSD or depression trajectories. METHODS: Three hundred children who were exposed to the Wenchuan earthquake reported PTSD and depression symptoms 4, 16, 29, 40 and 52 months after the disaster, and potential predictors (age, earthquake exposure, prequake trauma and parental relationship) were identified. The PTSD and depression trajectories were identified with latent growth mixture modeling (LGMM), and the predictors were explored with multinomial logistic regression. RESULTS: Two depression trajectories emerged: resilient (66.2%) and chronic (33.8%). Three PTSD trajectories emerged: resilient (74.9%), recovery (7.5%) and relapsing (17.7%). Overall, 57.3% of the children had low depression and PTSD symptoms over four years. Depression trajectories were significantly predicted by age and parental relationship, while PTSD trajectories were significantly predicted by trauma exposure and prequake trauma experience. LIMITATIONS: The children's prequake mental health statuses were unknown, and all assessments relied on self-report questionnaires. CONCLUSION: The postdisaster developmental course of depression was more stable than that of PTSD, and PTSD and depression had different risk factors. Previous studies that focus only on PTSD or depression trajectories may overestimate children's resilient responses. Longer-term postdisaster intervention should pay more attention to depression than to PTSD.