Prevalence of post-traumatic stress disorder after earthquakes among the elderly in China: A meta-analysis

doi:10.5847/wjem.j.1920-8642.2021.02.009

Abstract

Abstract:

BACKGROUND: The study aims to investigate the occurrence of post-traumatic stress disorder (PTSD) after earthquakes among the elderly.

METHODS: Data from cross-sectional studies focusing on the prevalence of PTSD after earthquakes among the elderly were collected from PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure in December 2019. The search terms included post-traumatic stress disorder, earthquake, and elderly. This study used Review Manager 5.0 to evaluate the impact of the results. In addition, forest plots, sensitivity analysis, and bias analysis were carried out on the included articles. The combined estimate of the risk ratio and the standard deviation of the 95% confidence interval (95% CI) were measurements of the size of the effect.

RESULTS: There were 4,834 patients included from 10 eligible studies. The sample sizes of PTSD group and non-PTSD group were 1,277 and 3,557, respectively. The meta-analysis showed that the overall occurrence of PTSD after earthquakes among the elderly was 0.25; the occurrence in females was higher than that in males, and the occurrence in the same province indicated little difference (Wenchuan city 0.25 and Ya’an city 0.24).

CONCLUSIONS: After earthquakes, the occurrence of PTSD is higher among the elderly than among other age groups, and higher among the females than among the males, while there is little difference among different areas within the same province. This indicated that prioritized specific psychological interventions should be provided to the aged and the females.

Key words: Post-traumatic stress disorder, The elderly, Earthquake

Yong Liang, Hong Zeng, Yu-geng Liu, Ai-min Xu, Wen-hong Liu. Prevalence of post-traumatic stress disorder after earthquakes among the elderly in China: A meta-analysis[J]. World Journal of Emergency Medicine, 2021, 12(2): 137-142.

Figures/Tables 3

Table 1

Table 2

Figure 1.

References 36

1	Zhu CZ, Situ MJ, Zhang Y, Fang H, Jing LS, Wang D , et al. Influence factors of post-traumatic stress disorder (PTSD) and depression symptoms in children and adolescents after Wenchuan earthquake in China. Chin J Prev Med. 2011; 45(6):531-6.
2	Tang BH, Deng QY, Glik D, Dong JQ, Zhang LL . A meta-analysis of risk factors for post-traumatic stress disorder (PTSD) in adults and children after earthquakes. Int J Environ Res Public Health. 2017; 14(12):E1537. doi: 10.3390/ijerph14121537 pmid: 29292778
3	Shang J, Lui S, Meng Y, Zhu H, Qiu C, Gong Q , et al. Alterations in low-level perceptual networks related to clinical severity in PTSD after an earthquake: a resting-state fMRI study. PLoS One. 2014; 9(5):e96834. doi: 10.1371/journal.pone.0096834 pmid: 24823717
4	Wang X, Gao L, Shinfuku N, Zhang H, Zhao C, Shen Y . Longitudinal study of earthquake-related PTSD in a randomly selected community sample in North China. Am[J] Psychiatry. 2000; 157(8):1260-6.
5	Zhao CZ, Wang XD, Gao L . Longitudinal study of earthquake-related PTSD in North China. Chinese Mental Health Journal. 2000; 14(6):361-3.
6	Zhao CZ, Li JF, Wang MS, Fan QL, Zhang F, Zhang HB , et al. Prevalence and correlated factors of PTSD in adolescents 17 months after earthquake. Chinese Mental Health Journal. 2001; 15(3):145-7.
7	Ziaaddini H, Nakhaee N, Behzadi K . Prevalence and correlates of PTSD among high school students after the earthquake disaster in the City of Bam, Iran. Am[J] Appl Sci. 2009; 6(1):130-2. doi: 10.3390/app6050130
8	Qu Z, Wang CW, Zhang X, Ho AH, Wang X, Chan CL . Prevalence and determinants of depression among survivors 8 months after the Wenchuan earthquake.[J] Nerv Ment Dis. 2014; 202(4):275-9. doi: 10.1097/NMD.0000000000000118
9	Liu P, Wang L, Cao CQ, Wang RC, Zhang JX, Zhang B , et al. The underlying dimensions of DSM-5 posttraumatic stress disorder symptoms in an epidemiological sample of Chinese earthquake survivors.[J] Anxiety Disord. 2014; 28(4):345-51. doi: 10.1016/j.janxdis.2014.03.008
10	Cao CQ, Wang L, Wang RC, Qing YL, Zhang JX . TPH2 genotype is associated with PTSD’s avoidance symptoms in Chinese female earthquake survivors. Psychiatr Genet. 2014; 24(6):257-61. doi: 10.1097/YPG.0000000000000048 pmid: 25014617
11	Giannopoulou I, Dikaiakou A, Yule W . Cognitive-behavioural group intervention for PTSD symptoms in children following the Athens 1999 earthquake: a pilot study. Clin Child Psychol Psychiatry. 2006; 11(4):543-53. doi: 10.1177/1359104506067876 pmid: 17163223
12	de Berardis D, Fornaro M, Orsolini L, Valchera A, Carano A, Vellante F , et al. Alexithymia and suicide risk in psychiatric disorders: a mini-review. Front Psychiatry. 2017; 8:148. doi: 10.3389/fpsyt.2017.00148 pmid: 28855878
13	Engel-yeger B, Muzio C, Rinosi G, Solano P, Geoffroy PA, Pompili M , et al. Extreme sensory processing patterns and their relation with clinical conditions among individuals with major affective disorders. Psychiatry Res. 2016; 236:112-8. doi: 10.1016/j.psychres.2015.12.022 pmid: 26738981
14	Li HH, Wang L, Shi ZB, Zhang YQ, Wu KK, Liu P . Diagnostic utility of the PTSD checklist in detecting PTSD in Chinese earthquake victims. Psychol Rep. 2010; 107(3):733-9. doi: 10.2466/03.15.20.PR0.107.6.733-739 pmid: 21323132
15	Inkelas M, Loux LA, Bourque LB, Widawski M, Nguyen LH . Dimensionality and reliability of the Civilian Mississippi Scale for PTSD in a postearthquake community.[J] Trauma Stress. 2000; 13(1):149-67.
16	Sezgin U, Punamäki RL . Earthquake trauma and causal explanation associating with PTSD and other psychiatric disorders among South East Anatolian women.[J] Affect Disord. 2012; 141(2-3):432-40. doi: 10.1016/j.jad.2012.03.005
17	Chen GH, Shen HZ, Chen GM . A cross-sectional study on posttraumatic stress disorder among elderly Qiang citizens 3 years after the Wenchuan earthquake in China. Can[J] Psychiatry. 2012; 57(9):547-53.
18	Chen H, Chen YL, Au M, Feng L, Chen Q, Guo HX , et al. The presence of post-traumatic stress disorder symptoms in earthquake survivors one month after a mudslide in southwest China. Nurs Health Sci. 2014; 16(1):39-45. doi: 10.1111/nhs.12127 pmid: 24635896
19	Xiao C, Zhao XM, Huang XY . Study on suspected post-traumatic stress disorder in the elderly at 6 months after Lushan earthquake. Beijing Da Xue Xue Bao Yi Xue Ban. 2015; 47(6):1046-9.
20	Fan HM, Sun MQ, Xiao XR, He R, Shen GL, Li Y , et al. Investigation on post-traumatic stress disorder of old cadres hospitalized in Chengdu Military Region General Hospital after Wenchuan earthquake. Occupational Health and Damage. 2009; 24(6):337-9.
21	Fan HM, Sun MQ, Xiao XR, He R, Shen GL, Li Y , et al. Investigation on post-traumatic stress disorder of elderly military hospitalized cadres after Wenchuan earthquake. Sichuan Medicine. 2010; 31(7):1012-4.
22	He HQ, Yang HQ, Huang BX . Incidence and influencing factors of post-traumatic stress disorder in the elderly in different disaster areas after Wenchuan earthquake. Chinese Journal of Gerontology. 2009; 29(10):1275-7.
23	Jia ZB, Tian WH, Liu WZ, Cao Y, Yan J, Shun ZS . Are the elderly more vulnerable to psychological impact of natural disaster? A population-based survey of adult survivors of the 2008 Sichuan earthquake. BMC Public Health. 2010; 10:172. doi: 10.1186/1471-2458-10-172 pmid: 20353554
24	Kang P, Lv Y, Hao L, Tang BH, Liu ZP, Liu X , et al. Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: a neglected problem. Psychiatry Res. 2015; 230(2):517-23. pmid: 26476590
25	Kun P, Tong X, Liu Y, Pei X, Luo H . What are the determinants of post-traumatic stress disorder: age, gender, ethnicity or other? Evidence from 2008 Wenchuan earthquake. Public Health. 2013; 127(7):644-52. doi: 10.1016/j.puhe.2013.04.018 pmid: 23806187
26	Zhang Z, Shi ZB, Wang L, Liu MX . Post-traumatic stress disorder, anxiety and depression among the elderly: a survey of the hard-hit areas a year after the Wenchuan earthquake. Stress Health. 2012; 28(1):61-8. doi: 10.1002/smi.1403 pmid: 22259159
27	Thordardottir K, Gudmundsdottir R, Zoëga H, Valdimarsdottir UA, Gudmundsdottir B . Effects of Yoga practice on stress-related symptoms in the aftermath of an earthquake: a community-based controlled trial. Complement Ther Med. 2014; 22(2):226-34. doi: 10.1016/j.ctim.2014.01.008
28	Farooqui M, Quadri SA, Suriya SS, Khan MA, Ovais M, Sohail Z , et al. Posttraumatic stress disorder: a serious post-earthquake complication. Trends Psychiatry Psychother. 2017; 39(2):135-43. doi: 10.1590/2237-6089-2016-0029 pmid: 28700042
29	Eksi A, Peykerli G, Saydam R, Toparla D, Braun KL . Vivid intrusive memories in PTSD: responses of child earthquake survivors in Turkey.[J] Loss Trauma. 2008; 13(2-3):123-55.
30	Wang SL, Tao J, An Y . Analysis of acute and post-traumatic stress symptoms and related factors among victims of Wenchuan earthquake in Sichuan Province. China Journal of Nature Medicine. 2009; 11(05):328-31.
31	Song YQ, Zhou DF, Wang XD . Increased serum cortisol and growth hormone levels in earthquake survivors with PTSD or subclinical PTSD. Psychoneuroendocrinology. 2008; 33(8):1155-9. doi: 10.1016/j.psyneuen.2008.05.005
32	Cheng YZ, Wang F, Wen J, Shi YK . Risk factors of post-traumatic stress disorder (PTSD) after Wenchuan earthquake: a case control study. PLoS One. 2014; 9(5):e96644. doi: 10.1371/journal.pone.0096644 pmid: 24800944
33	Samouei R, Shooshtari S, Bahrami M, Abedi MR, Maracy MR . Prioritization of factors related to mental health of women during an earthquake: A qualitative study. World[J] Emerg Med. 2019; 10(3):160-8.
34	Wu CH, Chen SH, Weng LJ, Wu YC . Social relations and PTSD symptoms: a prospective study on earthquake-impacted adolescents in Taiwan.[J] Trauma Stress. 2009; 22(5):451-9.
35	Naeem F, Ayub M, Masood K, Gul H, Khalid M, Farrukh A , et al. Prevalence and psychosocial risk factors of PTSD: 18 months after Kashmir earthquake in Pakistan.[J] Affect Disord. 2011; 130(1-2):268-74. doi: 10.1016/j.jad.2010.10.035
36	Matsubara C, Murakami H, Imai K, Mizoue T, Akashi H, Miyoshi C , et al. Prevalence and risk factors for post-traumatic stress reaction among resident survivors of the tsunami that followed the great east Japan earthquake, March 11, 2011. Disaster Med Public Health Prep. 2016; 10(5):746-53. doi: 10.1017/dmp.2016.18 pmid: 27075401

Study	Year	Language	Country	Age range, years	Groups	n	Year of onset
Chen et al^[17]	2012	English	China	71.3±11.7	PTSD	65	July 2011 to August 2011
Chen et al^[17]	2012	English	China	71.3±11.7	Non-PTSD	222	July 2011 to August 2011
Chen et al^[18]	2014	English	China	75.0±13.4	PTSD	194	October 2010 to November 2010
Chen et al^[18]	2014	English	China	75.0±13.4	Non-PTSD	845	October 2010 to November 2010
Xiao et al^[19]	2015	Chinese	China	78.0±11.2	PTSD	491	October 2010 to November 2010
Xiao et al^[19]	2015	Chinese	China	78.0±11.2	Non-PTSD	1,018	October 2010 to November 2010
Fan et al^[20]	2009	Chinese	China	82.5±7.7	PTSD	35	May 2008 to June 2008
Fan et al^[20]	2009	Chinese	China	82.5±7.7	Non-PTSD	135	May 2008 to June 2008
Fan et al^[21]	2010	Chinese	China	80.2±7.2	PTSD	35	May 2008 to June 2008
Fan et al^[21]	2010	Chinese	China	80.2±7.2	Non-PTSD	135	May 2008 to June 2008
He et al^[22]	2009	Chinese	China	72.3±8.2	PTSD	154	June 2008 to July 2008
He et al^[22]	2009	Chinese	China	72.3±8.2	Non-PTSD	316	June 2008 to July 2008
Jia et al^[23]	2010	English	China	58.5±11.9	PTSD	31	August 2009 and September 2009
Jia et al^[23]	2010	English	China	58.5±11.9	Non-PTSD	107	August 2009 and September 2009
Kang et al^[24]	2015	English	China	62.3±12.5	PTSD	66	December 2010 to January 2011
Kang et al^[24]	2015	English	China	62.3±12.5	Non-PTSD	303	December 2010 to January 2011
Kun et al^[25]	2013	English	China	59.5±13.5	PTSD	134	August 2008 to September 2008
Kun et al^[25]	2013	English	China	59.5±13.5	Non-PTSD	264	August 2008 to September 2008
Zhang et al^[26]	2011	English	China	69.0±7.1	PTSD	72	June 2009 to July 2009
Zhang et al^[26]	2011	English	China	69.0±7.1	Non-PTSD	212	June 2009 to July 2009

Study	Risk of bias					Concern of applicability
Study	Patient	Index test	Reference standard	Flow and time	Overall	Patient	Index test	Reference standard	Overall
Chen et al^[17]	Yes	?	Yes	Yes	Low	Yes	Yes	Yes	Low
Chen et al^[18]	?	No	Yes	Yes	Low	Yes	Yes	Yes	Low
Xiao et al^[19]	Yes	No	Yes	No	High	Yes	Yes	Yes	Low
Fan et al^[20]	Yes	No	Yes	?	Low	Yes	Yes	Yes	Low
Fan et al^[21]	?	?	Yes	Yes	Low	Yes	Yes	Yes	Low
He et al^[22]	Yes	?	Yes	Yes	Low	Yes	Yes	Yes	Low
Jia et al^[23]	Yes	Yes	No	No	High	Yes	Yes	Yes	Low
Kang et al^[24]	Yes	Yes	No	Yes	Low	Yes	Yes	Yes	Low
Kun et al^[25]	Yes	Yes	Yes	No	Low	Yes	Yes	Yes	Low
Zhang et al^[26]	Yes	Yes	No	Yes	Low	Yes	Yes	Yes	Low

[1]	Rahele Samouei, Shahin Shooshtari, Masoud Bahrami, Mohammad Reza Abedi, Mohammad Reza Maracy. Prioritization of factors related to mental health of women during an earthquake: A qualitative study [J]. World Journal of Emergency Medicine, 2019, 10(3): 160-168.
[2]	Salima Kerai, Omrana Pasha, Uzma Khan, Muhammad Islam, Nargis Asad, Junaid Razzak. Association of post-traumatic stress disorder and work performance: A survey from an emergency medical service, Karachi, Pakistan [J]. World Journal of Emergency Medicine, 2017, 8(3): 214-222.
[3]	Nahid Tavakoli, Mohammad H Yarmohammadian, Reza Safdari, Mahmoud Keyvanara. Patient tracking in earthquake emergency response in Iran: A qualitative study [J]. World Journal of Emergency Medicine, 2017, 8(2): 91-98.
[4]	Sedigheh Iranmanesh, Batool Tirgari, Hojat Sheikh Bardsiri. Post-traumatic stress disorder among paramedic and hospital emergency personnel in south-east Iran [J]. World Journal of Emergency Medicine, 2013, 4(1): 26-31.
[5]	Xiang-hui Li, Shi-ke Hou, Jing-chen Zheng, Hao-jun Fan, Jian-qi Song. Post-disaster medical rescue strategy in tropical regions [J]. World Journal of Emergency Medicine, 2012, 3(1): 23-28.