Three-year follow-up study of the relationship between posttraumatic stress symptoms and quality of life among earthquake survivors in Yu-Chi, Taiwan
Introduction
Most studies have shown evidence of psychological sequelae in survivors after a disaster, including posttraumatic stress disorder (PTSD), major depressive disorder; sleep disorder, anxiety, and substance abuse (Rubonis and Bickman, 1991, Maj et al., 1989, Green et al., 1992, McFarlane and Papay, 1992, Lima et al., 1989, Holbrook et al., 2002, Wang et al., 2000a, Holbrook et al., 2001, Chou et al., 2004a, Chou et al., 2004b, Tural et al., 2004, Armen, 1993, Schelling et al., 1998, Ware and Sherbourne, 1992). More recent work has supported earlier observations that traumatic events, including man-made and natural disasters, cause emotional, biological, behavioral, and interpersonal alternations, and elicit PTSD (McFarlane and Papay, 1992). Earthquakes caused some of the most devastating natural disasters of the 20th century (Rubonis and Bickman, 1991, Maj et al., 1989, Green et al., 1992, Lima et al., 1989). The prevalence of PTSD was 10.0–34.3% in Taiwan after the 1999 earthquake (Chou et al., 2004a, Chou et al., 2004b), 25% in Turkey after the 1999 earthquake (Tural et al., 2004), and 74% in Armenia after the 1988 earthquake (Armen, 1993). Understanding how a catastrophic earthquake and its sequelae affect people is necessary for determining their quality of life (QOL) (Wang et al., 2000a, Chou et al., 2004a, Chou et al., 2004b).
Several follow-up studies have suggested the association of PTSD with lower QOL in survivors of physical trauma or illness (Holbrook et al., 2002, Holbrook et al., 2001, Schelling et al., 1998). For example, Holbrook et al. (2001), in a study of eligible trauma patients, reported PTSD had a prolonged and profound impact on short- and long-term outcomes and on QOL. Stress symptom scores were the most significant predictors of mental health-related QOL outcomes. However, we are aware of only a few studies that have specifically investigated PTSD among adults after natural disasters. The results of these studies indicated that PTSD could have a persistent course over many years (Green et al., 1992, McFarlane and Papay, 1992, Lima et al., 1989, Holbrook et al., 2002, Wang et al., 2000a, Chou et al., 2004a). The experience of an earthquake was associated with a multidimensional impairment of QOL, and that prompt and effective post-earthquake intervention mitigated the impact of the initial experience and reduced the probability of developing PTSD (Wang et al., 2000a, Chou et al., 2004a). However, few follow-up studies have measured changes in QOL when PTSD is remissive or delayed.
The International QOL Assessment project developed by Ware and Sherbourne (1992) was conducted to test the conceptual equivalence and cross-cultural relevance of the Medical Outcomes Study Short Form-36 (MOS SF-36) in different countries (Hays et al., 1988). One Taiwanese version of the MOS SF-36 was conducted (Fuh et al., 2000). Although most studies (Wang et al., 2001, Salman et al., 2001) have used the MOS SF-36 to examine the relationship between physical illness and QOL, only a few have examined the relationship between mental disorders and QOL (Wang et al., 2000a, Holbrook et al., 2001, Chou et al., 2004a, Chou et al., 2004b). Therefore, the purpose of our study was to prospectively evaluate the relationship between the clinical course of posttraumatic stress symptoms (PTSS) and QOL among earthquake survivors 3 years after a major earthquake.
Section snippets
Subjects
The devastating Chi-Chi earthquake, which registered 7.3 on the Richter scale, struck Taiwan in the early morning of September 21, 1999. More than 10,000 people died or were injured as a result (Chou et al., 2004b). Yu-Chi Township, only 17 km from the epicenter, was selected for the population survey because it was a representative sample of a conservative and traditional Taiwanese township with severe damage. Earthquake survivors 16 and older were included in this survey.
There were 4223
Results
The average age of the 1756 respondents was 54.5 ± 16.7 (range: 16–98); 54.4% were women (male: 801; female: 955). The educational level was predominantly primary school or lower (64.5%). Most respondents (77.5%) were married. Because most of the residents lost to follow-up were those who left Yu-Chi Township for a job, they were younger, more predominantly male, unmarried, and better educated than the final sample.
At 0.5 and 3 years after the earthquake, the estimated rate of PTSS was 23.8% and
Discussion
We believe that the study has several strengths: (1) it is one of only a few epidemiological studies of the relationship between PTSS and QOL in survivors after a natural disaster; (2) our research teams monitored these township residents for 3 years; and (3) in general, DRPST can be used to effectively and rapidly screen for PTSS after an earthquake, despite the usual resource limitations (Chou et al., 2003). However, the study has three limitations: (1) We lost contact with those who left the
Conclusion
Three years after the earthquake, the prevalence of PTSS had declined. Participants with PTSS demonstrated a lower QOL for physical and mental components at both 0.5 and 3 years after the quake, and the QOL of the respondents varied with how much their PTSS had improved.
With the fading of the disaster, the QOL of the persistently healthy and persistent PTSS groups improved. The recovery group improved the most in every QOL subscale. Nonetheless, the QOL of the group with delayed PTSS worsened
Acknowledgements
The study was supported by grants from the National Science Council, Republic of China (Nos. NSC 90-2625-Z-010-001 and NSC 91-2625-Z-280-001).
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