Three-year follow-up study of the relationship between posttraumatic stress symptoms and quality of life among earthquake survivors in Yu-Chi, Taiwan

Abstract

Objective: To prospectively evaluate the relationship between the clinical course of posttraumatic stress symptoms (PTSS) and quality of life (QOL) among Taiwan earthquake survivors for 3 years.

Methods: A population survey was done in a Taiwan township near the epicenter of a severe earthquake (7.3 on the Richter scale). Trained assistants used the Medical Outcomes Study Short Form-36 (MOS SF-36) and the Disaster-Related Psychological Screening Test to interview earthquake survivors 16 and older. A total of 1756 respondents were surveyed during the 3-year follow-up period.

Results: At 0.5 and 3 years after the earthquake, the estimated rate of PTSS (cutoff point, 3/4) was 23.8% and 4.4%, respectively. The survivors with PTSS scored lower for each concept of the MOS SF-36 at these two intervals. Three years after the earthquake, the survivors in the persistently healthy group showed the highest scores in all subscales and domains of the MOS SF-36; second-highest was the recovering group; third-highest was the delayed PTSS group; and the persistent PTSS group showed the lowest scores in all concepts and domains. Notably, survivors with delayed onset PTSS exhibited a lower QOL when PTSS occurred.

Conclusions: Three years after the earthquake, the estimated rate of PTSS had declined, and the QOL of the survivors varied according to how their PTSS had progressed.

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.