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Epidemiological Characteristics and Risk Factors of Posttraumatic Stress Disorder in Chinese Children After Exposure to an Injury

Published online by Cambridge University Press:  15 October 2019

Huiting Yu
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
Chan Nie
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
Yanna Zhou
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
Xue Wang
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
Haiyan Wang
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
Xiuquan Shi*
Affiliation:
Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China Center for Injury Research and Policy and Center for Pediatric Trauma Research, The Research Institute at Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
*
Correspondence and reprint requests to Xiuquan Shi, Department of Epidemiology and Health Statistics, School of Public Health, Zunyi Medical University, Zunyi563006, Guizhou, PR China (e-mail: [email protected]).

Abstract

Objective:

The aim of this study is to describe the risk factors of injured children’s posttraumatic stress disorder (PTSD) in China and provide the scientific data for PTSD prevention and control in children.

Methods:

Electronic databases, including Medline, Science Direct, Google Scholar, and CNKI (China National Knowledge Infrastructure), were searched for articles published on or before October 30, 2018, searching for the words, “PTSD,” “child”/“children,” “injury”/“injuries,” and “China”/“Chinese.” Forty-seven articles met the inclusion criteria and were meta-analyzed using random-effect models.

Results:

The total sample size in our meta-analysis was 65 298, and there were 13 402 children diagnosed with PTSD. The prevalence of PTSD after suffering from injury was 20.52% (95% CI = 17%–23%). PTSD occurrence was higher in girls than boys (24.61% vs 19.36%, P < 0.001). The PTSD rate for students was 51.82%, 37.12%, and 14.02% in senior, junior high school children, and primary school student, respectively. PTSD prevalence was 58.93% in rural children and higher than the urban children (57.36%). The prevalence of PTSD in ethnic minority children was significantly higher than that of Han Chinese children (35.38% vs 13.50%).

Conclusion:

PTSD in injured children is significantly higher in girls, senior high school children, in rural areas, and in ethnic minority children. PTSD prevention and control should be focused on these 4 subgroups.

Type
Systematic Review
Copyright
© 2019 Society for Disaster Medicine and Public Health, Inc.

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References

REFERENCES

Chen, Z, Zhou, D, Cao, J, et al. The epidemiological characteristics and the progress of prevention and treatment of post-traumatic stress disorder. Int J Psychiatry. 2018;45(5):797-799.Google Scholar
Acharya, S, Bhatta, DN, Assannangkornchai, S. Post-traumatic stress disorder symptoms among children of Kathmandu 1 year after the 2015 earthquake in Nepal. Disaster Med Public Health Prep. 2018;12(4):486-492.10.1017/dmp.2017.100CrossRefGoogle ScholarPubMed
Qi, W, Gevonden, M, Shalev, A. Prevention of post-traumatic stress disorder after trauma: current evidence and future directions. Curr Psychiatry Rep. 2016;18(2):20.CrossRefGoogle ScholarPubMed
American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
Breslau, N. The epidemiology of posttraumatic stress disorder: what is the extent of the problem? J Clin Psychiatry. 2001;62(Suppl 17):16-22.Google Scholar
Copeland, WE, Keeler, G, Angold, A. Posttraumatic stress without trauma in children. Am J Psychiatry. 2010;167(9):1059-1065.CrossRefGoogle ScholarPubMed
Bal, A. Post-traumatic stress disorder in Turkish child and adolescent survivors three years after the Marmara earthquake. Child Adolesc Psychiatry Ment Health. 2010;13(3):134-139.CrossRefGoogle Scholar
Shemesh, E, Bartell, A, Newcorn, JH. Assessment and treatment of depression in medically ill children. Curr Psychiatry Rep. 2002;4(2):88-92.CrossRefGoogle ScholarPubMed
Zhang, H. Epidemiological characteristics and risk factors of injuries among children in China. Occup Health. 2016;32(19):2725-2728.Google Scholar
Eli, B, Cheng, J, Liang, YM, et al. The relationship between post-traumatic stress and depressive symptoms in children: a two-year longitudinal study. Chin Sci Bull. 2018;63(20):2071-2080.Google Scholar
Li, J, Zhang, XW, Wang, CL, et al. Investigation of posttraumatic stress disorder in children after animal-induced injury in China. Pediatrics. 2010;126(2):e320-e324.Google Scholar
Tang, WJ, Zhao, JD, Lu, YL. Suicidality, posttraumatic stress, and depressive reactions after earthquake and maltreatment: a cross-sectional survey of a random sample of 6132 Chinese children and adolescents. J Affect Disord. 2018;232:363.10.1016/j.jad.2018.02.081CrossRefGoogle ScholarPubMed
Xu, W, Yuan, GZ, Liu, Z, et al. Prevalence and predictors of PTSD and depression among adolescent victims of the summer 2016 tornado in Yancheng City. Arch Psychiatr Nurs. 2018;32(5):777-781.CrossRefGoogle ScholarPubMed
Wang, FM. Analysis on the influencing factors of post-traumatic stress disorder in children with road traffic injury. Dissertation. Wenzhou Medical University; 2017.Google Scholar
Shi, X, Zhou, Y, Geng, F, et al. Posttraumatic stress disorder symptoms in parents and adolescents after the Wenchuan earthquake: a longitudinal actor-partner interdependence mode. J Affect Disord. 2018;226:301-306.CrossRefGoogle Scholar
Dorsey, S, McLaughlin, KA, Kerns, SEU, et al. Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol. 2017;46(3):303-330.CrossRefGoogle ScholarPubMed
Loney, PL, Chambers, LW, Bennett, KJ, et al. Critical appraisal of the health research literature: prevalence or incidence of a health problem. Chronic Dis Can. 1998;19(4):170-176.Google ScholarPubMed
Higgins, JP, Thompson, SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539-1558.CrossRefGoogle ScholarPubMed
Higgins, JP, Thompson, SG, Deeks, JJ, et al. Measuring inconsistency in meta-analyses. BMJ (Clin Res Educ). 2003;327:557-560.CrossRefGoogle ScholarPubMed
Cheng, J, Liang, Y, Fu, L, et al. Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake. Eur J Psychotraumatol. 2018;9(1):e1472992.CrossRefGoogle ScholarPubMed
Jia, Z, Shi, L, Duan, G, et al. Traumatic experiences and mental health consequences among child survivors of the 2008 Sichuan earthquake: a community-based follow-up study. BMC Public Health. 2013;13(1):104.CrossRefGoogle ScholarPubMed
Jin, Y, Deng, H, An, J, et al. The prevalence of PTSD symptoms and depressive symptoms and related predictors in children and adolescents 3 years after the Ya’an earthquake. Child Psychiatry Human Dev. 2019;50(2):300-307. doi: 10.1007/s10578-018-0840-6.CrossRefGoogle ScholarPubMed
Liu, D, Fu, L, Jing, Z, et al. Post-traumatic stress disorder and its predictors among Tibetan adolescents 3 years after the high-altitude earthquake in China. Arch Psychiatr Nurs. 2016;30(5):593-599.CrossRefGoogle Scholar
Liu, M, Wang, L, Shi, Z, et al. Mental health problems among children one-year after Sichuan earthquake in China: a follow-up study. PLoS One. 2011;6(2):e14706.10.1371/journal.pone.0014706CrossRefGoogle ScholarPubMed
Ma, X, Liu, X, Hu, X, et al. Risk indicators for post-traumatic stress disorder in adolescents exposed to the 5.12 Wenchuan earthquake in China. Psychiatry Res. 2011;189(3):385-391.CrossRefGoogle ScholarPubMed
Peng, M, Liu, A, Zhou, J, et al. Association between posttraumatic stress disorder and preflood behavioral characteristics among children aged 7-15 years in Hunan, China. Med Princ Pract. 2011;20(4):336-340.CrossRefGoogle ScholarPubMed
Tang, W, Lu, Y, Xu, J. Post-traumatic stress disorder, anxiety and depression symptoms among adolescent earthquake victims: comorbidity and associated sleep-disturbing factors. Soc Psychiatry Psychiatr Epidemiol. 2018;53(11):1241-1251.CrossRefGoogle ScholarPubMed
Tang, W, Zhao, J, Lu, Y, et al. Mental health problems among children and adolescents experiencing two major earthquakes in remote mountainous regions: a longitudinal study. Compr Psychiatry. 2017;72:66-73.CrossRefGoogle ScholarPubMed
Wang, L, Zhang, L, Armour, C, et al. Assessing the underlying dimensionality of DSM-5 PTSD symptoms in Chinese adolescents surviving the 2008 Wenchuan earthquake. J Anxiety Disord. 2015;31:90-97.CrossRefGoogle ScholarPubMed
Wang, M, Armour, C, Li, X, et al. The factorial invariance across gender of three well-supported models: further evidence for a five-factor model of posttraumatic stress disorder. J Nerv Ment Dis. 2013;201(2):145-152.10.1097/NMD.0b013e31827f627dCrossRefGoogle ScholarPubMed
Wang, R, Wang, L, Li, Z, et al. Latent structure of posttraumatic stress disorder symptoms in an adolescent sample one month after an earthquake. J Adolesc. 2013;36(4):717-725.10.1016/j.adolescence.2013.05.008CrossRefGoogle Scholar
Zhou, X, Wu, XC, Zhen, R. Assessing the latent structure of DSM-5 PTSD among Chinese adolescents after the Ya’an earthquake. Psychiatry Res. 2017;254:33-39.CrossRefGoogle ScholarPubMed
Wu, F, Meng, WY, Hao, CZ, et al. Analysis of posttraumatic stress disorder in children with road traffic injury in Wenzhou, China. Traffic Inj Prev. 2016;17(2):159-163.CrossRefGoogle ScholarPubMed
Xu, JP, Wang, Y, Tang, WJ. Posttraumatic stress disorder in Longmenshan adolescents at three years after the 2013 Lushan earthquake. Gen Hosp Psychiatry. 2018;54:45-51. doi: 10.1016/j.genhosppsych.2018.05.009.CrossRefGoogle ScholarPubMed
Zhang, N, Zhang, Y, Wu, K, et al. Factor structure of the Children’s Revised Impact of Event Scale among children and adolescents who survived the 2008 Sichuan earthquake in China. Scand J Psychol. 2011;52(3):236-241.CrossRefGoogle ScholarPubMed
Zhang, Z, Ran, MS, Li, YH, et al. Prevalence of post-traumatic stress disorder among adolescents after the Wenchuan earthquake in China. Psycholog Med. 2012;42(8):1687-1693.10.1017/S0033291711002844CrossRefGoogle ScholarPubMed
Zhao, GF, Zhang, Q, Pang, Y, et al. Application of the Children’s Impact of Event Scale (Chinese version) on a rapid assessment of posttraumatic stress disorder among children from the Wenchuan earthquake area. Chin J Epidemiol. 2009;30(11):1160-1164.Google ScholarPubMed
Zhou, P, Zhang, Y, Wei, C, et al. Acute stress disorder as a predictor of posttraumatic stress: a longitudinal study of Chinese children exposed to the Lushan earthquake. Psychol J. 2016;5:206-214.Google ScholarPubMed
Dong, XY, Zhao, PL, Shi, ZB. Post-trauma mental health problem among 8-14 year old children and its risk factors one year after Sichuan earthquake in Mian Yang. Chin J Clin Psychol. 2010;18(6):753-755.Google Scholar
Du, N, Situ, MJ, Zhu, XZ,et al. The changes of PTSD and depressive symptoms of surviving middle school students in Dujiangyan area after Wenchuan earthquake: 3-year follow-up study. Dissertation. Academic meeting of the Psychiatry Foundation and Clinical Branch of the Chinese Society of Neuroscience; 2012.Google Scholar
Du, N, Min, J, Zhu, CZ, et al. Comparative study on the symptoms of PTSD and depression of the children exposed to the Wenchuan earthquake 2 and 3 years after it. Chin J Behav Med Brain Sci. 2012;21(5):447-449.Google Scholar
Fan, F, Liu, WM, Zheng, YH, et al. Mental health problems and correlates among adolescents 6 months after exposed to the Wenchuan earthquake. Chin J Clin Psychol. 2010;18(1):56-59.Google Scholar
Fu, L, Cheng, J, Liu, ZK. Cross-lagged analysis of acute stress disorder, posttraumatic stress disorder and depressive symptoms among children after Lushan earthquake. Chin Ment Health J. 2017;31(7):548-553.Google Scholar
Geng, FL, Fang, F, Zhang, L. Poor sleep quality associated with PTSD, anxiety, and depression among adolescents exposed to 2008 Wenchuan earthquake, China. Chin J Clin Psychol. 2012;20(2):172-175.Google Scholar
He, J, Xu, SS, Zhu, ZH, et al. A study of symptoms of the post-traumatic stress disorder and its related factors in adolescents after the Wenchuan earthquake, China. Chin J Clin Psychol. 2011;19(1):103-105.Google Scholar
Huang, YS, Zheng, XF, Wang, HT, et al. Attributional style, anxiety sensitivity and posttraumatic stress symptoms of children exposed to Wenchuan earthquake. Chin J Clin Psychol. 2010;18(6):750-752.Google Scholar
Jiang, X, Zhu, JH, Zhang, L, et al. Relationship between post-traumatic stress disorder and coping style in children with debris flow in Zhouqu. Chin J Neuropsychiatr Dis. 2013;39(8):489-492.Google Scholar
Jin, LS. A study of the post traumatic stress and depressive reactions of adolescents in the severe disaster areas after the Wenchuan earthquake. Chin J Behav Med Brain Sci. 2009;18(3):193-195.Google Scholar
Jin, LS. Research on post-traumatic stress disorder of students in a secondary school in Dujiangyan after Wenchuan earthquake. West China Med J. 2013;27(3):27-30.Google Scholar
Liu, YY, Zhang, XM. Epidemiological investigation of post-traumatic stress disorder in children caused by road traffic accidents. Int J Pediatr. 2016;43(11):899-901.Google Scholar
Ma, ZJ. Prevalence of post traumatic stress disorder and its risk factors among 11-15 years old children after flood. Chin J Behav Med Brain Sci. 2014;23(12):1108-1110.Google Scholar
Qiu, YP, Zhang, YX, Wang, YQ, et al. PTSD of survivors of tremendous explosion case in Fangl Primary School. China J Health Psychol. 2007;15(1):77-78.Google Scholar
Shi, WL. Rapid interaction between norepinephrine and glucocorticoids on excitatory synaptic regulation of magnocellular neurons in hypothalamic supraoptic nucleus. Dissertation. Second Military Medical University; 2011.Google Scholar
Tang, WJ, Zhao, JD, Lu, Y, et al. Effect of gender and exposure on PTSD among adolescents victims after Lushan earthquake. Chin J School Health. 2018;39(07):1041-1042.Google Scholar
Wei, Q, Cao, YF, Liao, CZ. Surveillance of posttraumatic stress disorder (PTSD) among students in quake-hit regions after Wenchuan earthquake. Chin J School Health. 2016;37(10):1483-1486.Google Scholar
You, MN, Chen, WH. Mental health status of junior middle school students after witnessing big building fire. Chin Ment Health J. 2012;26(3):181-185.Google Scholar
Yu, YL. The relationship among the level of disaster exposure resilience and trauma psychology among middle school students in earthquake stricken area. Dissertation. Sichuan Normal University; 2010.Google Scholar
Zhao, PL. Post traumatic disorder and depressive symptoms among survived children six-months after the Yshu earthquake. Chin J Clin Psychol. 2011;19(6):787-789.Google Scholar
Zhou, X. The relationship between the degree of trauma exposure and post-traumatic stress disorder in adolescents: the role of core belief challenge, degree of subjective fear and invasive ruminant. Acta Psychologica Sinica. 2015;47(4):455-465.CrossRefGoogle Scholar
Zhou, X, Wu, XC, Yuan, XJ, et al. The role of core beliefs challenge, subjective fear, and intrusive rumination in association between severity of traumatic exposure and posttraumatic stress disorder among adolescent survivors after the Yaan earthquake. Acta Psychologica Sinica. 2016;48(8):969-980.CrossRefGoogle Scholar
Zhu, CZ, Siti, MJ, Zhang, Y, 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):531-536.Google ScholarPubMed
Yang, YF, Ye, YL, Li, T, et al. Mental health status among middle school students in Wenchuan earthquake region. Chin J Prev Med. 2010;44(2):134-139.Google ScholarPubMed
Shi, XQ, Nie, C, Shi, SP, et al. Effect comparison between Egger’s test and Begg’s test in publication bias diagnosis in meta-analyses: evidence from a pilot survey. Int J Res Stud Biosci. 2017;5:14-20. doi: 10.20431/2349-0365.0505003.Google Scholar
Garbarino, J, Kostelny, K. The effects of political violence on Palestinian children’s behavior problems: a risk accumulation model. Child Dev. 2010;67(1):33-45.CrossRefGoogle Scholar
Roussos, A, Goenjian, AK, Steinberg, AM, et al. Posttraumatic stress and depressive reactions among children and adolescents after the 1999 earthquake in Ano Liosia, Greece. Am J Psychiatry. 2005;162(3):530-537.CrossRefGoogle ScholarPubMed
Felton, JW, Cole, DA, Martin, NC. Effects of rumination on child and adolescent depressive reactions to a natural disaster: the 2010 Nashville flood. J Abnorm Psychol. 2013;122(1):64-73.10.1037/a0029303CrossRefGoogle ScholarPubMed
Liu, Y, Cheng, ZY, Zhang, YQ, et al. Ethnic differences in post-traumatic stress disorder. Adv Psycholog Sci. 2011;19:1511-1517.Google Scholar