Abstract
PurposeTo examine the longitudinal relationships between Posttraumatic Stress Disorder (PTSD) and sleep problems among adolescent survivors in the Wenchuan earthquake, China.Methods350 adolescent survivors were randomly selected from several primary and secondary schools in the counties of Wenchuan and Maoxian, the two areas most severely affected by the Wenchuan earthquake. Participants completed Revised Child PTSD Symptom Scale and Sleep Problems Subscale of Self-generated Child Behavior Problems Questionnaire at one year (T1), one-and-a-half years (T2), two years (T3) after the earthquake, respectively.ResultsThere was a bidirectional relationship between intrusive symptom clusters of PTSD and sleep problems from T1 to T2, and this relationship became non-significant from T2 to T3. There was a one-way predictive relationship of avoidance symptom clusters of PTSD onto sleep problems from T1 to T3. The hyperarousal symptom clusters of PTSD had effects on sleep problems from T1 to T2 but not from T2 to T3, while sleep problems have no significant effect on hyperarousal symptom clusters of PTSD from T1 to T3. In addition, the relationships between three symptom clusters of PTSD and sleep problems weakened with time change.ConclusionsFrom 1 year to 1.5 years after the earthquake, all the three symptom clusters of PTSD could be important predictive factors for the development and maintenance of sleep problems, while sleep problems could only be risk factors for the intrusive symptom clusters of PTSD. From 1.5 years to 2 years, only the avoidance symptom clusters of PTSD were risk factors for sleep problems, and sleep problems had no significant effects on any symptom clusters of PTSD. Overall, the relationship between PTSD and sleep problems weakened with time change.
Highlights
As one of the most destructive of natural disasters, the earthquake that occurred in Wenchuan, China in 2008 caused widespread life and property losses
The findings of this study were as follows: There was a bidirectional relationship between intrusive symptom clusters of posttraumatic stress disorder (PTSD) and sleep problems from T1 to T2, whereas this relation was non-significant from T2 to T3
The present analyses were based on the data collected in a longitudinal research project that investigated the relationship between the three PTSD symptoms clusters and sleep problems over time
Summary
As one of the most destructive of natural disasters, the earthquake that occurred in Wenchuan, China in 2008 caused widespread life and property losses Adolescent survivors of this earthquake experienced significant psychological reactions; posttraumatic stress disorder (PTSD) is often considered to be the most frequent psychological reactions in the aftermath of disasters [1]. Some researchers have even suggested that PTSD commonly co-occur with sleep problems [3], and indicated that there is a consistent relation between PTSD and sleep problems after trauma [4,5]. Among a sample of 2853 adolescent survivors after disaster, increases in sleep problems paralleled increases in PTSD symptom severity [4] These studies mainly examined the relationship between global PTSD levels and severity of sleep problems among individuals with PTSD. The global PTSD, in the DSM-IV-TR, includes three specific types of symptoms: re-experiencing (intrusive) symptoms (e.g., nightmares, flashbacks), avoidance symptoms (e.g., avoiding reminders of the event), and hyperarousal symptoms (e.g., increased startle response, anger outbursts) [7]
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