| Background On May12,2008, a powerful earthquake measuring8.0on the Richter Scale struck Sichuan province, China. More than69,200people were confirmed dead, more than374,600were seriously injured, and more than17,900were reported missing, making it one of the deadliest natural disasters in history. Schools collapsed, over5,300children were confirmed dead or missing, the direct economic loss reached up to845billion. It is critically important to help the survivors rebulid their community in a scientific way. As an indispensible part of rebuilding, mental-health-rebuilding has been paid with great attention by the government and other social groups. Nevertheless, the majority of psychological support techniques are from abroad, and their application in China has not been proved. In addition, from an international perspective, epidemiological and psychological researches after disasters are little. Thus, the occurrence of Sichuan earthquake lend us a precious opportunity to investigate problems with the mental-health-rebuilding process, and make contributions in the areas of disaster-related psychological rescue.Methods The research discussed the status quo and developing trend of mental crisis for child and adolescent survivors, examined the problems with disaster-related psychological rescue, and proposed suggestions for improving the work of mental-health-rebuilding in Sichuan earthquake. The research could be divided in three parts as follows. First, the theoretical study summarized the manifestations, developing mechanisms, categories and diagnostic standards of child mental crisis, and concluded the objectives and techniques of child mental crisis interventions. Second, the field study showed the mental health and quality of life among child survivors of Sichuan earthquake, and investigated mental health care utilization and social support situation among them. Third, health policy research discussed the characteristics of high-risk populations, and suggested possible ways to improve the provision of mental health services.Results From the1st to the3rd year after the earthquake, there were no significant changes in the prevelances of both PTSD and depression, which remained above10%and13%, respectively. For those who had been badly hurt, had lost family members or significant others, the prevalences of PTSD and depression went up to20%. The regression analysis showed that the loss of family members is the biggest contributor for the occurrence of PTSD and depression, with OR at6.6and4.1 respectively. The above results suggested that mental health symptoms prevailed among surviving children, with almost1-2positive in10. When combining the suicide rate (13%) of PTSD patients, the research estimated that44,000students suffered from suicide risk out of the3.4million students in the severely affected areas.As to the child quality of life, the research found that quality of life scores among the child and adolescent survivors are beneath the national average. From the1st to the3rd year after the earthquake, child witnessed a marked decline of quality of life scores, at2.0for the overall scores and4.6for school functioning scores. PTSD and depression patients also reported lower scores over the time, while non-PTSD and non-depression patients almost remained the same. The regression analysis showed that PTSD and depression were the biggest contributors of quality of life, and one point increase in PTSD or depression would result in0.3-0.5decline of quality of life scores.The disaster area also witnessed a significant decline of mental health service utilization among the child and adolescent survivors, with34.6%in the1st year and9.5%in the3rd year. Moreover, the utilization rate of PTSD and depression patients staggered around10%-25%, which meant that the majority of the patients had not utilized the services. The study also found that social support could decrease the risk of mental health symptoms among these children.Policy implications The study suggested that, psychological support after disasters should focus on not only the groups with traumatic experiences, but also the indirect exposure group, minorities, female and Mao residents. Considering the critical mental health situation confronted by the children, as well as factors such as the shortage of human resources for psychological support, many social groups could not continue their work in the disaster area, the study proposed to establish a nation-managed support system based on the reference of successful examples in other countries, and to make it as a regular section of disaster relief in the next days. Concrete measures included the establishment of multi-level psychological support system, the development of professional human resources for psychological support, and the formation of mental health profiles for these children. As to individual interventions, to overcome the shortcomings of an isolated measure, the study suggested an integrated model of psychology support, social support and culture support. |
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