| Objective:Tangshan earthquake which had a magnitude of 7.8 killed approximately 250,000 people in China in 1976.In the present study,we sought to determine the prevalence and risks of mental disorders in adults who experienced earthquake as an infant or in the prenatal period.Methods:This cross-sectional cohort study recruited participants based on the urban resident registry of Tangshan,Hebei province,2013 using a multistage stratified cluster sampling method with selection probabilities proportional to size.We recruited subjects who were born between July 29,1975 and April 28,1978 that was one year before and 1.9 years after the occurrence of Tangshan Earthquake,respectively.The total number of participants who met the enrollment criteria was 1608,1380 of whom participated in and effectively completed various examinations,and the completion rate was 85.8%.Based on the date of birth of the subjects,they were divided into three groups:the infant exposure group(392 persons were investigated,whose date of birth was from July 29,1975 to April 28,1976,i.e.those who were exposed to the earthquake at the age of 3-12 months after birth)fetal exposure group(the birth date was from July 29,1976 to April 28,1977,i.e.those who were exposed to the earthquake during the fetal period,399 people were investigated);no exposure group(born from July 29,1977to April 28,1978,i.e.1-1.9 years after the earthquake,589 people were investigated)Using the self-designed questionnaire,we collected the social and demographic information of the subjects,their mother's conditions during pregnancy and childbirth,the conditions when the fetus was born,the mother's experience of earthquake,and the past history of physical diseases.Children Trauma Questionnaire-28 short form(CTQ-SF)and life event scale(LES)were used to assess the stress experienced in childhood and adulthood.Hamilton Depression Scale 17 items(HAMD-17),Hamilton Anxiety Scale 14items(HAMA-14)and Pittsburgh Sleep Quality Index(PSQI)were used to evaluate the mood and sleep of the subjects.Family Adaptability and Cohesion Evaluation Scale,second edition(FACES II)and Social Support Rating Scale(SSRS)were used to assess the social support of the subjects.Structured Clinical Interview for DSM-IV-TR Axis I Disorders,Research Version,Patient Edition(SCID-I/P)was used to determine the diagnosis of DSM axis I disorders.Results:1. There were significant differences in the average age among infant exposure group,fetal exposure group and no exposure group,and there were no significant differences in the other socio-demographic data,maternal physical disease during pregnancy,and the situation of experiencing earthquake stress and the conditions at birth of the participants.2. The comparison of traumatic experiences in childhood and adulthood among the three groups:the total score of physical abuse(5.60±1.612 vs.5.53±1.772 vs.5.56±1.551,Z=17.756,P=0.000)and CTQ(33.42±8.153 vs.34.72±8.841 vs.33.80±7.754,Z=6.452,P=0.040)in infant exposure group were significantly lower than those in fetal exposure group and no exposure group.The scores of positive life events(15.04±17.492 vs.17.18±18.849 vs.17.97±18.793,Z=6.452,P=0.034),family related problems(18.33±21.118 vs.22.06±24.048 vs.21.80±22.115,Z=7.998,P=0.018),learning and occupation related problems(3.56±6.898 vs.3.80±8.461 vs.4.48±8.537,Z=6.657,P=0.036),and other social problems(0.81±2.708 vs.0.85±3.512 vs.1.23±4.967,Z=6.477,Z=6.477,P=0.039)in infant exposure group were significantly lower than those in fetal exposure group and no exposure group.There were no significant differences in LES(21.90±23.230 vs.25.03±26.943vs.27.07±32.988,Z=5.599,P=0.061)and negative life events(7.63±12.640vs.9.32±17.339 vs.9.33±16.222,Z=2.674,P=0.263).There was no significant difference among the three groups in social psychological support(FACE-CV and SSRS scores).3. There were 225 participants found with sleep disorders(PSQI?7)(16.3%),and there was no significant difference in the incidence of sleep disorders among the three groups(17.1%vs.16.7%vs.15.4%,?~2=0.283,P=0.868).In addition,7.5%of the study population had anxiety symptoms(HAMA?7),and the incidence of anxiety symptoms in the three groups was not statistically significant(6.6%vs.8.5%vs.7.4%,?~2=1.302,P=0.522).2.5%of the subjects had depressive symptoms(HAMD?7).There was no significant difference in the incidence of depressive symptoms among the three groups(2.6%vs.3.0%vs.1.7%,?~2=2.407,P=0.359).4.231 people(16.7%)were found with one lifetime DSM-IV axis I disorder,and 175 people(12.7%)currently were found with one DSM-IV axis I disorder.Among them,a total of 10 patients(0.7%)were found with current bipolar disorder,and the number of patients with lifetime bipolar was 10(0.7%).A total of 24 patients(1.7%)were currently found with major depressive disorder,and the number of patients with lifetime major depressive disorder was 34(2.5%).A total of 86 patients(6.2%)were currently found with alcohol use disorders,and the number of patients with lifetime alcohol use disorder was 106(7.7%)A total of 14 patients(1.0%)were currently found with schizophrenia is,and the number of patients with lifetime schizophrenia was 14(1.0%).A total of 50 patients(3.6%)were found with current anxiety disorder,and the number of patients with lifetime anxiety disorder was 76(5.5%).The current and lifetime prevalence of any kinds of DSM-IV axis I disorders were as follows:There were no significant differences in the current and lifetime prevalence of bipolar disorder(0.8%vs.0.6 vs.0.9%,?~2=0.412,P=0.814)among the infant exposure group,fetal exposure group and no exposure group.There were no significant differences in the current(1.9%vs.2.3%vs.1.6%,?~2=0.994,P=0.608)and lifetime(2.8%vs.2.5%vs.2.3%,?~2=0.356,P=0.837)prevalence of major depression among the three groups.No significant differences were found in the current(7.0%vs.6.8%vs.5.3%,?~2=1.905,P=0.386)and lifetime prevalence(7.9%vs.8.3%vs.7.1%,?~2=0.476,P=0.788)of alcohol use disorder among the three groups.There were no significant differences in the current and lifetime prevalence of anxiety disorder(3.9%vs.3.6%vs.3.9%,?~2=0.067,P=0.967)and lifetime prevalence(4.9%vs.5.7%vs.5.7%,?~2=0.457,P=0.796)among the three groups.The prevalence of schizophrenia was significantly higher in fetal exposure group(2.3%)than in infant exposure group(1.0%)and no exposure group(0.2%),which was statistically significant(1.0%vs.2.3%vs.0.2%,?~2=10.273,P=0.006).5. The results of univariate analysis showed that the current and lifetime prevalence of bipolar disorder were significantly different between individuals with premature birth(5.3%vs.0.6%,?~2=11.095,P=0.029)and low birth weight(2.3%vs.0.6%,?~2=5.141,P=0.023)and those without.The prevalence of alcohol use disorders in women(1.6%vs.7.0%,?~2=8.039,P=0.003),individuals with premature birth history(15.8%vs.5.9%,?~2=6.180,P=0.026)and low birth weight(11.7%vs.5.7%,?~2=7.269,P=0.012)were significantly different compared with individuals who without,and the difference was statistically significant.The lifetime prevalence of alcohol use disorders in women(1.6%vs.8.8%,?~2=11.742,P=0.000),low education level(4.3%vs.8.6%,?~2=5.046,P=0.025),premature birth history(28.9%vs.7.2%,?~2=6.180,P=0.026)and low birth weight(14.8%vs.7.1%,?~2=8.947,P=0.003)were significantly different compared with those who without.The current and lifetime prevalence of schizophrenia in female(3.2%vs.0.7%,?~2=22.692,P=0.000),individuals who were unmarried(4.5%vs.0.7%,?~2=14.594,P=0.003)and low birth weight(5.5%vs.0.6%,?~2=27.875,P=0.000)were significantly different from those who without.Compared with no exposure group,fetal exposure group(2.3%vs.0.2%,?~2=10.329,P=0.002)had significant differences in the current and lifetime prevalence of schizophrenia,and the difference was statistically significant.Prenatal stress might play an important role in the high prevalence of schizophrenia.The current and lifetime prevalence of schizophrenia in infants with stress(1.0%vs.0.2%,?~2=3.358,P=0.086)were also different from those in no exposure group,but the difference was not statistically significant.There was no significant difference in the current and lifetime prevalence of major depression and anxiety disorders between women,those with low education level,unmarried,low income,smoking history,drinking history,premature birth history,low birth weight and those without the above conditions(P>0.05).Multiple regression analysis showed that the independent risk factors of bipolar disorder were low birth weight(OR=4.257,95%CI=1.087-16.677,P=0.038),as shown in table 9-1;the independent risk factors of current alcohol use disorder were male gender(OR=4.762,95%CI=1.486-15.385,P=0.009)and low birth weight(OR=4.250,95%CI=1.316-4.329,P=0.004);and the risk factors of lifetime alcohol use disorder were male gender(OR=4.762,95%CI=1.486-15.385,P=0.009),low level of education(OR=2.196,95%CI=1.120-4.306,P=0.000),low birth weight(OR=1.887,95%CI=1.054-3.378,P=0.032)and premature birth(OR=4.018,95%CI=1.864-8.662,P=0.000).The independent risk factors of current and lifetime schizophrenia were female gender(OR=7.424,95%CI=2.438-22.610,P=0.000),unmarried(OR=8.333,95%CI=2.433-28.571,P=0.000)and low birth weight(OR=13.095,95%CI=4.049-42.355,P=0.001).Prenatal and infant earthquake stress exposure were not the risk factors of any DSM-IV axis I disorder,but prenatal stress did have a certain trend of influence on the prevalence of schizophrenia,the results have a moderately statistical effect(OR=1.949,95%CI=0.965-3.922,P=0.063).Conclusions:1.Adults who were exposed to earthquake in the prenatal period had a significantly higher rate of schizophrenia than those who were not exposed or who experienced earthquake in their infancy.2.There was no significant difference between the prevalence rate of other DSM-IV Axis I mental disorders and lifetime prevalence rate among individuals exposed to seismic stress in fetal period,seismic stress in infant period and individuals not exposed.3.Furthermore,prenatal earthquake stress exposure was not a significant risk of any of the lifetime or current DSD-IV axis I disorders. |
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