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Sleep Problems Among Adolescent Survivors Following the 2008 Wenchuan Earthquake in China: A Cohort Study

Fulei Geng, MPsy; Fang Fan, PhD; Lei Mo, PhD; Ian Simandl, MSc; and Xianchen Liu, MD, PhD

Published: January 15, 2013

Article Abstract

Objective: To examine sleep problems and associated risk factors among adolescent survivors following the 2008 Wenchuan earthquake, the deadliest earthquake to strike China in 30 years.

Method: A cohort of students (N = 1,573) in the 7th and 10th grades from Dujiangyan City, 21 kilometers from the epicenter, was followed up periodically for 2 years. Participants were assessed at 12 months (n = 1,398; May 18-22, 2009), 18 months (n = 1,288; November 23-27, 2009), 24 months (n = 1,313; May 17-21, 2010), and 30 months (n = 1,038; November 22-26, 2010) after the earthquake. Adolescents were asked to complete the Pittsburgh Sleep Quality Index (PSQI; cutoff for sleep problems: total score of ≥ 8), Post-Traumatic Stress Disorder Self-Rating Scale (cutoff for probable posttraumatic stress disorder: ≥ 50), Depression Self-Rating Scale for Children (cutoff for depressive disorder: ≥ 15), Screen for Child Anxiety Related Emotional Disorders (cutoff for clinical anxiety: ≥ 25), Social Support Rate Scale, and Adolescent Self-Rating Life Events Checklist and provide demographic information. Trajectory analysis was used to examine sleep disturbance changes and associated risk factors.

Results: Twelve months after the earthquake, 48.90% of participants reported sleeping less than 7 hours per night, 27.68% disclosed difficulties initiating sleep, 8.82% experienced problems staying sleep, 22.60% felt their sleep quality was poor, and 40.01% had difficulties functioning during daytime hours. Overall sleep problems, as assessed by the PSQI global scale, were stable from 18 months to 30 months following the earthquake, and the prevalence rates were between 28.79% and 30.18%. The risk of sleep issues was significantly increased in senior high school students (OR = 2.29) and in those who witnessed the tragic events directly (OR = 1.21). Depression (OR = 1.69), anxiety (OR = 1.57), poor social support (OR = 1.83), and negative life events (OR = 2.62) were also associated with increased risk and persistence of sleep problems.

Conclusions: Sleep disturbances are common and persistent in adolescent earthquake survivors. Multiple demographic, psychosocial, and earthquake-related factors are associated with the increased risk of sleep difficulties.

J Clin Psychiatry 2013;74(1):67-74

Submitted: April 29, 2012; accepted November 16, 2012 (doi:10.4088/JCP.12m07872).

Corresponding author: Fang Fan, PhD, Center for Studies of Psychological Application South China Normal University Shipai Rd, Guangzhou, 510631, China (

Volume: 74

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