Depression, Social Support, and Coping Styles among Pregnant Women after the Lushan Earthquake in Ya’an, China

PLOS ONE, Dec 2019

Aim The aim of this study is to assess the depression of pregnant women in the aftermath of an earthquake, and to identify the social support that they obtained, their coping styles and socio-demographic factors associated with depression. Methods A total of 128 pregnant women from three hospitals in the epicenter area were recruited immediately after the Ya’an earthquake. Their depression was investigated using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of 14; the social support that they obtained was measured using the Social Support Questionnaire; and their coping styles were assessed using the Coping Styles Questionnaire. Results Immediately after the earthquake, the incidence rate of depression in pregnant women was 35.2%, higher than that of the general pregnant population (7%-14%). The EPDS scores were significantly correlated with gestation age at the time of the earthquake, objective support, subjective support, use of support, negative coping style, and positive coping style. The regression analysis indicated that risk factors of prenatal depression include the number of children, relatives wounded, subjective support, and coping styles. A further analysis of the interaction between social support and two types of coping styles with depression showed that there was interaction effect between subjective social support and positive coping styles in relation to EPDS scores. There was an inverse relationship between low EPDS scores and positive coping styles and high social support, and vice versa. Conclusion The timing of the occurrence of the earthquake may not necessarily affect the progress of the illness and recovery from depression, and psychological intervention could be conducted in the immediate aftermath after the earthquake. The impact of coping styles on prenatal depression appeared to be linked with social support. Helping pregnant women to adopt positive coping styles with good social support after a recent major earthquake, which is a stressor, may reduce their chances of developing prenatal depression.

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Depression, Social Support, and Coping Styles among Pregnant Women after the Lushan Earthquake in Ya’an, China

August Depression, Social Support, and Coping Styles among Pregnant Women after the Lushan Earthquake in Ya'an, China Jianhua Ren 0 1 Xiaolian Jiang 0 1 Jianrong Yao 0 1 Xirong Li 0 1 Xinghui Liu 0 1 Meiche Pang 0 1 Chung Lim Vico Chiang 0 1 0 1 Department of Obstetrics, West China Second University Hospital , Chengdu, Sichuan , China , 2 West China School of Nursing/West China Hospital, Sichuan University , Chengdu, Sichuan , China , 3 School of Nursing, The Hong Kong Polytechnic University , Hong Kong , Hong Kong, 4 Obstetrics Department, Ya'an People's Hospital , Ya'an, Sichuan , China 1 Editor: Jodi Pawluski, University of Rennes-1, FRANCE - Competing Interests: The authors have declared that no competing interests exist. The aim of this study is to assess the depression of pregnant women in the aftermath of an earthquake, and to identify the social support that they obtained, their coping styles and socio-demographic factors associated with depression. A total of 128 pregnant women from three hospitals in the epicenter area were recruited immediately after the Ya’an earthquake. Their depression was investigated using the Edinburgh Postnatal Depression Scale (EPDS) with a cutoff score of 14; the social support that they obtained was measured using the Social Support Questionnaire; and their coping styles were assessed using the Coping Styles Questionnaire. Immediately after the earthquake, the incidence rate of depression in pregnant women was 35.2%, higher than that of the general pregnant population (7%-14%). The EPDS scores were significantly correlated with gestation age at the time of the earthquake, objective support, subjective support, use of support, negative coping style, and positive coping style. The regression analysis indicated that risk factors of prenatal depression include the number of children, relatives wounded, subjective support, and coping styles. A further analysis of the interaction between social support and two types of coping styles with depression showed that there was interaction effect between subjective social support and positive coping styles in relation to EPDS scores. There was an inverse relationship between low EPDS scores and positive coping styles and high social support, and vice versa. The timing of the occurrence of the earthquake may not necessarily affect the progress of the illness and recovery from depression, and psychological intervention could be conducted in the immediate aftermath after the earthquake. The impact of coping styles on prenatal depression appeared to be linked with social support. Helping pregnant women to adopt positive coping styles with good social support after a recent major earthquake, which is a stressor, may reduce their chances of developing prenatal depression. On April 20, 2013, an earthquake measuring 7.0 on the Richter scale hit Lushan County of Ya’an City, which is located approximately 100 kilometers away from the city of Chengdu, in China’s Sichuan province. The earthquake resulted in 196 deaths, 11,470 injuries, and over 85 billion RMB in property damage [1]. Apart from economic losses, victims suffered from psychological trauma, especially depression [2–3]. Empirical studies have shown that major depression is common among earthquake victims [4–5]. Pregnant women who are experiencing great physical and psychological changes might be particularly vulnerable [6]. Studies on depression suffered by pregnant women after an earthquake indicated higher rates (13.1%-40.8%) [7–9] than among pregnant women in the general population (7%-14%) [10–12]. In addition, the women who lived in the epicenter immediately after a major earthquake may suffer greater depression. A study on public health conducted after the 2008 earthquake in Wenchuan found different physical and mental health outcomes depending on the extent to which local populations had been exposed to the earthquake [13]. A systematic review [14] of disasters and perinatal health also suggested that the extent to which pregnant women are exposed to a disaster, in which the time and place of the disaster are relevant factors, could pose different risks to their perinatal health. It is thought that the people living in the epicenter area shortly after the occurrence of an earthquake are under the greatest stress, and might be more prone to depression. Depression during pregnancy may have negative consequences for maternal and child health, with such consequences as increased rates of suicides, preterm births, and adverse psychological developments in the offspring [11, 15–17]. Therefore, it is necessary to investigate the depression of pregnant women and its risk factors at the epicenter immediately after a major earthquake in order to develop intervention strategies for this population. However, most research of prenatal depression after an earthquake focus on either the psychological impact to the pregnant women several months after the disaster [18], or to the target (...truncated)


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Jianhua Ren, Xiaolian Jiang, Jianrong Yao, Xirong Li, Xinghui Liu, Meiche Pang, Chung Lim Vico Chiang. Depression, Social Support, and Coping Styles among Pregnant Women after the Lushan Earthquake in Ya’an, China, PLOS ONE, 2015, Volume 10, Issue 8, DOI: 10.1371/journal.pone.0135809