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
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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)