Jun-Cheng Guo， Zhi-Liang Tian， Xiao-Dan Wang， Min Guo， Meng-Yong-Wei Li，Yun-Suo Gao， Xiang-Ling Jiang， Lin-Mei Fu， Tao Huang， Li Xiang， Yu Shu-Feng， Li You

1People's Hospital of Hainan Province， Haikou， Hainan， 570311， China

2Affiliated Hainan Hospital， University of South China， Haikou， Hainan， 570311， China

3The Second Hospital， University of South China， Hengyang， Hunan， China

4School of Public Health， Hainan Medical University， Hainan， China

Post-Traumatic Stress Disorder after typhoon disaster and its correlation with platelet 5-HT concentrations

Jun-Cheng Guo1，2， Zhi-Liang Tian3， Xiao-Dan Wang4， Min Guo1*， Meng-Yong-Wei Li1，Yun-Suo Gao1， Xiang-Ling Jiang1， Lin-Mei Fu1， Tao Huang4， Li Xiang1， Yu Shu-Feng1， Li You1

1People's Hospital of Hainan Province， Haikou， Hainan， 570311， China

2Affiliated Hainan Hospital， University of South China， Haikou， Hainan， 570311， China

3The Second Hospital， University of South China， Hengyang， Hunan， China

4School of Public Health， Hainan Medical University， Hainan， China

ARTICLE INFO

Article history:

Received 15 May 2016

Received in revised form 16 June 2016

Accepted 1 July 2016

Available online 20 September 2016

Post-traumatic stress disorder

Objective: To investigate residents’ psychological stress factors and research the correlation between Post-Traumatic Stress Disorder （PTSD） and platelet 5-HT concentrations so as to provide scientif i c bases for diagnosis and treatment of PTSD and psychological intervention for people in the disaster area. Methods: A questionnaire survey of 5 500 residents who have accepted psychological help was conducted by the emphatic investigation method. While high performance liquid chromatography were used to detect the platelet serotonin concentration of 100 PTSD patients and 100 healthy people. Results: （1） Of the 5 114 cases， 3 167 （61.93%）showed positive results in screening for psychological stress symptoms， and 399 （7.8%） were tested with apparent PTSD symptoms. Male and female prevalence showed no signif i cant difference （χ2=-0.380， P=0.704）. The differences of prevalence between different age groups were statistically signif i cant （χ2=381.89， P=0.000）. （2） The dif f erences in the level of platelet 5-HT between PTSD patients and normal control group were statistically signif i cant. Conclusions: The typhoon of Hainan province caused relatively large psychological problems to the disaster victims. Compared with normal control group， the platelet 5-HT levels of PTSD patients in the disaster areas are lower. It may be related to incidents exposure levels， cultural background， religious ideas， social concerns and psychological rescue of the residents who live in the disaster areas of Hainan.

1. Introduction

To Recent ten years， irresistible natural disasters and occasionally unconventional emergencies lead to the constant increase of thePTSD （Post-Traumatic Stress Disorder， PTSD） incidence. PTSD refers to exposed individuals’ mental disorders that delay happened and persistent for long term after unconventional contingencies or catastrophic life events. The clinical manifestations are characterized by re-experience of the trauma， and accompanied by emotional irritability and avoidance behavior. PTSD has serious social harm， and its incidence has a signif i cant increase in unconventional emergencies， natural disasters and other trauma. It is a hot and diffi cult problem in psychiatry and psychology. However，our attention and research in this area are relatively few. This paper summarizes the research status of epidemiology， basic neurobiology，etiology diagnosis， treatment and other aspects of PTSD.

PTSD refers to persistent mental disorders of individuals appearing after affected by abrupt， threatening or disastrous life affairs. Its clinical manifestations are characterized by experiencing the trauma again and combined with unstable emotion and avoidance behaviors， which showed severe social and family perniciousness. PTSD performs high incidence rate in traumatic incidents such as war， social violence， fatal traffic accidents and natural disasters，which has become a new hot spot for the psychiatry department and psychological studies in recent years. However， there are few understandings and researches on this aspect in our country by far. This study aimed to sum up the status of researches of epidemiology，neurobiological basis， etiology and diagnosis and treatment associated with PTSD.

2. Materials and methods

2.1. Investigation objects

A questionnaire survey of 5 500 residents in the disaster area of typhoon Rammasun of Hainan Province who have accepted psychological help was conducted by the emphatic investigation method， and 5 114 copies of ef f ective questionnaire were taken back with a recovery rate of 93%.

2.2. Investigation methods

After typhoon Rammasun， staff of the Hainan Psychological Crisis Intervention Laboratory rushed to the disaster area to of f er psychological help to the affl icted people. A questionnaire survey of 5 114 affl icted people was carried out by a one-to-one investigation method.

2.3. Questionnaire

2.3.1. General condition questionnaire

The general condition questionnaire included gender， age，personality， marriage， education and so on.

2.3.2. PTSD CheckList-Civilian Version （PCL-C）

PCL-C scale includes four factors， namely awareness of symptoms， avoidance response， traumatic experiences repeatedly produce reproducible and feeling numb feeling， a total of 17 entries. Rating Scale using fi ve criteria was applied: none （1 score）， a little（2 scores）， moderate （3 scores）， a considerable degree （4 scores），extreme （5 scores）. 38 is a critical value， ＞ = 38 scores is defined as positive for PTSD （50 -85 scores is considered to have more obvious symptoms of post-traumatic stress disorder， 38 -50 scores is considered to have some degree of post-traumatic stress disorder symptoms）； ＜ = 37 points is def i ned as negative for PTSD.

2.4 . Statistical analysis

Epidata 3.1 was employed for a double entry of data. Then， SPSS 19.0 was used to establish a database and analyze the data. Chisquare tests and t tests were used for data analysis and the test level is 0.05.

3. Results

3.1. The determination of symptoms of PTSD

Among the 5 114 cases， 2 944 were males and 2 170 were females with a sexual proportion of 1.36:1. The average age was （41.3±11.1）years. There are 3 167 cases （61.93%） who were classif i ed as PTSD symptoms positive group， and there are 399 cases （7.8%） who were considered to have more obvious post-traumatic stress disorder symptoms. The positive rate in females and males were 69.58% and 69.84%， respectively. The dif f erence of incidence rates in males and females had no statistical signif i cance （χ2=-0.380， P=0.704） （Table 1）. There were 2 194 young people， 2 778 middle-aged people and 142 old people in the 5 114 cases. The positive rates of them were 59.62%， 80.45% and 14.79%， respectively. The positive rates of the three groups showed statistical signif i cance （χ2=381.89， P=0.000）（Table 1）.

Table 1The determination of symptoms of PTSD ［ n（%）］.

3.2. The comparison of platelet 5-HT levels between the two groups （ng/109）

After typhoon， 100 cases that were randomly selected from 399 PTSD patients of the disaster areas and 100 healthy volunteers whowere randomly selected from Hainan Provincial People's Hospital Medical Center in the same period（control group） were analyzed by t-test. The platelet 5-HT levels of the PTSD patients and normal control group were （271.43±181.66） ng/109and （350.50±169.19）ng/109respectively ， showing signif i cant dif f erence between the two groups.

4. Discussion

The results of this study showed that after typhoon Rammasun the incidence rate of PTSD was 61.93% and 7.8% of them presented obvious symptoms of PTSD， which indicated that the disaster caused severe psychological trauma to people there ［2］. It may be related to the lagging overall level of socio-economic development of Hainan Province and the failing to carry out rescue and psychological intervention timely after disaster. At the same time， the lower level in socio-economic status， income， education and possession of various social resources of the affected people who mostly are coastal residents contribute to the increase of the incidence and symptoms of PTSD and the severe of the residents’ stress response［3］. The survey also found that the young and middle-aged have a high prevalence and a low metal capacity who are more susceptible to psychological symptoms. Therefore， the young and middle-aged people should be given more attention and concern when mental health workers carry out mental health relief in the af f ected areas［4］. 5-HT dysfunction make the body cannot maintain a stable stress neurotransmitter during stress， which may be an important etiologic basis of stress or related disorders［5］. 5-HT dysfunction of PTSD patients may be related to individual exposure and trauma-related dif f erences. There is a threshold relationship between the dif f erences， unpredictability，controlling of stressors disaster itself and stress responses of individuals. Individual psychological defense mechanism obeys passively to the disasters that are sudden and strong stimulus， thus losing its own willingness to control events adverse consequences，which appear PTSD ［6］. Meanwhile， the low level of platelet 5-HT in affected people with PTSD may be associated with individual exposure levels， acculturation， religious and cultural and so on factors of Hainan typhoon disaster area residents ［7］.

Currently， varieties of unconventional unexpected events occur more and more frequently. Hainan has a high incidence of typhoons，tsunamis and other natural disasters， and almost every region will experience this or that unconventional emergency. Sudden traumatic event sometimes cause non-objective harm to body and mind，which in addition to the harm on the body， it brings significant mentally and psychologically damage to af f ected people， as well as the resulting pluralism changes in thinking， emotional expression，values， philosophy of life， and understanding of life value and many other aspects of personality. This study shows that psychological symptoms （somatization， hostility， interpersonal sensitivity，paranoia， depression， obsessive-compulsive symptoms， anxiety，terror， psychotic） and low level in platelet 5-HT are the risk factor of PTSD. To help the government establish mechanisms for postdisaster psychological crisis intervention， develop psychological rescue plan and provide a scientific basis for clinical diagnosis of PTSD， psychological crisis intervention service agencies that can cover all areas of Hainan province should be built and postdisaster psychological crisis intervention should be carry out. It also embodies the humane care to af f ected populations， the building of harmonious society and the stabilizing of social situation.

Conflict of interest statement

We declare that we have no conf l ict of interests.

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10.1016/j.apjtm.2016.07.011

Jun-Cheng Guo， People's Hospital of Hainan Province， Haikou， Hainan，570311， China.

Tel； 18876087888

E-mail: g5738m@163.com

*Corresponding author: Min Guo， People’s Hospital of Hainan Province， Haikou，Hainan， China.

Tel: 13707587018

E-mail: g2002m@163.com

Foundation project: This study was supported by the National Science Foundation（Grant No. 81260209）， the Special International Technology Cooperation of Hainan Province （Grant No. KJHZ2014-09）， the Provincial University Students' Innovation and Pioneering Training Program of Hainan Province （Grant No. 20140119）.

Inf l uential factors

5-HT

Typhoon