The course of post-disaster health problems of victims with pre-disaster psychological problems as presented in general practice

BACKGROUND: Survivors of disaster with pre-disaster psychological problems are believed to be at risk for presenting post-disaster psychological and physical morbidity. Up till now this statement is based on cross-sectional studies with self-reported data and without pre-disaster measurement. OBJECTIVE: To monitor post-disaster health care utilization and morbidity presented in general practice after a man-made disaster by victims and controls with and without pre-disaster psychological problems. METHODS: A controlled cohort study with pre-disaster (1 year) and post-disaster (two-and-a-half years) data. Victims (N = 2518) of an exploding fireworks depot in a residential area and matched controls (N = 2512), representing patients in 30 general practices, were included. Main outcome measures were utilization measured by GP attendances, and psychological and physical problems registered by the GP using the International Classification of Primary Care. RESULTS: Only victims without pre-disaster psychological problems demonstrated a significant increase in utilization in the first half year post-disaster. Victims with pre-disaster psychological problems did not. Being a victim (OR = 6.13; 95% CI = 4.84-7.77) had a greater effect than pre-disaster psychological problems (OR = 4.96; 95% CI = 3.96-6.21) on presenting post-disaster psychological problems. Pre-disaster psychological problems had more effect (OR = 1.93; 95% CI = 1.79-2.08) than the effect of being a victim (OR = 1.25; 95% CI = 1.18-1.32) on the development of post-disaster physical symptoms. CONCLUSION: Post-disaster increases in utilization and psychological morbidity were observed. Post-disaster psychological problems were more influenced by the disaster, while post-disaster physical symptoms were more influenced by pre-disaster psychological problems. GPs should concentrate on the pre-disaster health history of victims of man-made disasters in their practices.     

Health problems of victims before and after disaster: a longitudinal study in general practice

BACKGROUND: We aimed to quantify the health problems and to assess the possible risk factors for developing health problems in persons affected by the explosion of a firework depot at Enschede, The Netherlands, on May 13, 2000. The explosion considerably damaged buildings in the local neighbourhood and caused 22 immediate deaths and injuries in over 1000 people. METHODS: A longitudinal study of (89% of all) victims (n = 9329) and controls (n = 7392) with pre-disaster baseline morbidity for 16 months and post-disaster data for 2.5 years was conducted using the electronic medical records of general practitioners. Symptoms and diagnoses were recorded using the International Classification of Primary Care (ICPC). Prevalence rates for clusters of symptoms were compared between victim and control groups pre- and post-disaster. Risk factors for developing health problems were examined in hierarchical linear models. RESULTS: Two and a half years post-disaster, the prevalence of psychological problems in victims who had to relocate was about double and in the non-relocated victims one-third more than controls. Victims with pre-disaster psychological problems were at a greater risk for post-disaster psychological problems. Relocated victims showed an excess of medically unexplained physical symptoms (MUPS) especially in a period of increased media attention. Both groups of victims showed some increase of gastrointestinal (GI) morbidity 2.5 years post-disaster compared with their pre-disaster rate, and compared with the control group. CONCLUSIONS: Two and a half years post-disaster an excess of psychological problems, MUPS, and gastrointestinal morbidity was observed. Pre-disaster psychological problems and inevitable relocation were predictors of more post-disaster psychological problems.     

Does disaster affect immigrant victims more than non-immigrant victims in Dutch general practice: a matched cohort study

Background  In the literature, immigrant victims appear to be more vulnerable to health effects of a disaster than indigenous victims. Most of these studies were performed without pre-disaster measurement and without using a control group. Aim  The objective of the study is to monitor differences between two groups of victims, Turkish immigrants and indigenous Dutch, in utilization and morbidity as presented in general practice after a man-made disaster. Methods  A matched cohort study was performed with pre-disaster (1 year) and post-disaster (4 years) measurements of patients from 30 general practices in Enschede. Turkish victims (N = 303) and Dutch victims (N = 606), matched on age, gender and socioeconomic status, were included. Main outcome measures were psychological problems and physical symptoms as recorded by the general practitioner, using the International Classification of Primary Care (ICPC). Results  The Turkish victims showed higher utilization than the Dutch victims prior to the disaster. In the 1st post-disaster year, both groups of victims showed an increase in utilization, but the increases did not differ significantly. The Turkish group showed no significantly greater increase than the Dutch group in the five most prevalent clusters of health problems (psychological, respiratory, skin, musculoskeletal, and digestive). Conclusion  The Turkish victims in general practice were as vulnerable as the Dutch victims for the effects on their health of this man-made disaster. Differences between Turkish and native Dutch victims of this man-made disaster can largely be explained by the differences that existed already before the disaster.     

Previous consultation and self reported health status as predictors of future demand for primary care

STUDY OBJECTIVE: There has been little prospective investigation of what predicts general practice consultation. The objective of this study was to investigate the extent to which previous primary care consultation and self reported health status are predictors of future primary care consultation. DESIGN: Population based cohort study in two phases. Firstly, a baseline survey (1995/96) to identify the cohort and to obtain self reported health status using the UK census limiting long term illness (LLI) question and the Short Form-36 (SF-36) health profile. Secondly, analysis of general practice medical records for two years (1994/1995) before the survey and for two years (1997/1998) after the survey. Analysis was performed on: (a) all contacts coded by the GP, (b) the subgroup of contacts given a diagnostic morbidity code by the GP. SETTING: One general practice in North Staffordshire, UK. PARTICIPANTS: 738 survey respondents who had consented to viewing of medical records including all those who reported LLI together with an age-gender matched control group of those who reported no LLI. MAIN RESULTS: High frequency consulters in 1994/95 were more likely than non-consulters or average consulters in that year to be high consulters in 1997/98 (odds ratio 5.6, 95% confidence interval 3.82 to 8.25, for all contacts; 4.4 for diagnostic coded consultations). Self reported role disability and physical limitation from the SF-36 at baseline increased the probability of being a future high consulter but the effects were weaker than for previous consultation. Previous consultation within a diagnostic group was the main predictor for future consultation within that group with weaker but significant prediction by self reported health status. CONCLUSIONS: Reliable morbidity coding in general practice provides the best available basis for predicting future demand in primary care. Self reported health status survey instruments add to this information but on their own are weaker predictors of future consultation.     

The importance of estimating selection bias on prevalence estimates shortly after a disaster

PURPOSE: The aim was to study selective participation and its effect on prevalence estimates in a health survey of affected residents 3 weeks after a man-made disaster in The Netherlands (May 13, 2000). METHODS: All affected adult residents were invited to participate. Survey (questionnaire) data were combined with electronic medical records of residents' general practitioners (GPs). Data for demographics, relocation, utilization, and morbidity 1 year predisaster and 1 year postdisaster were used. RESULTS: The survey participation rate was 26% (N = 1171). Women (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.28-1.67), those living with a partner (OR, 2.00; 95% CI, 1.72-2.33), those aged 45 to 64 years (OR, 2.00; 95% CI, 1.59-2.52), and immigrants (OR, 1.50; 95% CI, 1.30-1.74) were more likely to participate. Participation rate was not affected by relocation because of the disaster. Participants in the survey consulted their GPs for health problems in the year before and after the disaster more often than nonparticipants. Although there was selective participation, multiple imputation barely affected prevalence estimates of health problems in the survey 3 weeks postdisaster. CONCLUSIONS: Estimating actual selection bias in disaster studies gives better information about the study representativeness. This is important for policy making and providing effective health care.     

A longitudinal comparative study of the physical and mental health problems of affected residents of the firework disaster Enschede, The Netherlands

OBJECTIVES: After the firework disaster in Enschede, The Netherlands, on 13 May 2000, a longitudinal health study was carried out. Study questions were: (1) did the health status change over this period; and (2) how is the health status 18 months after the disaster compared with controls? STUDY DESIGN: A longitudinal comparative study with two surveys at 3 weeks and 18 months after the disaster. METHODS: A control group for the affected residents was included in the second survey. Respondents filled in a set of validated questionnaires measuring their physical and mental health problems. RESULTS: The prevalence of physical and emotional role limitations, severe sleeping problems, feelings of depression and anxiety, as well as intrusion and avoidance decreased from 3 weeks to 18 months after the disaster for the affected residents. Independent of background characteristics and other life events, residents had 1.5 to three times more health problems than the control group; for example, physical role limitations (odds ratio [OR]=1.5, 95% confidence interval [CI] 1.2-2.0) and anxiety (OR=3.1, 95% CI 2.4-4.2). CONCLUSIONS: Although health problems decreased compared with 3 weeks after the disaster, 18 months after the disaster, the affected residents had more health problems than the people from the control group.     

Clinical multimorbidity and physical function in older adults: a record and health status linkage study in general practice

BACKGROUND: Multiple chronic conditions occurring in the same individual are associated with adverse health outcomes. In family practice, individuals are seen who, over time, may experience many different symptoms, illnesses and chronic diseases. Measures for defining multimorbidity, which incorporate the diverse range of health problems seen in population-based family practice, remain to be developed. We have investigated whether routinely collected consultation data could be used as the basis for a simple classification of multimorbidity that reflects an individual's overall health status. METHODS: Morbidity consultation data for 9,439 English patients aged 50 years and over in an 18-month time period were linked to their self-reported physical health status measured by Short-Form 12 at the end point. Associations between physical function and all-cause multimorbidity counts were estimated relative to single morbidity only, and between physical function and morbidity severity (185 morbidities categorized on four ordinal scales of severity) relative to persons who had not consulted about any of the 185. RESULTS: In the 18-month period, 19% had consulted for a single morbidity and 23% for six or more (a high multimorbidity count). An estimated 24% of poor physical function in the family practice consulting population may be attributable to high multimorbidity. There was an increasing strength of association between poor physical function and increasing severity of multimorbidity on all four severity scales. Estimated associations (adjusted odds ratios) of the most severe morbidity categories with poor physical function were, for each of the four scales, respectively, 5.6 for chronicity [95% confidence interval (CI) 4.4-7.1], 7.0 for time course (4.5-10.6) and 3.6 for health care use (2.0-6.6) and for patient impact (6.7; 5.2-8.8). CONCLUSIONS: Multimorbidity defined by using routinely collected family practice consultation data and classified by count and by severity was associated with poorer physical function. This approach offers the potential for systematic use of routine records to classify multimorbidity and to identify groups with high likelihood of poor physical status for needs assessment and targeted intervention.     

Psychological, musculoskeletal, and respiratory problems and sickness absence before and after involvement in a disaster: a longitudinal study among rescue workers

Aims: To examine the longitudinal course of psychological, musculoskeletal, and respiratory problems and sickness absence among rescue workers involved.

Methods: The study population was composed of 1036 rescue workers. Data on health and sickness absence both before and after the disaster were collected from the electronic database of the rescue workers' occupational physicians. Health problems were coded according to an adapted version of the ICD-10.

Results: After the disaster a long term increase was found in psychological, musculoskeletal, and respiratory problems. Compared to six months before the disaster, the average length of sickness absence in the first half year after the disaster increased from 6.6 to 11.6 days, and decreased slowly in the following six month periods.

Conclusions: Rescue workers involved in a disaster may experience subsequent impairment in occupational functioning.

     

Psychological distress after employment transitions: the role of subjective financial position as a mediator

OBJECTIVE: To explore the extent to which the mental health effects of transitions into unemployment, or other forms of non-employment, and vice versa, are mediated by financial changes. METHODS: Longitudinal analysis of the British Household Panel Survey from 1991 to 2000. There were 89,264 person-years of observation from 14,686 individuals aged > or =16 years. Main outcome measure was psychological distress measured by the 12-item General Health Questionnaire. RESULTS: Transitions to unemployment were associated with increased risk of psychological distress for men (adjusted odds ratio (OR) 3.15 (95% confidence interval (CI) 2.50 to 3.98)) and for women (OR 2.60 (95% CI 1.97 to 3.43)). Women who left work to look after the family were also more likely to experience psychological distress (OR 1.72 (95% CI 1.45 to 2.05)). A reduced risk of psychological distress was seen for transitions from unemployment to paid employment for men (OR 0.52 (95% CI 0.41 to 0.68)) and for women (OR 0.68 (95% CI 0.69 to 1.40)). Financial difficulty partially mediated these relationships: men who became unemployed and were worse off financially were more likely to experience psychological distress (OR 4.19 (95% CI 3.20 to 5.50)) than men who were not (OR 1.48 (95% CI 0.95 to 2.33)). Conversely, the beneficial health effect for people who left unemployment and became employed was confined to those who were better off financially (OR 0.34 (0.25 to 0.48) for men). CONCLUSIONS: Changes in employment status have both direct and indirect effects, through changes in financial circumstances, on subsequent psychological distress. The results support the view that the direction of causation runs from employment transitions to financial difficulties and psychological distress.     

Psychological distress and the perception of radiation risks: the Fukushima health management survey

Objective

To assess relationships between the perception of radiation risks and psychological distress among evacuees from the Fukushima nuclear power plant disaster.

Methods

We analysed cross-sectional data from a survey of evacuees conducted in 2012. Psychological distress was classified as present or absent based on the K6 scale. Respondents recorded their views about the health risks of exposure to ionizing radiation, including immediate, delayed and genetic (inherited) health effects, on a four-point Likert scale. We examined associations between psychological distress and risk perception in logistic regression models. Age, gender, educational attainment, history of mental illness and the consequences of the disaster for employment and living conditions were potential confounders.

Findings

Out of the 180 604 people who received the questionnaire, we included 59 807 responses in our sample. There were 8717 respondents reporting psychological distress. Respondents who believed that radiation exposure was very likely to cause health effects were significantly more likely to be psychologically distressed than other respondents: odds ratio (OR) 1.64 (99.9% confidence interval, CI: 1.42–1.89) for immediate effects; OR: 1.48 (99.9% CI: 1.32–1.67) for delayed effects and OR: 2.17 (99.9% CI: 1.94–2.42) for genetic (inherited) effects. Similar results were obtained after controlling for individual characteristics and disaster-related stressors.

Conclusion

Among evacuees of the Fukushima nuclear disaster, concern about radiation risks was associated with psychological distress.     

什邡地震灾区984名灾民心理健康调查

目的了解什邡地震灾区灾民的心理健康状况,为对灾民进行心理干预提供科学依据。方法采用卫生部颁发的《心理健康自评问卷》（SRQ-20）对什邡市4个大型安置点的984名灾民进行了随机问卷调查。结果什邡灾民心理问题需要心理干预者占与55．28％,其中较突出者并需心理干预者占9．35％,有自杀倾向者28．05％;男女严重度无明显差异;死者家属心理健康受损度高（x^2=15．55,P〈0．01）;文化程度方面学历较低者受损程度高,小学及以下〉初中=高中。最常见的心理问题是感到疲劳（78．46％）,其次是焦虑担心（77．64％）、抑郁不高兴（71．95％）。结论地震灾害造成灾民的心理健康问题较为突出,加强心理卫生教育及对灾民的心理干预是非常必要的。     

Mothers' mental health and infant growth: a case-control study from Rawalpindi, Pakistan

BACKGROUND: Epidemiological studies in Pakistan show high rates of depression in women, while rates of malnutrition in children are also high. This study aimed to determine whether poor maternal mental health is associated with an increased risk of infant undernutrition. METHODS: Clinic-based case-control study. A total of 172 consecutive infants and their mothers attending for 9-month measles immunization were recruited over a 3-month period. Eighty-two undernourished infants [weight for age below the National Centre for Health Statistics (NCHS)/World Health Organization (WHO) third centile] were matched to 90 controls (weight for age above 10th centile), and their mothers interviewed for mental distress using the Self-Reporting Questionnaire (WHO SRQ-20, a psychiatric screening instrument). Infants' exposure to maternal distress (score > or = 10 on SRQ-20) and other potential risk or protective biological, social, socio-economic and family factors were measured. RESULTS: Mental distress determined by WHO SRQ-20 was associated with increased risk of undernutrition in infants (odds ratio 3.91, 95% confidence interval 1.95-7.86). This association remained significant after controlling for birthweight and social factors. CONCLUSION: Exposure to maternal mental distress is associated with undernutrition in 9-month infants in urban Pakistan. These mothers may represent a group whose children are at higher risk of ill health, and potentially be a specific target for advice on infant care. Early recognition and treatment of mental health problems in mothers may help reduce morbidity and mortality rates in children.     

Parent-reported infant health and illness in a whole year birth cohort

OBJECTIVE: To describe parent-reported infant health and illness experience at 8 weeks. SETTING: Coventry. STUDY DESIGN: Prospective whole year birth cohort. OUTCOME MEASURES: Period prevalences (birth to 8 weeks) and incidences, unadjusted and adjusted for differential cohort attrition, of parent-reported infant health outcomes. METHODS: Of 3891 live births in 1996, 2572 (66%) were recruited into the study. Data were collected by health visitors as part of routine child health surveillance, at 8 weeks using the Warwick Child Health and Morbidity Profile (WCHMP) incorporated into the Parent Held Record. Period prevalences and incidences of parent-reported health outcomes in the first 8 weeks of life were calculated with and without adjustment for the effects of different rates of cohort attrition by sociodemographic group. RESULTS: Data were collected on 2572 infants at recruitment. Health outcome data were available on 2072 (53% of all 1996 live births) infants at 8 weeks. There was differential attrition by social group between enrollment and 8 weeks. Nineteen (95% confidence intervals (CIs) 14,24)/1000 infants were reported as not very healthy/unhealthy, 12 (95% CIs 8,16)/1000 as having impaired health-related quality of life and 11 (95% CIs 7,15)/1000 impaired functional health. Chronic illness had a period prevalence rate of 19 (95% CIs 14,24)/1000. Sixty-six (95% CIs 55,77)/1000 had acute illnesses requiring medical attention and 43 (95% CIs 34,52)/1000 were admitted to hospital at least once. More minor illness than expected was reported in 87 (95% CIs 75,99)/1000. The incidence rate of accidents requiring medical attention was 16 (95% CIs 9,21)/1000. Behavioural problems had a prevalence rate of 78 (95% CIs 66,90)/1000. CONCLUSIONS: Infant health status data have traditionally been based on mortality, hospital admissions and specific diagnoses. This is the first report of health and illness experience during infancy in a whole year birth cohort based on a validated measure of parent-reported health status incorporated into the Parent Held Record and administered by the family health visitor as part of routine child health surveillance. These data give a more comprehensive picture of infant health and illness experience than traditional measures and provide the basis for infant health needs assessment.     

Seismic intensity and mental stress after the Great Hanshin-Awaji Earthquake

Objective For 1,361 victims of the Great Hanshin-Awaji Earthquake, to evaluate the usefulness of seismic intensity information for mental health activities, we examined the quantitative relationship between experienced seismic intensity and earthquake-related life events or mental health. Methods Questionnaires were administered concerning seismic intensity, life events and mental health to the victims. Results The incidence of serious life events, such as death of a close family member and mental disorders were higher in areas of high seismic intensity than in low-intensity areas. Victims who experienced intensity 7 (Japan Meteorological Agency) scored 11 or more on the Modified Mercalli (MM) scale, perceived more depressive symptoms [odds ratio (OR) 2.11, 95% confidence interval (95% CI), 1.49–2.98)] and lower mental health status (OR 1.87, 95% CI 1.34–2.61) than those who suffered intensity 4 or less, who scored 7 or less on MM scale after controlling for various sociodemographic factors. Conclusions Higher seismic intensity was associated with each severe life event and ill mental health among earthquake victims.     

Social and demographic predictors of parental consultation for child psychological difficulties

BACKGROUND: Results from previous studies examining determinants of parental consultation for child mental health provide inconsistent evidence concerning socio-demographic predictors. The aim of this study is to identify the sociodemographic predictors of parental consultation for child psychological difficulties. METHOD: An epidemiological cross-sectional analysis was carried out using a sample of 5,913 children aged between 4 and 15 years from the Health Survey for England. The Strengths and Difficulties Questionnaire (SDQ) was the measure of child psychological morbidity. RESULTS: Parents of children with psychological difficulties were less likely to seek a consultation if their child was a girl, as household income decreased or if the head of household came from manual social class. In contrast, parents were more likely to seek a consultation if they were in receipt of a benefit than if they were not in receipt of a benefit. Age of child and family type did not predict parental consultation. CONCLUSIONS: The results of this analysis confirm that a substantial proportion of children with mental health difficulties in the general population (42 per cent) have not been seen by a professional, and these are likely to be girls and children in low-income families, indicating a significant unmet need for services across the nation. These results suggest that parents and health professionals should be made more aware of the symptoms of psychological problems in girls and that services need to be planned in a way that improves uptake by low-income parents.     

Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education?

BACKGROUND: Of the many studies assessing the impact of childhood living conditions on health and health inequalities in adulthood, only few have combined information on current determinants of health with detailed individual level data on different aspects of childhood living conditions and adversities. This study aims (i) to assess the role of parental education, self-reported childhood adversities and family structure as determinants of different dimensions of health in early adulthood, and (ii) to identify the role of the respondent's own education as a modifier of the association between childhood living conditions and health. METHODS: The study is based on a representative sample (n = 3669; participation rate 83%) of young adults aged 18-39 years in 2000 in Finland. The main outcome measures were poor self-rated health (SRH), psychological distress (by GHQ12) and somatic morbidity. RESULTS: Parental education, problems in childhood and the respondent's own education were independently related to SRH and psychological distress. The impact of childhood living conditions on health varied by gender and according to the measure of health. Childhood conditions were strongly associated with poor SRH and psychological distress, whereas the connection with somatic morbidity was weaker. The associations remained relatively unchanged after controlling for the respondent's own education. CONCLUSIONS: Childhood living conditions and adversities are strongly associated with poor SRH and psychological distress in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing health problems in adulthood.     

Risk factors for groin wound infection after femoral artery catheterization: a case-control study.

OBJECTIVE: Groin wound infection (GWI) after femoral artery catheterization is unusual. However, several reports of GWI associated with the use of a Perclose device appear in the surgical literature. DESIGN: A case-control study. SETTING: We pooled 23 cases and 83 controls from a university hospital and a community medical center. PATIENTS: A case was defined as a patient who developed a GWI after a femoral artery catheterization. At the university hospital, 3 controls were randomly selected from the at-risk population and matched to each case by time of procedure only (within 2 weeks). At the community medical center, 4 controls were selected and matched to each case by time of procedure (within 2 weeks), sex, and age (within 5 years). RESULTS: We considered several covariates, including age, sex, body mass index, medical conditions, Perclose use, hematoma formation, and antithrombotic therapy. In a multivariate model, only hematoma formation (odds ratio, 68.8; 95% confidence interval, 12.1-391.4) and glycoprotein IIb/IIIa platelet inhibitor therapy (odds ratio, 6.1; 95% confidence interval, 1.1-33.6) were statistically significant predictors of GWI; Perclose use (odds ratio, 0.9; 95% confidence interval, 0.2-3.7) was not a statistically significant predictor of GWI. However, most of the hematomas (15/17) formed after procedures during which a Perclose device was used. CONCLUSION: Perclose use did not have any additional effect on GWI risk beyond the effect that hematoma formation had.     

What makes new mothers unhappy: psychological distress one year after birth in Italy and France

The aim of this report is to present results on the factors associated with psychological distress in 724 Italian and 629 French women 12 months after birth. The prevalence of distress was ascertained by the 12-item Goldberg Health Questionnaire (GHQ), using a cut-off score of > 5. Results show that, in both countries, after controlling for previous psychological health, the variables significantly associated with mothers' distress were: an unsatisfactory couple relationship; lack of a confidante; a baby with serious health problems, financial worries. In Italy, also being an older mother and a discrepancy between actual and desired employment status were associated with a high GHQ score. These results point out to the high prevalence of mothers' psychological distress in Latin countries too, and stress the role played by family and social factors.     

Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study

Objective

To assess whether having a subsequent child had an effect on the mental health of Chinese mothers who lost a child during an earthquake.

Methods

A cross-sectional survey of bereaved mothers was conducted 30 to 34 months after the 2008 Sichuan earthquake using individual structured interviews to assess sociodemographic characteristics, post-disaster experiences and mental health. The interviews incorporated standardized psychometric measures of anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief (CG). Social support was also assessed. An adjusted model taking potential confounders into account was used to explore any association between psychological symptoms and the birth of a subsequent child.

Findings

The prevalence of psychological symptoms was higher in mothers who did not have a child after losing the first one. In an adjusted model, symptoms of anxiety (odds ratio, OR: 3.37; 95% confidence interval, CI: 1.51–7.50), depression (OR: 9.47; 95% CI: 2.58–34.80), PTSD (OR: 5.11; 95% CI: 2.31–11.34) and CG (OR: 10.73; 95% CI: 1.88–61.39) were significantly higher among the 116 women without a subsequent child than among the 110 mothers who had another child after bereavement. More than two thirds of the mothers with new infants had clinically important psychological symptoms.

Conclusion

Women who have lost an only child in a natural disaster are especially vulnerable to long-term psychological problems, especially if they have reached an age when conception is difficult. Research should focus on developing and evaluating interventions designed to provide women with psychosocial support and reproductive services.     

Association of sexual problems with social, psychological, and physical problems in men and women: a cross sectional population survey

STUDY OBJECTIVE: To investigate the association of sexual problems with social, physical, and psychological problems. DESIGN: An anonymous postal questionnaire survey. SETTING: Four general practices in England. PARTICIPANTS: 789 men and 979 women responding to a questionnaire sent to a stratified random sample of the adult general population (n = 4000). MAIN RESULTS: Strong physical, social, and psychological associations were found with sexual problems. In men, erectile problems and premature ejaculation were associated with increasing age. Erectile problems were most strongly associated with prostate trouble, with an age adjusted odds ratio of 2.6 (95% confidence intervals 1.4, 4.7), but hypertension and diabetes were also associated. Premature ejaculation was predominantly associated with anxiety (age adjusted odds ratio 3.1 (95% confidence intervals 1.7, 5.6)). In women, the predominant association with arousal, orgasmic, and enjoyment problems was martial difficulties, all with odds ratios greater than five. All female sexual problems were associated with anxiety and depression. Vaginal dryness was found to increase with age, whereas dyspareunia decreased with age. CONCLUSIONS: This study indicates that sexual problems cluster with self reported physical problems in men, and with psychological and social problems in women. This has potentially important consequences for the planning of treatment for sexual problems, and implies that effective therapy could have a broad impact on health in the adult population.