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In the present study, 350 adolescent survivors were randomly selected from several primary and secondary schools in the counties of Wenchuan and Maoxian, the two areas most severely affected by the Wenchuan earthquake. All adolescents have no psychiatric conditions prior to the earthquake. The mean age of the adolescents was 15.65 (SD = 1.74) years at the first measurement wave, with ages ranging from 12.0 to 19.0 years. Of the 350 participants, 201 (57.4%) were female and 149 (42.6%) were male. With respect to ethnicity, 67 (19.1%) belonged to the Han ethnic group, 87 (24.9%) belonged to the Tibetan ethnic group, 188 (53.7%) belonged to the local Qiang group, and 8 (2.3%) belonged to other minor ethnic categories. This project was approved by the Research Ethics Committee of Beijing Normal University and the local education authorities (i.e., County Departments of Education) as well as the participating school principals. Written informed consent was obtained from school principals and classroom teachers. In China, research projects that are approved by local education authorities and the school administrators and that are deemed to provide a service to the students do not require parental consent. Thus, the current project was not required to obtain written informed consent from parents. The purpose of the study and the autonomy of the students were highlighted before the survey. Written informed consent was obtained from each subject, and the right to withdraw from the survey at any time was provided for them. Three assessments were conducted at different time points under the supervision of trained individuals with Master's degree in psychology. No compensations were provided to the students for their participation other than possible counseling if needed. Of 350 participants, all the participants completed the first assessment at one year after the earthquake (T1). At the second assessment, a year and a half after the earthquake (T2), 334 (95.4%) of the original 350 sample completed the survey; 279 (77.4%) completed the third assessment at two years after the earthquake (T3). During the course of the follow-up, all adolescents were free of medications as well as drug abuse. In each follow-up survey, some students dropped out the school or graduated from the school, thus there are some drop-out rates. To investigate the potential impact of attrition, we tested the differences in demographic variables (e.g., age, gender and ethnicity) and the main study variables (i.e., three symptom clusters of PTSD and sleep problems) from the first assessment between the longitudinal sample and the subjects who did not follow up for unknown reasons (i.e., other than dropout and graduation). Attrition analysis results showed that except for age [χ2(7) = 15.38, p<0.05], there were no significant differences in gender [χ2(1) = 1.03, p>0.05], ethnicity [χ2(3) = 4.40, p>0.05], intrusive symptom clusters of PTSD [t(348) = 0.86, p>0.05], avoidance symptom clusters of PTSD [t(348) = 0.60, p>0.05], hyperarousal symptom clusters of PTSD [t(348) = 0.78, p>0.05] and sleep problems [t(348) = 0.63, p>0.05].
The Child PTSD Symptom Scale: Posttraumatic stress symptoms were assessed with the Child PTSD Symptom Scale [27], a 17-item self-reported scale designed to measure the occurrence and frequency of PTSD symptoms according to the Diagnostic and Statistical Manual of Mental Disorders in relation to the most distressing event. In the current study, all the items were translated into Chinese, children rated the frequency of symptoms during the previous two weeks on a 4-point-Likert scale of 0 (not at all/only at one time) to 3 (almost always 5 or more times a week). Subscale scores ranged from 0 to 15 for intrusion, 0 to 21 for avoidance, and 0 to 15 for hyperarousal. The overall severity score was generated by adding the scores of all three subscales. In the current sample, the scale exhibited good internal consistency (alpha coefficient for global PTSD was 0.89 at T1, 0.90 at T2 and 0.91 at T3; the alpha coefficients for intrusive symptoms, avoidance symptoms and hyperarousal symptoms were 0.80, 0.77 and 0.80 at T1; 0.71, 0.74 and 0.78 at T2; 0.75, 0.79 and 0.83 at T3, respectively) and good fit indices in confirmative factor analysis (χ2/df = 2.21, NFI = 0.87, CFI = 0.93, RMSEA = 0.059).
The Child Behavior Problems Questionnaire: The Child Behavior Problems Questionnaire was generated by (a) evaluating the adolescents' circumstances after the Wenchuan earthquake and (b) revising the Youth Risk Behavior Survey Questionnaire [28]. This questionnaire included a seven factor structure with 19 items assessing behavior problems. The seven factor structure included conflict behaviors, sleep problems, suicidal ideation, dietary behaviors, drug addiction, networked behaviors and related negative behaviors. The response scale ranged from 0 (I did not experience this change) to 2 (I experienced this change a great deal). In the current study, we used the sleep problems subscale, which had 3 items, including difficulty in sleep, sleepless nights and early-morning wakefulness. The subscale demonstrated good internal consistency (alpha coefficient was 0.74 at T1, 0.72 at T2 and 0.94 at T3).
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