Application of the Chinese Posttraumatic Stress Disorder Checklist to Adolescent Earthquake Survivors in China

Article excerpt

The Wenchuan earthquake measuring 8.0 on the Richter Scale occurred on May 12, 2008 in the Sichuan province of China. It was one of the deadliest and most devastating natural disasters in China and killed at least 68,700 people, including more than 5,000 adolescents. Posttraumatic stress disorder (PTSD) is a psychiatric disorder that develops in some people following exposure to a traumatic event, such as military combat, violent crime, assault, or a natural disaster (American Psychiatric Association, 2000). Because adolescence is a period when individuals are coping with significant physical and psychological developmental changes, adolescents are likely to develop PTSD after exposure to traumatic events (Joseph, Brewin, Yule, & Williams, 1993; Lonigan, Shannon, Saylor, Finch, & Sallee, 1994). According to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 2000) and the Chinese Classification and Diagnostic Criteria of Mental Disorders (CCMD; Chinese Psychiatry Society, 2001), the main clusters of PTSD symptoms are reexperiencing/intrusion of the traumatic event, avoidance/numbing, and increased hyperarousal. Defining symptoms include trauma-associated dreams and nightmares, efforts to avoid reminders of the stressful experience, and heightened physiologic arousal episodes during the month after the event (Smith, Redd, DuHamel, Vickberg, & Ricketts, 1999).

The PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and Impact of Event Scale (IES; Horowitz, Wilner, & Alvarez, 1979) are two major tools used to diagnose PTSD. It is difficult to identify and assess PTSD in people in mainland China because the Chinese (Mandarin) version of the PTSD measure is not well-established. Although the IES has been used widely to examine traumatic events, the items included do not have direct reference to the diagnostic criteria in the DSM-IV (Wu & Chan, 2003; Wu, Chan, & Yiu, 2008).

However, the PCL, a 17-item self-report rating scale, matches the diagnostic criteria of the DSM-IV and is, therefore, a more reliable measure and is also more likely to produce results indicating greater validity than the IES. Because it takes only about 5 minutes to administer the PCL, compared to 40 to 60 minutes for diagnostic interviews, such as those used in the Clinician-Administered PTSD Scale (Foa, Riggs, Dancu, & Rothbaum, 1993; Smith et al., 1999; Wu, Chan, & Yiu, 2008), in our study we used the civilian version (Weathers, Litz, Huska, & Keane, 1994) of the PCL to examine PTSD.

Many researchers have shown that the PCL has satisfactory reliability and validity (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996; Forbes, Creamer, & Biddle, 2001; Keen, Kutter, Niles, & Krinsley, 2008; Lang, Laffaye, Satz, Dresselhaus, & Stein, 2003; Palmieri, Weathers, Difede, & King, 2007). For example, Weathers, Litz, Herman, Huska, and Keane (1993) found that the PCL has a high test-retest reliability (r = 0.9) and validity (kappa coefficient = 0.6) for the diagnosis of PTSD from the structured clinical interview for DSM-III-R (Spitzer, Williams, Gibbon, & First, 1990). However, different models have been used to assess PTSD symptom scores. For example, Cordova, Andrykowski, and Jacobsen (1997) used a three-factor model and King, Leskin, King, and Weathers (1998), Asmundson et al. (2000), and Wu et al. (2008) used a four-factor model.

The focus in the present study was mainly on two areas. The first was exploring risk factors for PTSD among middle-school students who survived the Wenchuan earthquake in China and then evaluating the incidence of PTSD among this group. The second was examining the psychometric properties of the Chinese version of the PCL.

Method

Sample and Procedure

The survey was conducted in July 2008, two months after the Wenchuan earthquake. …