The prevalence and distribution characteristics of anxiety disorders, social support, and quality of life in the population many years after the lushan earthquake in Ya’an, China

doi:10.21203/rs.3.rs-3573270/v1

Purpose

To explore (1) the anxiety disorders prevalence, relevant infuencing factors of anxiety disorders; and (2) the current status of social support and quality of life of people with anxiety disorders in the affected areas many years after Lushan earthquake in Ya’an, China.

Methods

An epidemiological mental health survey was conducted to identify the prevalence of anxiety disorders in general peoples in Ya’an.A multi-stage, group-matching random sampling method was adopted.By face-to-face interviewed,firt stage used the scale for preliminary screening by traned psychiatric nurses,and the second stage used the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) for diagnosis by trained Psychiatrists.

Results

There were 8876 valid questionnaires.The adjusted 12-month and lifetime prevalence of anxiety disorder was 3.83% and 4.44%,respectively.The total scores of SSRS and SF-36 in patients with anxiety disorder were lower than others(all P < 0.05). Regression analysis showed that being female, middle or old, and with chronic physical diseases were risk factors for anxiety disorder, and minority ethnicity, higher education level, and middle or high income were protective factors.

Conclusion

Though after many years of Lushan earthquake, we also should pay more attention the people of th female, middle or old, with lower education level, lower income level, and chronic physical diseases.

Anxiety disorders

Earthquakes social support quality of life

Epidemiology

Anxiety disorders are one of the most common psychiatric disorders, with complex and variable clinical manifestations and a prolonged and repetitive course, which may lead to mental disability or suicide, seriously affecting the quality of life (Penninx et al., 2021; Crawford et al., 2019). With population growth and social development, the disease burden of anxiety disorders has been increasing year by year. According to The Global Burden of Disease (GBD) 2019, the burden of disease for anxiety disorders ranked 24th in the global burden of disease, up 10 places from the 1990 ranking, and ranked 2nd in the burden of disease for mental disorders (Diseases et al., 2020). According to China Mental Health Survey (CMHS) 2019, the lifetime prevalence of anxiety disorders is about 7.6%, which is the highest prevalence of mental disorders in Chinese community populations (Huang et al., 2019). In December 2019, there was a global outbreak of COVID-19, which lasted for a long period of time as a sudden catastrophic event, leading to a worldwide population anxiety disorder prevalence increased to 25.6% (COVID-19 Mental Disorders Collaborators., 2021).

Earthquake is a frequent catastrophic event, which also is a primary trigger for anxiety and depression disorders (Navarro-Mateu et al., 2017). Studies reported that individuals who have experienced multiple earthquakes in a short period of time are more likely to be negatively affected by the added stress and trauma (Xie et al., 2017; Harada et al., 2015). It was found that 55.3% of the post-earthquake population had prominent psychological problems, of which 28.1% were suicidal (Ren et al., 2008). Therefore, psychological problems have become another prominent problem after post-disaster reconstruction and resource provision. The loss of family menber, the deterioration of the living environment, and the unpredictability of the future caused by the earthquake disaster will cause individuals to have different degrees of anxiety disorders, and the continued development of anxiety can be manifested as symptoms such as fear, compulsion, and suspicion, etc. Meanwhile, individuals with anxiety disorders usually also have coexisting depression, and long-term depression leads to an increased potential risk of individual suicide (Cai et al., 2021).

Quality of life is a comprehensive evaluation of a person's physical function, psychological state, and social ability, and it is the consensus of medical researchers worldwide to promote optimal human health and improve quality of life. Social support not only plays a positive role in the fulfillment of an individual's emotional needs and the maintenance of physiological health, but also buffers the impact of stressful events on quality of life, and is an important protective factor for the quality of an individual's survival (Lee et al., 2021). Investigations have found that patients with anxiety disorders have varying degrees of decreased quality of life (King et al., 2023). Meanwhile, negative emotions, such as anxiety, cause individuals to have less interest in socializing and fewer sources of social support, which further leads to a decrease in quality of life (Landi et al., 2020).

Ya’an city is Located in the western part of Sichuan Province,China, a multi-ethnic gathering place,including Han Chinese,and ethnic minorities such as the Yi and Tibetan. The region's economy is relatively backward, and in 2019, Ya'an's per capita GDP was about 6,712 USD per person, ranking 19th among 21 cities in Sichuan Province (http://www.stats.gov.cn/). Influenced by its special geographic location, Ya'an is an earthquake-prone area.On May 12, 2008, an 8.0-magnitude earthquake occurred in Wenchuan County, Sichuan Province, and the city of Ya'an was 233 km away from the epicenter, and the tremor was strongly felt.On April 20, 2013, another 7.0-magnitude earthquake occurred in Lushan County, Ya'an City, and the quake caused 196 deaths and more than 10,000 injuries,with severe house collapses and damages (https://reliefweb.int/report/china/5- 2013 Sichuan-Ta’an Earthquake). The Ya'an area suffered two strong earthquakes consecutively in five years, and the double earthquake stress had a serious impact on the mental health of the residents in the disaster area, and more research should be conducted to provide a basis for further prevention, control and intervention.

With the social concern about the mental health of the population caused by the earthquakes, there has been a gradual increase in the number of studies conducted by academics centered on the Lushan earthquake in Ya'an City (Gao et al., 2022; Zhang et al., 2022; Gao et al., 2021). The epidemiological survey of mental disorders in Ya'an City obtained epidemiological information on various types of mental disorders, mainly including the prevalence of mental disorders in the population, children and adolescents' mental health, and the mental health of ethnic minorities, etc., but it did not carry out an in-depth investigation on the prevalence and distributional characteristics of anxiety disorders in the population, as well as on social support and quality of life, and there are fewer reports at home and abroad on the short or long term population anxiety disorders related to the earthquake after the catastrophic event. There are fewer reports at home and abroad on anxiety disorders in short or long-term populations after catastrophic events. The purpose of this study are:1) to explore the prevalence and distribution of anxiety disorders in the population for many years after the Lushan earthquake, and 2) to understand the current status of social support and quality of life of people with anxiety disorders, so as to provide reference for psychological assistance and mental health services for the population after a catastrophic event.

According to the Ya’an Statistical Year Book(2018), the permanent population of Ya 'an at the end of 2017 was about 1,538 million (Bai et al., 2018),and the prevalence of mental disorders in China published by the National Health Commission(NHC) in 2017 was 17.5% (Phillips et al., 2009),with an estimated tolerance error of 20%, the minimum sample size for the epidemiological survey of mental disorders in Ya 'an was about 6200 cases. Considering the small population size of some ethnic minorities, the sample size was expanded to 9000 cases. According to the proportion of permanent residents in urban and rural areas of the city was about 1:2.6, the sample size was divided into 2500 cases in urban areas and 6500 cases in rural areas.

Sampling method

Using a multi-stage stratified cluster random sampling method, both urban and rural areas of Ya 'an City were included in the sampling frame, and their demographic characteristics were basically consistent with the permanent population of Ya 'an area. In the first stage, taking towns (streets) as sampling units, a total of 153 towns (streets) from the city's two districts and six counties were listed and 33 towns (streets) were randomly selected. In the second stage, the village (neighborhood) was selected as the sampling unit, and the list of villages (neighborhood) under the jurisdiction of the selected township (street) was discharged and 27 villages (neighborhood) were randomly selected. In the third stage, in the selected villages (neighborhood committees), according to the list of household registration population provided by the local public security department, all the people who met the conditions were included in the survey.

Inclusion criteria: age ≥15 years old; Living in Ya 'an area for ≥6 months at the time of investigation; Experienced Lushan earthquake. Exclusion criteria: age < 15 years old; Those who refuse to participate in the survey, or who are not fully conscious (or mentally ill) and unable to cooperate with the data collection; Not personally experienced Lushan earthquake. Exclusion criteria: The contents of the questionnaire were unqualified, which affected the analysis of the results of this study. If the main sample could not be found for three consecutive times during the survey, it was defined as the dropped sample, and the replacement sample was selected as the first replacement sample in the framework of the same village (neighborhood committee) by matching the principle of gender and age (±2 years old).

Preparation and investigators training

All investigators were provided with the information of the project aims, procedures and detailed content. Those who were responsible for recruitment and assessment were trained for on-site communication skills and the measuring tools.

Measuring tools

Self-made basic information questionnaire: general demographic data such as gender, age, ethnicity, residence, marriage, employment, income, education level, substance abuse, physical health status, and distribution of disaster areas were collected.

General Health Questionnaire (GHQ-12): developed by Goldberg, it is a screening tool for general health level. The supplemented GHQ-12 has good sensitivity (Chen et al., 2023).There are 12 items with a total score of 0 -12, which can be summarized into 3 factors: lack of pleasure and sleep disturbance, social role and loss of confidence. Yang Ting-zhong et al. (Ting-zhong et al., 2003) confirmed that GHQ-12 can be used as a screening tool for the epidemiological investigation of mental disorders in China, and considered that 3/4 is the best cut-off value in the Chinese population. According to the total GHQ-12 score, the subjects were divided into high-risk group (GHQ≥4), Moderate-risk group (GHQ score of 2 or 3); Low-risk population (GHQ score of 0 or 1). The internal consistency is α = 0.91.

Neurosis Questionnaire: It is provided by World Health Organization (WHO), containing a total of 10 questions, and Shen Yucun and Professor Cooper added a total of 12 questions about neurasthenia and hysteria after consultation.Each question contains two parts, the first is the presence of symptoms, the score is 0-2;the second is the moderate or severe symptoms, the score is 1-2, the maximum score for each question is 2 points.The standard cutoff scores were used to define:≥2 as positive,<2 as negative. Questionnaire has good sensitivity and specificity (Yu et al., 1985).

Social Support Rating Scale (SSRS): It is designed by Xiao Shuiyuan et al on the basis of foreign scales and according to the actual situation in our country, which can comprehensively evaluate people's social support status (Shuiyuan X, 1994).The scale had 10 items, including three dimensions: objective support (3 items), subjective support (4 items) and the utilization of social support (3 items). The higher the total score and the score of each subscale, the better the degree of social support.

The MOS item short from health survey (SF-36):It is one of the most common standardized measurement tools for quality of life in the world, containing a total of 36 questions,8 health domains: physical functioning, role limitation due to physical health problems, bodily pain, general health, vitality, social functioning, role limitation due to emotional problems, and mental health. Each subscale was scored from 0-100. The above eight subscales can be further grouped into two categories: physical summary of health and mental summary of health. Higher scores indicate better functional status in that area and higher quality of life (Kubo et al., 2020).

In the second stage, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) was used as the diagnostic criteria, and the Structured Clinical Examination for DSM-5 Axis Disorders-Research Edition (SCID-5-RV) was used as the diagnostic tool.

Investigation procedure: the investigators in this study were doctors and nurses engaged in psychiatry, and the field investigation time was from January to May 2019. Before the investigation, the project team contacted in advance by telephone to determine the investigation date and investigation cooperation, and guided by village cadres or primary health workers, 3 investigators (1 doctor and 2 nurses) carried out household investigation. All subjects with positive results in the high-risk and intermediate-risk neuroses screening table, and subjects with study number 1 in the low-risk group were diagnosed according to DSM-5 by attending psychiatrists who received unified training in SCID-5-RV.

Quality control: in order to ensure the standardization of the survey steps and the consistency of the survey tools, all the investigators were trained before the survey began, and the test was conducted after the training, and the consistency isα=0.875.The survey quality control group and quality control personnel were set up, and the completion of various scales was counted every day, and the accuracy and completeness of the scales were verified and signed for confirmation.Feedback the existing problems to the investigators in time, eliminate or verify and supplement the non-conforming or incomplete data.

Statistical analysis

EpiData3.1 software was used to input data, and SPSS 22.0 software was used for statistical processing of data results. Continuous variable data were presented as and categorical variable data were presented as numbers or percentages. Adjusted prevalence rates were calculated based on the current (last 12 months) and lifetime number of patients diagnosed with anxiety disorders in the three risk groups. Single factor analysis of qualitative data using chi-square test; After stepwise manual screening of independent variables, multivariate logistic regression was used to analyze the influencing factors of anxiety disorder. The test level α=0.05.

Ethical permission

The study was approved by the medical ethics committee of the Ya’an Fourth People’s Hospital on July 17, 2018 (No: 2/2018).

A total of 9000 participants agreed to take in the survey, 124 people due to migrant work, business trips, refusal to answer, etc.were not complete questionaires were excluded from this study.In the initial screening stage, collected 8876(98.62%) valid samples, including 4373(49.27%) males and 4503(50.73%) females. 2851(32.12%) participants were aged 15-39 years,4031(45.41%) were aged 60-64, and 1994(22.47%) others were aged 65 and over.7798(87.85%) are Han Chinese and 1078(12.15%) are ethnic minorities. 2263(25.50%) people live in urban and 6613(74.50%) in rural areas. 3776(42.54%) had an education level of primary school or less, 3104(34.97%) had a primary Chinese level, 1235(13.91%) had a high Chinese level, and the remaining 761(8.57%) had a college education level or above. 6604 (74.40%) never smoked or drank, and 2272 (25.60%) smoked or drank. 1218 (13.72%) were single, 6932 (78.10%) were married, and 726 (8.18%) were divorced or widowed. 5243 (59.07%) had a regular job, 3201 (36.06%) didnot have, and 432 (4.87%) were students. 5059 (57.00%) had low income, 2781 (31.33%) had medium income, and 1036 (11.67%) had high income. 6685(75.32%)didnot accompany any chronic diseases, and 2191(24.68%) with one or more chronic disease. 2492 (28.08%) from the ordinary disaster areas, 5175(58.30%) from severely affected areas and 1209(13.62%) from the extremely severely affected areas.

The anxiety disorders prevalence of participants

Table 1 shows the 12-month and life-time prevalence of anxiety disorders. Through the second round of anxiety disorder diagnoses, 223 cases were positive, the weighted 12-month prevalence was 3.83%, and the number of life-time illnesses cases was 277, the weighted life-time prevalence was 4.44%. There were differences in weighted 12-month prevalence and weighted life-time prevalence for different types of anxiety disorders. Unspecified anxiety disorder and generalized anxiety disorder had the higher 12-month prevalence(2.19%, 0.81%) and weighted life-time prevalence(2.35%, 1.07%) than other types of anxiety disorders.

(There is table1)

Comparison of SF-36 and SSRS scores in participants with/without anxiety disorders

Table 2 shows the comparison of SF-36 and SSRS scores in participants with/without anxiety disorders.The SSRS scores, subjective support scores, and Utilization of support scores of 223 participants with anxiety disorders were lower than those of 8653 participants without anxiety disorders(P<0.01), and there was no significant difference in objective support scores between the two groups(P>0.05).The SF-36 of participants in the anxiety disorders group and the non-anxiety disorders group were compared, and the SF-36 scores, physical health scores and mental health scores of the former were lower than the latter(P<0.01).

(There is table 2)

Demographic and anxiety disorders-related characteristics of participants

Table 3 shows that the signifcant diferences of anxiety disorders prevalence were found in different characteristics. Female participants had higher prevalence of anxiety disorders than the male (P<0.01).Among the three age groups, participants aged 40-64 years had the highest prevalence of anxiety disorders，and participants aged 15-39 years had the mildest degree of anxiety disorders(P<0.05). Minority participants had slightly lower prevalence of anxiety disorders than Han participants(P<0.05). There were significant differences in the prevalence of anxiety disorders among participants with different marital status. The divorced or widowed participants had more severe anxiety disorders than those who were married or single(P<0.01). Participants with low education, low income, and no job had significantly higher prevalence of anxiety disorders than the other groups(P<0.01).Participants who smoked or drank alcohol had lower prevalence of anxiety disorders than participants who did not(P<0.05). Participants with one or more chronic disease had higher prevalence of anxiety disorders than participants without chronic disease(P<0.01).There were no signifcant diferences in the anxiety disorders between participants in urban and rural areas, also no significant difference in anxiety disorders among participants from different earthquake-affected areas(P>0.05).

(There is table 3)

Factors associated with the 12-month prevalence of anxiety disorders

Table 4 shows the factors associated with the 12-month prevalence of anxiety disorders. The prevalence of anxiety disorders in female was 1.43 times than male(95%CI=1.07-1.91, P<0.05). In different age groups, participants aged 40-64 years had a higher prevalence of anxiety disorders compared to participants aged 15-39 years(95%CI=1.24-3.60, P<0.01), while there was no significant difference in those 65 years and over(P>0.05). Ethnic was also a contributing factor in the development of anxiety disorders, with lower rates among minority participants than Han participants(95%CI=0.32-0.94, P<0.05). Among participants with different education attainment, participants with primary school or below education had the highest incidence of anxiety disorders(95%CI=0.27-0.94, P<0.05). Participants with high income status had lower prevalence of anxiety disorders than those with lower income status, and middle-income participants were 0.70 times more likely to be in low-income participants(95%CI=0.49-1.00, P<0.05). The prevalence of anxiety disorders in participants with one or more chronic diseases was significantly higher than that of those without chronic diseases, which was 2.79 times(95%CI=2.11-3.70, P<0.05).

(There is table 4)

Based on the first epidemiologic survey of mental disorders conducted five years after the Ya'an earthquake, this study further explores the prevalence and related factors of anxiety disorders, and assesses the social support and quality of life of people with/without anxiety disorders. Due to the influence of population distribution, regional economic development level, catastrophic events, and different generations, the prevalence of anxiety disorders in this study differed from the data of similar studies conducted at home and abroad. This study demonstrated the prevalence and distribution of anxiety disorders among local people in Ya'an many years after the catastrophic event of the earthquake, which may provide a reference for future exploration of the intervention of psychological crises in the population after a catastrophic event.

The present study showed that the prevalence of anxiety disorders in the population of Ya'an region many years after the Lushan earthquake (adjusted December prevalence of 3.83%) was lower than the results of the 2015 China Mental Health Survey(weighted December prevalence of 5.0%) (Huang et al., 2019). Ya'an city is in the marginal mountainous region of western Sichuan, with a relatively homogeneous economic structure (dominated by agriculture), and the earthquake had less impact on the production methods of the residents, and competitive pressures were low compared with other developed cities, and the results were in line with the relevant study in Hainan Province (Huang et al., 2019). Previous studies have shown that the detection rate of anxiety disorders in outpatient clinics of general hospitals in China is 4.1% (Xuehong et al., 2019), the lifetime prevalence of patients with anxiety disorders in the United States reaches 5% to 6% (Baldwin et al., 2017), the detection rate of anxiety disorders among students in grades three to five of primary school is 20% after the Beichuan earthquake one year (Liu et al., 2011), and the rate of anxiety disorders among adolescents is 37.6% after the Lushan earthquake one year (Pan et al., 2015). The differences between the above studies and the results of this study may be related to the differences in the characteristics of particpants and stressful catastrophic events, the assessment and diagnostic tools, and the time of the survey. Liu Jing et al.'s (Jing et al., 2009) study of people who went to the hospital for anxiety and depression assessment within 3 months after the 512 Wenchuan Earthquake found that the same population's post-earthquake anxiety scores were significantly higher than pre-earthquake scores (P<0.001), which may be related to after experiencing the trauma of the earthquake, the population's short-term anxiety symptoms will increase or the anxiety scale scores of people who have previously had anxiety disorders will be elevated, which are mainly the more stressful life and work of the urban residents, which is also consistent with this study.

This study showed that the prevalence diffrences of anxiety disorders in different gender, age, ethnicity, education level, economic income, and presence/absence of chronic diseases is significant (P<0.05) . The prevalence of anxiety disorders was higher in females than males, previous study (Anwar et al., 2011) reported higher prevalence of anxiety disorders in females than males in Pakistani population 3 years after the earthquake,which is consistent with this study. The reason may be influenced by different physiological characteristics, personality traits, social roles, and adaptive capacity, women are more vulnerable to disaster strikes and are more likely to show real emotions such as fear and anxiety, and women should be the focus of attention in mental health promotion (Kane et al., 2017; Wang et al., 2020). The prevalence of anxiety disorders among middle-aged people (40~64 years old) and Han Chinese people is higher than that of other groups (15~39 years old, 65 years old and over, Chinese ethnic minorities), which may be due to the influence of traditional concepts, middle-aged people take on more family responsibilities and experience high psychological pressure (Zeng et al., 2012); Han Chinese people and ethnic minorities, who have different cultural backgrounds, religious beliefs, and modes of production, are more fearful of death or disasters (Hoelterhoff et al., 2017), and together with the sudden trauma of the earthquake disaster, led to their greater vulnerability to anxiety or depression. People with lower income levels and education, severely life stress, family instability, low social respect, limited access to social support and more survival problems, are more likely to have anxiety disorders after a major traumatic event such as an earthquake (Gao et al., 2022); people with chronic illnesses have a higher incidence of anxiety disorders, and physical illnesses are prone to psychological problems, and sudden events are more likely to cause anxiety, depression or aggravation of existing psychological problems (Hidayati et al., 2020). This study also found that the incidence of anxiety disorders was higher among people with chronic illnesses.

This study also found that there was no significant difference in the prevalence of anxiety disorders among people with different degrees of disaster (P>0.05), which may be attributed to the fact that after the earthquake, the government, social organizations and other organizations responded promptly and carried out all kinds of rescues, which enabled the residents in the disaster area to recover their production and life in a short period of time, and the psychological trauma, such as anxiety, panic, depression and other undesirable traumas, was gradually alleviated. At the same time, the post-earthquake government's construction of housing projects and employment support, long-term psychological counseling, services and other measures have led to the improvement of the people's living conditions and the recovery or increase of economic income, accelerating the recovery from the earthquake trauma (Peng et al., 2021). In addition, good social support has led to an improvement in the quality of life, an increase in psychological stress tolerance, and post-traumatic growth (Wu et al., 2019).

In this study, we found that the social support and quality of life scores of those with anxiety disorders were significantly lower than those without anxiety disorders (P<0.001), and both groups had low social support and quality of life, similar to previous study on those who infected COVID-19 (King et al., 2023). The related reason for this is that the sudden catastrophic events of the earthquake and the COVID-19 themselves, as well as the subsequent prolonged effects, can traumatize individuals to varying degrees and lead to a decline in quality of life (Newnham et al., 2020;Vindegaard et al., 2020). Quality of life is an important indicator for determining the prognosis of people with anxiety disorders, and good social support can help individuals gain a sense of security and accelerate their adaptation to the current state of life (Ke et al., 2023). Paying attention to the mental health of the population many years after the earthquake, strengthening the social support of people with anxiety disorders, and promoting the positive coping of individuals with psychological stress is an effective way to improve their survival quality (Wang et al., 2019).

There are some limitations in this study.1) This study is a cross-sectional study, which could not confirm the causal relationship between anxiety disorders and the sample characteristics, social support, quality of life, etc. In the future, further cohort studies or intervention studies can be carried out in combination with social support and quality of life to confirm the associations with anxiety disorders; 2) The social support and quality of life conditions were surveyed by questionnaires, which may have recall bias, and the next step can be to optimize the research method to assess the actual conditions of participants more precisely in order to reduce the occurrence of bias. The next step could be to optimize the research methodology to assess the actual situation of the participants more accurately to reduce the occurrence of bias; 3) The results of this study may be limited by the geographic area and cross-sectional study design, and cannot represent the level of anxiety disorders in all the populations many years after the occurrence of a catastrophic event, which can be further verified by multi-center and large-sample studies in the future.

In conclusion, this study is based on the first epidemiologic survey of mental disorders conducted 5 years after the Ya'an earthquake, and was conducted to further explore the prevalence and related factors of anxiety disorders in the population, and to assess the social support and quality of survival status of people with/without anxiety disorders. The results of this study showed that the prevalence of anxiety disorders was higher among females, middle-aged, Han Chinese, lower economic income and education, and those with chronic diseases, and that social support and quality of life were worse among those with anxiety disorders than those without anxiety disorders. The results of this study may provide a reference for future exploration of psychological crisis intervention in populations after catastrophic events.

Acknowledgement Authors would like to all the participants and investigators in the community for the data collection in the research project.

Grant support This project was supported by the Ya’an Science and Technology Project Funding, in China, Project Number (2018yyjskf04).

Conflict of interest None.

Data availability Our data and materials will not be availability as the data contain some private information.

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Table 1 The anxiety disorders prevalence of participants(n=8876)

Diagnosis	Number of current cases	Adjusted 12-month prevalence(%)	Number of life-time illnesses cases	Adjusted life-time prevalence(%)
Anxiety disorders	223	3.83	277	4.44
Social anxiety disorder	1	0.01	1	0.01
Panic disorder	2	0.12	2	0.12
Generalized anxiety disorder	54	0.81	77	1.07
Anxiety disorders due to other medical conditions	35	0.70	51	0.88
Unspecified anxiety disorder	131	2.19	146	2.35

Table 2 Comparison of SF-36 and SSRS scores in participants with/without anxiety disorders(n=8876)

	Participants with anxiety disorders(n=223)	Participants without anxiety disorders(n=8653)	t	P
SSRS scores	37.45±7.74	39.90±7.66	4.708	＜0.001
Objective support scores	8.59±2.51	8.90±2.55	1.786	0.074
Subjective support scores	21.23±5.12	22.72±4.99	4.414	＜0.001
Utilization of support scores	7.63±2.20	8.27±2.16	4.385	＜0.001
SF-36 scores	521.12±120.47	657.19±104.20	19.173	＜0.001
Physical health scores	271.83±72.04	335.24±57.65	16.106	＜0.001
Mental health scores	249.30±64.02	321.95±55.68	19.161	＜0.001

Table 3 Univariate analysis of 12-month prevalence of anxiety disorders(n=8876)

Characteristic(N)	N(%)	X²	P
Gender		14.29	<0.01
Male(4373)	82(1.88)
Female(4503)	141(3.13)
Age group		64.86	<0.05
15-39(2851)	19(0.67)
40-64(4031)	122(3.03)
≥65(1994)	82(4.11)
Ethnic		6.30	<0.05
Han Chinese(7798)	208(2.67)
Chinese ethnic minorities(1078)	15(1.39)
Urban and rural areas		0.11	>0.05
Urban(2263)	59(2.61)
Rural(6613)	164(2.48)
Marital status		42.38	<0.01
Single(1218)	6(0.49)
Married(6932)	179(2.58)
divorce(726)	38(5.23)
Education attainment		56.04	<0.01
Primary school or below(3776)	145(3.84)
Junior high school(3104)	63(2.03)
Senior high school(1235)	12(0.97)
College or above(761)	3(0.39)
In work or not		9.95	<0.01
yes(5243)	134(2.56)
no(3201)	88(2.75)
student(432)	1(0.23)
Economic income status		27.71	<0.01
Low income(5059)	165(3.26)
Middle income(2781)	46(1.65)
High income(1036)	12(1.16)
Smoked or drank		4.13	<0.05
Yes(2272)	44(1.94)
No(6604)	179(2.71)
Accompany with chronic disease		114.25	<0.01
No chronic disease(6685)	100(1.50)
With one or more chronic disease(2191)	123(5.61)
Severity of Earthquake		0.46	>0.05
Extremely severely affected(1209)	27(2.23)
Severely affected(5175)	139(2.69)
Moderately afected(2492)	63(2.53)

Note: Ethnic：in China, ethnic minorities refer to the remaining 55 legal ethnic groups except the Han nationality, the main ethnic group, and most of the ethnic minorities involved in this study are Yi and Tibetans. Economic income status：referring to the income level of residents in the "2018 Ya'an Statistical Yearbook", the annual income ＜ 20,000 are low-income people, 20,000 ≤ annual income ＜40,000 are middle-income people, and the annual income ≥ 40,000 are high-income people. chronic disease:chronic medical diseases refer to the main chronic diseases that code and classify the causes of death according to the International Classification of Diseases, 11th edition (ICD-11): including malignant tumors, cardiovascular diseases, diabetes, chronic respiratory diseases, etc. Severity of Earthquake : extremely severely affected, according to the distance from the earthquake center and the severity of the disaster, the most severely affected area is Lushan County(earth quake center); Severely affected,inclued Yucheng District, Tianquan County, Mingshan District, Xingjing County and Baoxing County; Moderately afected: Shimian county and Hanyuan county.

Table 4 Multivariate logistic regression analysis of 12-month prevalence of anxiety disorders(n=223)

Variable	B	SE	Wald	P	OR(95%CI)
Constant	-4.86	0.47	105.14	<0.010	0.008
Gender group
Female	0.36	0.15	5.81	<0.05	1.43(1.07-1.91)
Age group
15-39					1
40-64	0.75	0.27	7.63	<0.05	2.11(1.24-3.60)
≥65	0.57	0.30	3.57	0.059	1.77(0.98-3.22)
Ethnic
Chinese ethnic minorities	-0.60	0.28	4.75	<0.05	0.55(0.32-0.94)
Marital status
Single					1
Married	0.57	0.45	1.61	0.205	1.77(0.73-4.27)
divorce	0.94	0.49	3.75	0.053	2.56(0.99-6.64)
Education attainment
Primary school or below					1
Junior high school	-0.29	0.17	2.85	0.091	0.75(0.54-1.05)
Senior high school	-0.69	0.32	4.61	<0.05	0.50(0.27-0.94)
College or above	-1.15	0.62	3.43	0.064	0.32(0.10-1.07)
In work or not
yes					1
no	-0.26	0.15	3.31	0.069	0.77(0.58-1.02)
student	-0.95	1.06	0.81	0.370	0.39(0.05-3.07)
Economic income status
Low income					1
Middle income	-0.36	0.18	3.93	<0.05	0.70(0.49-1.00)
High income	-0.42	0.32	1.70	0.193	0.66(0.35-1.24)
Accompany with chronic disease
With one or more chronic disease	1.03	0.14	51.01	<0.010	2.79(2.11-3.70)

No competing interests reported.

The prevalence and distribution characteristics of anxiety disorders, social support, and quality of life in the population many years after the lushan earthquake in Ya’an, China

Status:

Version 1

Abstract

Introduction

Study population

Results

Discussion

Declarations

References

Tables

Additional Declarations

Status:

Version 1