Social support following a natural disaster: A longitudinal study of survivors of the 2013 Lushan earthquake in China
Introduction
Each year millions of people are affected by disasters resulting from both natural hazards and human activities. There is substantial evidence that disasters can lead to a range of mental health problems, such as posttraumatic stress disorder (PTSD), depression and anxiety (Bonanno et al., 2010, Cofini et al., 2015, Gigantesco et al., 2013, Masahiro Kokai et al., 2004, Liang et al., 2019, Minardi et al., 2016, Norris et al., 2002, Xu et al., 2018). It has been generally assumed that post-disaster social support may buffer these negative consequences, however studies investigating the association between social support and mental health in the aftermath of disaster have produced inconsistent results. This inconsistency is partly due to the complex construct of social support (Kaniasty and Norris, 2004) with studies focusing on social support measuring received support (actual receipt of help; e.g., Cerda et al., 2013), social embeddedness (quality and type of relationships with others; Wyndol and Duane, 1985), perceived support (the belief that help would be available if needed; e.g., Chan et al., 2015, Chang et al., 2014, Cherry et al., 2015, Feder et al., 2013, Ward et al., 2018), or a mixture of the above (Ren et al., 2015, Zhang et al., 2017).
Compared with other facets of social support, received social support is less frequently addressed in disaster studies and the pattern of the findings observed when relevant measures are included have been mixed. For example, a small number of relevant studies have suggested a beneficial role of actual support received on psychological well-being in disaster context (e.g., Cerdá et al., 2013, Dekovic et al., 2008, Hussain et al., 2013, Norris and Kaniasty, 1996), while other studies have revealed no effects, or worse, documented positive associations between received support and increased mental health problems (e.g., Lowe et al., 2015, Morgan et al., 1995, Shiotani, 2014).
One key limitation of these prior disaster studies is that the social support instruments typically used assessed only the quantity (or frequency) of social support received. It may be that other features of received social support also matter, such as what type of support is provided and when and how it is delivered, as well as other dimensions related to the broader concept of quality of received support. For example, one qualitative study found that except for insufficiency of aid, survivors also complained about support that was distributed unfairly, or in a delayed or conditional manner (Ibañez et al., 2003).
The concept of quality of received social support is the foundation of the social support effectiveness model (SSE, Rini and Dunkel Schetter, 2010, Rini et al., 2006), which was initially developed to improve understanding of the effectiveness of support received by pregnant women from their partners. The SSE model encompassed dimensions of both quantity and quality, and identified five features which underlie the effectiveness of received social support: needs matching in quantity, needs matching in type, the skilfulness /sensitivity of support delivering, the ease of obtaining support, and the extent to which received help might negatively influence recipients’ self-concept. The SSE model provides a solid theoretical framework for assessing the effectiveness of social support but does not address all features important for support received in disaster context where substantial social support is provided by government or other organizations through intensive disaster aid distribution. In this context, research also suggests that dissatisfaction with aid distribution (such as unfairness or lack of transparency) predicts lower levels of subsequent social psychological well-being (Kaniasty, 2012). Thus, characteristics of the disaster aid distribution such as justice and fairness should also be considered in evaluating quality of received social support in disaster context.
The aim of this study was to examine the influences of both quantity and quality of received social support on mental health outcomes in a longitudinal study of earthquake survivors in China. It was conducted in the aftermath of a 7.0 magnitude earthquake that severely devastated Lushan County, Sichuan Province, China. The Lushan earthquake, which struck on April 20, 2013, affected close to 2 million people and resulted in 196 deaths, 21 missing individuals, and more than 13,000 injured survivors.
Section snippets
Participants and procedure
The first survey (T1) was conducted 7 months after the disaster. Participants were recruited from four towns, two from the worst-hit disaster areas and two from less severely affected areas. Convenience sampling was used in each town and participants were recruited during a free influenza vaccination program for the entire geographical area that was affected by the earthquake. Individuals 18 years of age and older and who were at the disaster area when the earthquake occurred were invited to
Sample
The follow-up sample (n = 161) was predominantly female (n = 108, 67%), aged between 20 and 76 years old (Mean = 41.61, SD = 12), and the participants completed 8.8 years of education on average (SD = 3.95; range: 0–18 years).
The non-responders of the follow-up survey were not significantly different from the remaining participants in terms of age (t197 = 1.31, p = .19), years of education (t197 = −0.91, p = .36), and gender (x2199 = 0.59, p = .44), baseline PTSD (t197 = 0.46, p = .31), and
Discussion
This study examined the prospective relationships involving two most important dimensions of received social support and mental health in the aftermath of a major earthquake in China. The results indicated that higher levels of quality, but not quantity, of social support received by earthquake victims within the first 7 months following the disaster predicted lower levels of posttraumatic stress symptoms and psychological distress assessed 31 months after the earthquake. These effects of
Conflicts of interest
None declared.
Acknowledgements
The first author received an Australian Government Research Training Program Scholarship to support her PhD studies. Data collection for this study was partially funded by Peking University Institute of Mental Health and the Department of Psychiatry, The University of Melbourne. We would like to thank all the participants who took part in this study, and thank staff in Psychiatric hospital of Ya'an City, Sichuan Province in China for their support in participants’ recruitment. Thank you also to
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