Elsevier

Psychiatry Research

Volume 273, March 2019, Pages 641-646
Psychiatry Research

Social support following a natural disaster: A longitudinal study of survivors of the 2013 Lushan earthquake in China

https://doi.org/10.1016/j.psychres.2019.01.085Get rights and content

Highlights

  • Greater quality of support received predicted lower levels of symptoms of posttraumatic stress and psychological distress.

  • Quantity of received social support did not predict of symptoms of posttraumatic stress or psychological distress.

  • These results were still robust when controlled for gender, negative life events and family financial status.

  • What appears to be critical in the process of supporting disaster survivors is the quality, not necessarily the quantity, of support provided.

Abstract

The idea that social support post-disaster is beneficial to survivors’ mental health is widely accepted by both researchers and practitioners. However previous social support studies are mainly focused on perceived social support, and the limited received social support studies have produced mixed results. In this study we modelled the influence of both quantity and quality of received social support on long-term mental health outcomes in a longitudinal study of 2013 Lushan earthquake survivors in China. Survivors were invited to complete a questionnaire interview 7 months after the earthquake and were followed up 31 months later (n = 161). Hierarchical regression analyses that controlled for disaster exposure variables showed that greater quality of social support received 7 months after disaster predicted lower levels of posttraumatic stress symptoms and psychological distress two years later, however quantity of received social support was not significant in predicting these two outcomes. These results remained robust when controlled for gender, negative life events and family financial status. The findings of this study suggest that what appears to be critical in the process of supporting disaster survivors is the quality, not necessarily the quantity, of support provided.

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

References (37)

  • Y.-S. Chang et al.

    Rotating night shifts too quickly may cause anxiety and decreased attentional performance, and impact prolactin levels during the subsequent day: a case control study

    BMC Psychiatry

    (2014)
  • T.A. Cheng et al.

    Internal consistency and factor structure of the Chinese Health Questionnaire

    Acta Psychiatr. Scand.

    (1990)
  • K.E. Cherry et al.

    Long-term psychological outcomes in older adults after disaster: relationships to religiosity and social support

    Aging Ment. Health

    (2015)
  • M. Dekovic et al.

    Factors associated with traumatic symptoms and internalizing problems among adolescents who experienced a traumatic event

    Anxiety Stress Coping

    (2008)
  • D.P. Goldberg et al.

    User's Guide to the GHQ

    (1988)
  • A. Hussain et al.

    Posttraumatic stress and symptom improvement in Norwegian tourists exposed to the 2004 tsunami – a longitudinal study

    BMC Psychiatry

    (2013)
  • G.E. Ibañez et al.

    Qualitative analysis of social support and conflict among Mexican and Mexican‐American disaster survivors

    J. Community Psychol.

    (2003)
  • K. Kaniasty

    Predicting Social Psychological Well-Being Following Trauma: the role of postdisaster social support

    Psychol. Trauma Theory Res. Pract. Policy

    (2012)
  • Cited by (30)

    • Do earthquake survivors want to escape the threats of earthquakes and why?

      2023, International Journal of Disaster Risk Reduction
    • Stress-related psychopathology during the COVID-19 pandemic

      2022, Behaviour Research and Therapy
      Citation Excerpt :

      Social support is one powerful buffer against the emergence of psychopathology following community-level stressors like natural disasters and terrorist attacks (Arnberg, Hultman, Michel, & Lundin, 2012; Ghuman, Brackbill, Stellman, Farfel, & Cone, 2014; Henrich & Shahar, 2008; LaGreca, Silverman, Lai, & Jaccard, 2010; McGuire et al., 2018; Shahar et al., 2009; Shahar & Henrich, 2016). Social support can be defined in numerous ways, but the quality of emotional support following stressors is particularly likely to buffer against the emergence of mental health problems (Cohen, 2004; Shang et al., 2019). The availability of social support is often eroded following natural disasters, which can disrupt entire communities and fracture social networks (Kaniasty & Norris, 1995; LaGreca et al., 2010; Lowe, Chan, & Rhodes, 2010).

    • Disaster survivors’ perceptions of received social support: Outcome, delivery, and provider all matter

      2022, International Journal of Disaster Risk Reduction
      Citation Excerpt :

      Like most Chinese people, Ya'an citizens are concerned about “face” (i.e., mianzi, sense of social value and respect from others) and are generally reluctant to seek help from others [17]. The current participants comprised n = 11 disaster survivors, who were a sub-group of 161 participants who were followed up as part of the longitudinal mixed-methods project [13]. These participants in the larger study completed quantitative questionnaires assessing demographic characteristics, disaster exposure, quantity and quality of received social support, and mental health symptoms.

    • Informal social support and disaster preparedness: Mediating roles of perceived collective efficacy and self-efficacy

      2022, International Journal of Disaster Risk Reduction
      Citation Excerpt :

      In the following section, we first review the study rationale and related work on disaster preparedness and then propose and empirically test the proposed mediation model based on the data collected from the two surveys. There is some evidence for the importance of informal social support for rapid response to and long-term recovery from the effects of disasters [21,22]. Informal social support is instrumental in quickly warning of imminent threats, providing preparation resources for loved ones and offering help immediately after natural disaster impact (Tyler et al., 2018).

    • Social support, interpersonal, and community dynamics following disasters caused by natural hazards

      2020, Current Opinion in Psychology
      Citation Excerpt :

      The quality of received social support may be more sensitive in registering its benefits than its mere amount. In a study of the 2013 Lushan earthquake in China [15•], it was the greater quality of received social support (e.g. fit with the needs, timeliness and sensitivity of delivery) that predicted less distress two years later, whereas the quantity of received support was not significant in predicting psychological outcomes. Findings of disaster studies examining the role of perceptions of social support are clearer.

    View all citing articles on Scopus
    View full text