Evaluating the moderating effects of risk and resilience factors on post-traumatic stress symptoms in child and adolescent survivors of the 2008 Sichuan, China earthquake

A year-long psychosocial intervention used art and sports to build resilience and improve mental health in young survivors of the Sichuan earthquake. This cross-sectional study investigates the effects of the psychosocial intervention on resilience factors associated with post-traumatic stress disorder (PTSD) in participants compared to a control group. Data were collected from a sample of 1,988 students from 6 intervention schools and 2,132 from 4 control schools. Respondents completed questionnaires measuring socio-demographics, risk exposure from the earthquake, resilience factors using The Connor-Davidson Resilience Scale and PTSD using the UCLA-PTSD Reaction Index. Bivariate logistic regression found that the intervention did not have an effect on the log odds of PTSD (p=0.09). However, use of multiple group structural-equation modeling demonstrated that risk and resilience factors may have moderated the effects on PTSD. Resilience Factor 1: Rational Thinking was negatively related to PTSD in both groups (p<0.001). Resilience Factor 2: Self-Awareness was positively associated with PTSD in both groups (p<0.001). Earthquake-related risk factors had a negative relationship with PTSD in the intervention group only (p<0.001). This may be the result of positive attachment relationships with caregivers and peers in the intervention. Results highlight the potentially powerful role social support from adult caregivers and peers in mitigating mental distress after a crisis, and the need for more cross-cultural research in resilience theory and local understandings of adaption in order to develop culturally relevant and appropriate intervention methodologies and evaluation measures aimed at enhancing child and adolescent resilience and mental health after a disaster.