J Child Fam Stud (2016) 25:2915–2923
DOI 10.1007/s10826-016-0454-1
ORIGINAL PAPER
A Cross-Sectional Study on Risk Factors of Posttraumatic Stress
Disorder in Shidu Parents of the Sichuan Earthquake
Ziqi Wang1 • Jiuping Xu1
Published online: 6 June 2016
Ó Springer Science+Business Media New York 2016
Abstract Of the 2008 Sichuan Earthquake survivors, there
was a special group known as Shidu parents, who lost their
only child in the disaster. The objective of this study was to
estimate the posttraumatic stress disorder (PTSD) preva-
lence in the Shidu parents from different counties and
explore the related risk factors. Across-sectional sample
survey was conducted to collect data in 10 heavily dam-
aged counties (n = 176) and 12 moderately damaged
counties (n = 148). Probable PTSD prevalence in Shidu
parents from the heavily damaged counties (83.5 %) was
found to be higher than that in the moderately damaged
counties (72.3 %). Many associated PTSD risk factors
were identified in the cross-sectional study, such as being
of Han ethnicity, losing a young child (18–27), losing a
male child, living in the countryside, receiving low social
support over the previous 6 years, and having high resi-
lience were significant in the heavily damaged areas, and
being of Han ethnicity, having a low monthly income,
having a high education level, losing a young child
(18–27), losing a male child, and having high resilience in
the moderately damaged areas.
Keywords Shidu parents
Sichuan earthquake
PTSD

Prevalence
Factors
& Jiuping Xu
xujiuping@scu.edu.cn
1
Institute of Emergency Management and Reconstruction in
Post-disaster, Sichuan University, No. 24, South Section 1,
Yihuan Road, Chengdu 610065, Sichuan,
People’s Republic of China
Introduction
On May 12, 2008, a destructive Ms 8.0 earthquake struck
Wenchuan in Sichuan Province, the deadliest earthquake to
hit China since the 1976 Tangshan earthquake (Lu and Xu
2014). According to the Ministry of Civil Affairs data, as
of July 21, 2008, there were 69,227 fatalities, 374,176
injured and a further 18,222 listed as missing (Xu and Song
2011). Many earthquake survivors experience psychosocial
problems (e.g., depression, anxiety) as they try to adjust to
a loss of housing, job or family members. Having direct
exposure to an earthquake disaster and losing a child are
extremely stressful life events which often result in long-
term health consequences (Xu et al. 2014). Previous studies
have shown that post-traumatic stress disorder (PTSD) is
the most frequently reported psychiatric morbidity in
earthquake disaster victims, with the rate of PTSD docu-
mented among survivors ranging from 2 to 87 % (Başoglu
et al. 2004; Xu and Song 2011; Hafstad et al. 2012). PTSD
is an anxiety disorder that often manifests after experi-
encing dangerous or disturbing events (Neria et al. 2008).
Of the Sichuan earthquake survivors, there is a partic-
ular group, known as Shidu parents, who lost their only
child in the earthquake. Studies have reported that parents
who lost children are at a higher risk of mental disorders
than those who experienced other traumatic experiences
such as economic loss or losing a job (Xu et al. 2014).
Since 1979 in China, when the one-child policy was
introduced, couples have only been allowed to have one
child (Murphy et al. 1999). This meant that if a child died,
families were often losing their one and only child. The
loss of a child is always devastating but when it is the only
adult child, the loss can be catastrophic, as the parents are
often too old to have another child (Xu et al. 2013).
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Three months after the earthquake, the State Family
Planning Commission began offering reproductive health
services to assist bereaved families have a subsequent
child. However, even with the assisted reproductive tech-
nologies, many couples failed to conceive owing to phys-
ical problems (e.g., hypertension, heart disease) or mental
illness (e.g., anxiety, obsessive–compulsive disorder)
(Song 2014). Many parents who had lost a child had a
subsequent child within one to five years of the disaster
(Xu et al. 2014). Therefore, the investigation in this paper
was conducted in 2014, 6 years after the earthquake. In
addition, couples in which the wife was 49 years or older
who had lost their only child received a monthly govern-
ment subsidy (Song 2014). Because all the wives of the
registered parents were at least 49 years old, their children
had already reached adulthood in 2008.
The loss of a child is considered one of the most
stressful events in a parent’s life (Galea et al. 2005). Until
recently, little research had focused on PTSD in bereaved
survivors following the sudden unexpected death of a child
in a natural disaster. Chan et al. (2012) suggested that the
loss of a child in an earthquake was a significant risk factor
for psychopathological symptoms and caused more severe
grief in parents than other bereavement types. Xu et al.
(2013) examined the psychological and social conse-
quences in parents who had lost a child in a natural or
human-made disaster. Xu et al. (2014) studied the mental
health of women who had had and not had a subsequent
child after losing their only child in a natural disaster.
However, to date, no systematic population-based PTSD
study has been conducted on Shidu parents who lost their
only child in an earthquake.
Previous studies have found that post-earthquake PTSD
is very common in females, Han Chinese (Xu and Song
2011; Kun et al. 2013) and survivors who had received low
post-earthquake social support (Neria et al. 2008). Income
level has also been found to be an important factor in post-
earthquake mental health, with survivors on lower incomes
having higher PTSD prevalence (Galea et al. 2005). Resi-
lience, which is commonly defined as a relatively positive
adaptation process despite having experienced significant
adversity or trauma (Masten 2001), has also been found to
be associated with mental health (Jowkar et al. 2010). In
Chinese traditional culture, a child is a major source of
hope and meaning for parents. In underdeveloped areas, a
son has often been considered to be able to make more
money than a daughter as they are stronger and more
suitable for agricultural work (Short et al. 2001).
In this study, we focused on married Shidu parents who
had lost their only adult child in the earthquake and had not
had a subsequent child as of September 2014. To our
knowledge, this is the first population-based systematic
research of PTSD prevalence in Shidu parents after an
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J Child Fam Stud (2016) 25:2915–2923
earthquake disaster. To understand the mental health issues
in Shidu parents so as to provide decision support for
possible psychological interventions, a cross-sectional
study was conducted on Shidu parent survivors from both
the heavily damaged and moderately damaged areas of the
2008 Wenchuan earthquake in Sichuan Province, China.
The objectives of this study were to estimate posttraumatic
stress disorder prevalence in Shidu parents from different
communities and to explore the related common risk fac-
tors in both groups and the specific risk factors in each
group. Based on previous studies, the following hypotheses
for this study are proposed: (1) Being female is not a sig-
nificant PTSD predictor in both groups; (2) Low social
support increases PTSD prevalence in Shidu parents from
heavily damaged counties; (3) Shidu parents with a lower
level of income have a higher propensity for PTSD in
moderately damaged counties; (4) Shidu parents who lost a
male child are at a higher risk of PTSD than those who lost
a female child in both groups; (5) High resilience is a
protective factor against PTSD development for Shidu
parents in both groups.
Method
Participants
A cross-sectional survey of 357 participants was conducted
from May to September 2014 in 22 earthquake-stricken
counties: Dujiangyan, Pengzhou, Chongzhou, Shifang,
Mianzhu, Jiangyou, Anxian, Pingwu, Beichuan, Jiange,
Qingchuan, Santai, Wenchuan, Lixian, Maoxian, Yanting,
Dayi, Zitong, Wangcang, Guanghan, Luojiang, Zhong-
jiang. From a State Seismological Bureau assessment, 10
counties were identified as heavily damaged; Dujiangyan,
Pengzhou, Shifang, Mianzhu, Anxian, Pingwu, Beichuan,
Qingchuan, Wenchuan, Maoxian; while the others were
identified as moderately damaged. The inclusion criteria
were: (1) having a high degree of earthquake exposure; and
(2) experiencing the complete process of the earthquake
and losing an only child. A total of 357 individuals were
initially involved in the survey with a final 324 completing
the questionnaire, a response rate of 90.76 %.
Of these 324 respondents, 176 respondents were from
the 10 heavily damaged counties and 148 respondents were
from the 12 moderately damaged counties. The results are
shown in Table 1. Across-sectional sample survey was
conducted to collect data in 10 heavily damaged counties
(n = 176) and 12 moderately damaged counties (n = 148).
The mean age of the Shidu parents from the heavily
damaged areas (n = 176) was 54.70 ± 4.62 years, with
males being 47.7 % of the sample. Of the respondents,
39.8 % earned less than $300 per month, and 23.3 % were
J Child Fam Stud (2016) 25:2915–2923 2917

Table 1 Descriptive statistics

Heavily damaged Moderately damaged
for the respondents in the
heavily and moderately n % n %
damaged counties
Gender
Male 84 47.7 70 47.3
Female 92 52.3 78 52.7
Age
46–50 44 25.0 41 27.7
51–55 59 33.5 46 31.1
56–60 57 32.4 48 32.4
61–65 16 9.1 13 8.8
Ethnicity
Han 140 79.5 126 85.1
a
Tibetan 17 9.7 9 6.1
Qiangb 13 7.4 6 4.1
Huic 6 3.4 7 4.7
Registered residence
City 41 23.3 40 27.0
Town 56 31.8 48 32.4
Countryside 79 44.9 60 40.5
Monthly income
\$300 70 39.8 48 32.4
$300–$450 74 42.0 57 38.5
[$450 32 18.2 43 29.1
Education level
Professional college or above 27 15.3 35 23.6
High school 56 31.8 52 35.1
Middle school or below 93 52.8 61 41.2
Age of child
18–27 103 58.5 87 68.8
28–37 58 33.0 53 35.8
[37 15 8.5 8 5.4
Gender of child
Male 102 58.0 87 58.8
Female 74 42.0 61 41.2
Social support past 6 years
Low 81 46.0 68 45.9
Moderate 54 30.7 66 44.6
High 41 23.3 14 9.5
Resilience
Low 75 42.6 62 41.9
Moderate 49 27.8 47 31.8
High 51 29.5 39 26.4
a
An ethnic minority in China
b
An ethnic minority in China
c
An ethnic minority in China

living in cities. In addition, 52.8 % of respondents had a Hui (3.4 %). Of the respondents, 58.5 % of their only
low education level (middle school or below). Besides the children had been between 18 and 27 years of age on their
main ethnic group (Han, 79.5 %), the following ethnic death, 58.0 % had lost a male child and 46.0 % reported
groups participated; Tibetan (9.7 %), Qiang (7.4 %), and that their social support in the previous 6 years had been

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low. In terms of resilience, 29.5 % of the respondents
reported a high score.
The mean age of the Shidu parents from the moderately
damaged areas (n = 148) was 54.60 ± 4.75 years, with
47.3 % being male. Of the respondents, 29.1 % earned a
monthly income of over $450 and 40.5 % lived in coun-
tryside. Overall, 41.2 % of the respondents had a relatively
low education level (middle school or less), and 58.8 %
had lost a male child. In terms of social support, 45.9 %
reported a low level over the previous 6 years. Further,
26.4 % of the respondents reported high resilience. The
Han ethnic group was the majority group in both the
heavily and moderately damaged areas (79.5 and 72.9 %).
Procedure
Shidu parents are a sensitive issue in China, so precise
details are classified. To protect human rights and privacy,
the survey was first approved by the local government.
Participants were assured of confidentiality and could
withdraw from the study at any moment. As a member of
the post-disaster reconstruction expert group, the first
author had had previous contact with Shidu parents. The
cross-sectional survey was conducted 6 years after the
Sichuan earthquake with the help of the Sichuan Province
Population and Family Planning Commission. There were
12,475 registered eligible families including 3132 divorced
parents, 2421 widowed parents, and 6922 married parents.
In our study, we focused on PTSD in married Shidu parents
who had not had a subsequent child as of September 2014.
For the survey, 6922 married parents were initially invited
to participate by email or telephone, with 357 parents
volunteering, including 197 parents from the 10 heavily
damaged counties and 160 respondents from the 12 mod-
erately damaged counties. Further, if only one of the par-
ents (father or mother) volunteered, the investigation was
judged as valid. There was no monetary reward for the
participants but some small gifts were given such as gloves,
detergent, and soap.
Survey teams were temporarily established and divided
into 22 small teams. Each team had a psychology teacher,
two graduate students and a staff member from the local
Family Planning Commission, at least one of whom was
fluent in the local dialect. All teams participated in a 5-day
training program, which included lectures describing the
study protocols and instruments, role-play interviews and
mutual discussions. Before the formal investigation, a pilot
test was conducted in March 2014 and minor modifications
and adjustments were made according to the feedback. The
final version of the questionnaire was used in the formal
investigation. All assessment forms were translated from
English to Chinese and back-translated by a bilingual team
of professionals. The questionnaire was distributed door to
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door by making an appointment, with the teams visiting all
participating households in the cities, towns or rural areas.
Measures
The assessment questionnaire had two parts. The first
collected basic demographic data such as age, gender,
ethnicity and social support over the previous 6 years. The
second section had two scales, as described in the
following.
PTSD symptoms were assessed using the PTSD Check-
List-Civilian Version (PCL-C) which has 17 items, each of
which correspond to a symptom in the Diagnostic and Sta-
tistical Manual of Mental Disorders, Fourth Edition (DSM-
IV) PTSD criteria B, C, and D. The Chinese version of the
PCL-C has shown good diagnostic agreement and sound
reliability and validity (Wang et al. 2011; Xu and Song 2011).
For the Sichuan earthquake, each symptom was measured on
a scale of 1–5 (with 1 = not at all, 2 = slightly, 3 = mod-
erately, 4 = severely, 5 = extremely severely). Criteria B
focused on re-experience of the earthquake (five symptoms),
criteria C focused on avoidance and emotional numbing
(seven symptoms) and criteria D focused on increased arousal
(five symptoms). PTSD was judged to be present with a score
of three or more in at least one of the four re-experience
symptoms, at least three of the seven avoidance symptoms,
and at least two of the five arousal symptoms. The Cronbach’s
alpha coefficient for PTSD was 0.89.
Social support was measured using the Chinese rating
scale developed by Xiao (Zhao et al. 2013). The Social
Support Rating Scale (SSRS) had been widely applied to
Chinese populations and has been shown to have excellent
reliability and validity (Xie et al. 2009; Zhao et al. 2013).
The SSRS has 10 items which measure three types of social
support: subjective support (4 items), objective support (3
items), and support availability (3 items) (Wu et al. 2014),
with final scores ranging from 12 to 66 and higher scores
indicating greater social support (Liu et al. 2015). The
2 month test–retest SSRS reliability exceeded 0.92 (Xie
et al. 2009). The SSRS Cronbach alpha coefficient was 0.91.
The Resilience Scale for Adults (RSA) is a 33-item self-
report scale for measuring protective resilience factors in
adults (Friborg et al. 2006). Several studies have found the
RSA to be both reliable and valid in Chinese (Li et al.
2012; Xu and Ou 2014). The revised version of the RSA
used in the present study had a seven-point semantic dif-
ferential scale in which each item had a positive and a
negative attribute at each end of the scale continuum
(Jowkar et al. 2010). The total RSA score ranged from 33
to 231, with higher scores indicating higher levels of pro-
tective resilience factors (Li et al. 2012). The final version
had a six-factor solution: (1) Self-perception, (2) Planned
future, (3) Social competence, (4) Structured style, (5)
J Child Fam Stud (2016) 25:2915–2923
Family cohesion, and (6) Social resources (Friborg et al.
2006). The RSA Cronbach alpha coefficient was 0.88.
Data Analyses
Statistical analyses were performed using SPSS Version
16.0. Simple descriptive statistics such as frequencies,
means, SD and proportions were calculated and shown in
Table 1. Comparisons between subject characteristics with
and without probable PTSD were analyzed using a Chi-
square test. Logistic regression was also used to analyze the
significant predictors for probable PTSD in Shidu parents.
All tests were two-tailed and significance was set at .05.
Results
The PTSD prevalence in Shidu parents form the heavily
damaged counties was found to be 83.5 % and in the mod-
erately damaged counties was 72.3 % (based on the DSM-IV
criteria). From Table 2, it can be seen that there were statis-
tically significant differences for PTSD prevalence in both
groups for age, ethnicity, education level, age of child, gender
of child, social support over the previous 6 years, and resi-
lience (p \ 0.05). However, there were no significant dif-
ferences found between genders in either group.
According to the logistic regression analysis in Table 3,
the PTSD risk factors in the group from the heavily dam-
aged areas were; being of Han ethnicity [odds ratio (OR)
0.279, 95 % confidence interval (CI) 0.143–0.543], losing
a young child (18–27) (OR 0.131, 95 % CI 0.032–0.548),
losing a male child (OR 0.204, 95 % CI 0.060–0.689),
living in the countryside (OR 5.598, 95 % CI
2.404–13.036), receiving low social support over the pre-
vious 6 years (OR 0.244, 95 % CI 0.108–0.550), and
having high resilience (OR 0.183, 95 % CI 0.051–0.651)
(p \ 0.05, 95 % CI). The risk factors for PTSD in the
group from the moderately damaged areas were; being of
Han ethnicity (OR 0.362, 95 % CI 0.198–0.661), having a
low monthly income (OR 0.211, 95 % CI 0.087–0.507),
having a high education level (OR 0.368, 95 % CI
0.174–0.782), losing a young child (18–27) (OR 0.181,
95 % CI 0.042–0.783), losing a male child (OR 0.149,
95 % CI 0.052–0.427), and having high resilience (OR
0.164, 95 % CI 0.042–0.517) (p \ 0.05, 95 % CI).
Discussion
The findings indicated that there was wide spread PTSD in
Shidu parents after the Sichuan earthquake. The probable
PTSD prevalence estimate (based on the DSM-IV criteria)
in our sample was 83.5 % (heavily damaged counties) and
2919
72.3 % (moderately damaged counties), indicating that
posttraumatic symptoms were quite common. The PTSD
rate reported in previous research was 84.8 % after
1 month, 65.6 % after 7 months, and 40.1 % 1 year after
the Sichuan earthquake (Chan et al. 2012; Xu and Song
2011). One possible explanation for these differences may
be that previous studies focused on other victim categories
such as the elderly or female survivors, and had different
survey times and PTSD measurement instruments. Second,
the closer the survivors were to the epicenter, the more
severe the PTSD seemed to be (Basoglu et al. 2004;
Murphy et al. 1999). Third, for Chinese parents, as a child
is a precious gift and is the main purpose for the continu-
ation of the parents’ lives, the death of a child is extremely
devastating (Chan et al. 2012).
Previous studies have pointed out being female was one
of the major PTSD factors in Sichuan earthquake victims
(Kun et al. 2013; Xu et al. 2014; Zhou et al. 2013).
However, in this survey, no significant associations were
found between gender and PTSD in either group, which
supported hypothesis 1. This may be because of Traditional
Clan Culture in China. Carrying on the family line is an
important task for both parents (father and mother). If
parents fail to carry on the family line, they are seen as
dishonoring their ancestors (Siah 2010). In addition, par-
ents may constantly feel guilty for not protecting their
children and about the end of their family tree (Fletcher
2002).
In this study, receiving low social support was found to
be a high risk factor for PTSD prevalence in the heavily
damaged counties, which was similar to previous findings
(Neria et al. 2008; Wu et al. 2014). The results confirmed
hypothesis 2. Earthquake survivors who received low
social support had a higher possibility of PTSD as they
struggled to face sudden bereavement, injuries and home-
lessness (Neria et al. 2008). Compared with the moderately
damaged counties, the heavily damaged counties had
received more support, care and assistance from the gov-
ernment, aid organizations, and volunteers, so their work
and living environments had greatly improved. Survivors
who were more exposed to the disaster were also more
likely to ask as well as receive emotional support and help,
which mayhave resulted in a more positive psychological
adjustment (Zhou et al. 2013). Shidu parents were also
encouraged to engage in reconstruction work, which
assisted them in relieving their stress and discovering their
own value. In addition, psychological services were pro-
vided to victims to enhance their psychological well-being,
which might have protected the survivors from serious
PTSD symptoms.
Similar to findings in other studies (Galea et al. 2005;
Wu et al. 2014), a low monthly income was found to be
significantly related to PTSD in the Shidu parents in the
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Table 2 Association of characteristics for Shidu parents with PTSD

Characteristics Heavily damaged Moderately damaged
2
PTSD [N (%)] v p PTSD [N (%)] v2 p

Overall 147 (83.5) 107 (72.3)

Gender 0.364 .546 0.432 .511
Male 67 (79.8) 47 (67.1)
Female 80 (87.0) 60 (76.9)
Age 26.773 .000** 21.459 .000**
46–50 37 (84.1) 32 (78.0)
51–55 52 (88.1) 38 (82.6)
56–60 47 (82.5) 31 (64.6)
61–65 11 (68.8) 6 (46.2)
Ethnicity 280.682 .000** 285.568 .000**
Han 127 (90.7) 96 (82.1)
Tibetan 9 (52.9) 5 (55.6)
Qiang 8 (61.5) 3 (50.0)
Hui 3 (50.0) 3 (42.9)
Registered residence 16.170 .002** 4.108 .128
City 26 (63.4) 24 (60.0)
Town 46 (82.1) 33 (68.8)
Countryside 75 (94.9) 50 (83.3)
Monthly income 18.318 .000** 2.041 .360
\$300 56 (80.0) 43 (89.6)
$300–$450 62 (83.8) 41 (71.9)
[$450 29 (90.6) 23 (53.5)
Education level 37.307 .000** 7.068 .029*
Professional college or above 24 (88.9) 28 (80.0)
High school 47 (83.9) 37 (71.2)
Middle school or below 76 (81.7) 42 (68.9)
Age of child 60.011 .000** 61.068 .000**
18–27 93 (90.3) 71 (81.6)
28–37 45 (77.6) 33 (62.3)
[37 9 (60.0) 3 (37.5)
Gender of child 4.455 .035* 4.568 .033*
Male 93 (91.2) 72 (82.8)
Female 54 (73.0) 35 (57.4)
Social support past 6 year 14.193 0.001** 38.000 0.000**
Low 74 (91.4) 55 (80.9)
Moderate 45 (83.3) 43 (65.2)
High 28 (68.3) 9 (64.3)
Resilience 20.465 0.000** 21.689 0.000**
Low 59 (78.7) 51 (82.3)
Moderate 33 (67.3) 30 (63.8)
High 27 (52.9) 19 (48.7)
** p \ .01; * p \ .05

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Table 3 Regression analysis of

B SE Wals Sig.a Exp (B)b Exp (B) 95 % CI
factors associated with PTSD in
Shidu parents Lower limit Upper limit

Heavily damaged counties

Gender -.165 .623 .070 .791 .848 .250 2.876
Age .112 .517 .047 .829 1.118 .406 3.081
Ethnicity -1.278 .341 14.063 .000 .279 .143 .543
Monthly income -.155 .443 .123 .726 .856 .359 2.040
Registered residence 1.722 .431 15.953 .000 5.598 2.404 13.036
Education level .332 .422 .619 .432 1.393 .610 3.183
Age of child -2.029 .729 7.751 .005 .131 .032 .548
Gender of child -1.591 .622 6.543 .011 .204 .060 .689
Social support past 6 year -1.410 .414 11.586 .001 .244 .108 .550
Resilience -1.637 .572 6.894 .000 .183 .051 .651
Constant 8.260 2.688 9.441 .002 3867.687
Moderately damaged counties
Gender .173 .511 .115 .735 1.189 .437 3.238
Age .099 .452 .048 .827 1.104 .455 2.679
Ethnicity -1.017 .308 10.930 .001 .362 .198 .661
Monthly income -1.558 .449 12.056 .001 .211 .087 .507
Registered residence .683 .379 3.247 .072 1.981 .942 4.165
Education level -.998 .384 6.760 .009 .368 .174 .782
Age of child -1.708 .746 5.234 .022 .181 .042 .783
Gender of child -1.902 .537 12.554 .000 .149 .052 .427
Social support past 6 year -.625 .379 2.718 .099 .535 .255 1.125
Resilience -1.362 .401 5.214 .000 .164 .042 .517
Constant 12.507 2.677 21.827 .000 270,348.118
a
Sig: Sig \.05 is significant; Sig. [.05 is not significant
b
Exp (B): means OR value

moderately damaged counties, which supported hypothesis
3. First, compared to the heavily damaged counties, Shidu
parents from the moderately damaged counties had rela-
tively low social support, so had to rely on their income
alone to cope. Lower socio-economic status was found to
be related to a greater possibility of PTSD in earthquake
survivors (Wu et al. 2014). In addition, victims with a high
income before an earthquake may face a large economic
level gap, which may be more unacceptable than the lower
income (Xu and Song 2011). Second, in Chinese traditional
culture, the purpose of accumulating wealth is to save for
old age, demonstrate the value of the clan and leave it for
later generations (Lee and Xiao 1998). When a family loses
their only child, low-income parents might suffer a mental
gap because it is the end of the line for the family and there
is no one to care for them.
In our study, the child’s gender was another significant
predictor for PTSD in Shidu parents in both groups and
confirmed hypothesis 4. In traditional Chinese culture, it is
more important for a family to have a son than a daughter
(Siah 2010). ‘‘Having no male heir is the gravest of three
cardinal offenses against filial piety’’, argued Mencius, an
ancient Confucian philosopher. The best way of showing
filial piety was to have a son who carried on the family
name. This preference for sons can be traced back to the
agricultural economy which relied significantly on the
collaboration of many workers, so the people’s belief at
that time was to have a big family with many sons (Ho
1989). Second, from 1979 until January 2016, the one-child
policy stipulated that parents could only have one child.
However, in Chinese tradition, taking care of the elderly
parents is largely the responsibility of a son rather than a
daughter (Short et al. 2001). Today in China, family sup-
port for the elderly is still mainly provided by the adult
children, particularly in the underdeveloped areas of China
(Cai et al. 2012). Therefore, parents prefer to have a son
and put more effort into cultivating them than a daughter to
ensure a bright future for their son and a comfortable old
age.
Resilience was also found to be a significant predictor of
PTSD in Shidu parents in both groups, which supported
hypothesis 5. Resilience is a multidimensional construct

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which regulates optimal human functioning and presents as
a positive psychology that addresses mental wellness rather
than mental illness (Jowkar et al. 2010). Resilient Shidu
parents had the ability to adapt in the face of tragedy and
other ongoing significant life stressors. One possibility is
that having a high resilience may result in earthquake
survivors having more effective coping strategies to suc-
cessfully adapt or change in the face of adversity (Li et al.
2012).
There are some limitations to this study. First, a self-
report instrument was used, so participants may have been
subject to recall bias, so may have been affected by other
traumatic experiences such as unemployment or car acci-
dents. Second, all respondents were selected from the
registered married parents based on a principle of volun-
tariness. Despite all respondents being told that no mone-
tary reward was to be given for participating in the survey
and were only given some small gifts, some respondents
may still have had other thoughts about the survey, such as
receiving additional assistance or gaining social attention.
Therefore, the sampling method may not have been fully
representative of all Shidu parents in all disaster areas and
the sample may have suffered from selection bias.
Despite the limitations, this exploratory study revealed
the prevalence and risk factors for probable PTSD in
Sichuan earthquake Shidu parents in different counties.
The prevalence of probable PTSD in the heavily damaged
counties (83.5 %) was higher than that in the moderately
damaged counties (72.3 %). Being of Han ethnicity, losing
a young child (18–27), losing a male child, living in the
countryside, receiving low social support over the previous
6 years, and having high resilience were found to be sig-
nificant risk factors in the heavily damaged group; while
the probable PTSD in the moderately damaged group was
related to being of Han ethnicity, having a low monthly
income, having a high education level, losing a young child
(18–27), losing a male child and having high resilience.
Health recovery interventions are required for those
Shidu parents with PTSD, such as early identification,
ongoing monitoring, and sustained psychosocial support.
This study may provide information to assist decision
makers in psychological interventions with Shidu parents
and to inspire those who work with similar groups in other
countries. In addition, because of the one-child policy,
Shidu parents who lost their only child may also have
suffered from other sudden events besides the earthquake
such as floods, mudslides, illnesses and automobile acci-
dents. As a special vulnerable group in China, there are
many issues regarding Shidu parents that need further
systematic research in order to evaluate their health status
and maintain social stability.
123
J Child Fam Stud (2016) 25:2915–2923
Acknowledgments This research was supported by the Major Bid-
ding Program of the National Social Science Foundation of China
(Grant No. 12&ZD217), and the Major Program of the Social Science
Foundation of Sichuan (Grant No. SC13ZD06). We appreciate this
organization for its support in both finance and spirit. Further, we
would like to thank all of the interviewees who showed great patience
in answering the questionnaires.
Compliance with Ethical Standards
Conflict of interest Jiuping Xu and Ziqi Wang declares that they
have no conflict of interest.
Human and Animal Rights All procedures performed in studies
involving human participants were in accordance with the ethical
standards of the institutional and/or national research committee and
with the 1964 Helsinki declaration and its later amendments or
comparable ethical standards.
Informed consent Informed consent was obtained from all individ-
ual participants included in the study.
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