New COVID-19 challenges and response strategies adopted by a national suicide prevention hotline: A qualitative study.

Crisis helplines provide important support for vulnerable individuals during the COVID-19 pandemic, which may also impact the helplines. We explored the challenges that the pandemic brought to Taiwan's national suicide prevention hotline and the hotline's responses. We interviewed 14 hotline workers and conducted data analysis using the framework method. The pandemic posed two new challenges to the hotline: potential service interruption and the adjustment of perceived role among hotline workers. The hotline's well-formulated response plan helped it sustain its services during the pandemic, although the workers also experienced stress and frustration resulted from role ambiguity. Our data highlighted the hotline workers' need for accurate COVID-19 information, relevant training, and timely support.

Curvilinear prediction of posttraumatic growth on quality of life: a five-wave longitudinal investigation of breast cancer survivors.

PURPOSE: Do cancer survivors experience positive changes (i.e., posttraumatic growth; PTG) resulting in better quality of life? The issue has yet to yield consistent notions. This longitudinal study extends the literature on the role of PTG by examining the curvilinear relationship between PTG and Health-Related Quality of Life (HRQoL), and explored whether PTG predicts subsequent HRQoL in a quadratic relationship across 2 years following surgery. METHODS: Women with breast cancer (N = 359; Mage = 47.5) were assessed at five waves over two years. On every measurement occasion, PTG measured by the posttraumatic growth inventory and HRQoL measured by SF-36 were assessed. The five waves reflect major medical demands and related challenges in the breast cancer trajectory, in which 1-day, 3 months, 6 months, 12 months, and 24 months after surgery were adopted as the survey timing. In a series of hierarchical linear modeling (HLM) analyses, the time-lagged predictions of PTG (i.e., linear, quadratic) on HRQoL were examined, controlling demographic and medical covariates. RESULTS: The results revealed that the quadratic term of PTG consistently significantly predicted physical and mental health quality of life (PCS and MCS), while the linear term of PTG did not significantly predict PCS or MCS. CONCLUSION: With multi-wave longitudinal data, this study demonstrated that the relationship between PTG and HRQoL is curvilinear, and this finding extends to PTG's prediction of subsequent HRQoL. The quadratic relationship has critical implications for clinical assessment and intervention. Details are discussed.

The Impact of the COVID-19 Pandemic on Calls to a National Suicide Prevention Hotline in Taiwan: An Analysis of Time Trend and Characteristics of Calls.

We investigated the impact of the COVID-19 pandemic on call volumes and call characteristics using data from a national crisis helpline. Data were extracted for 215,066 calls to Taiwan's national suicide prevention hotline (January 2018-May 2020). We used negative binomial regression to investigate changes in the weekly number of calls during the early period of the COVID-19 outbreak (January 21, 2020-May 25, 2020), relative to that expected according to the pre-pandemic trend. The call characteristics during the pandemic period (February 18, 2020-May 31, 2020) were compared between COVID-19 related vs unrelated calls. Higher-than-expected call volumes started from the 6th week of the pandemic and reached a peak in the 14th week, which was 38% (rate ratio = 1.38, 95% confidence interval 1.26-1.51) higher than that expected based on the pre-pandemic trend. The higher-than-expected call volumes were mainly attributable to higher-than-expected calls from non-suicidal and male callers. Calls in which COVID-19 was mentioned (13.2%) were more likely to be from male and first-time callers, occur outside 12 am-6 am, last less than 5 min, and were less likely to be from callers who had previous suicide attempts, recent suicidal ideation or suicide plans or actions than COVID-19 unrelated calls. Callers who made COVID-19 related calls were more likely to request information than other callers. Crisis helplines should strategically adapt to the increased need and callers' specific concerns related to the outbreak.

"I Can't See an End in Sight." How the COVID-19 Pandemic May Influence Suicide Risk.

Background: The COVID-19 pandemic and its consequences may affect population mental health and suicide risk. Aims: To explore the experiences among suicidal individuals who made calls to a suicide prevention hotline and to identify factors and psychological responses that may influence suicide risk. Method: We identified 60 eligible recorded calls to Taiwan's suicide prevention hotline (January 23, 2020-May 31, 2020) and analyzed the transcripts using a framework analysis. Results: We identified three themes: (a) effects of the COVID-19 pandemic on society (impacts on local economies, the fear of contagion, and disruptions caused by outbreak control measures); (b) stress experienced by callers, including increased challenges (financial burden, restricted freedom of movement, interpersonal conflicts, feelings of uncertainty, and education/career interruption) and reduced support (reduced access to health services and social support); and (c) the callers' psychological responses to stress, including anxiety, sleep disturbance, depression, loneliness, hopelessness, and entrapment, which may increase suicide risk. Limitations: Only the experiences among those who sought help by calling the hotline during the early months of the pandemic in 2020 were explored. Conclusion: Our findings revealed the potential process underlying the impact of the COVID-19 pandemic on suicide risk and have implications for prevention and intervention strategies.

The relationship between infertility family stigma, self-stigma and psychological well-being in female first-visit patients at a reproductive medicine center in Taiwan.

BACKGROUND: Steeped in Chinese culture which considers continuing the family lineage highly important, infertility stigma endorsed by others and oneself can both negatively impact psychological well-being in women with infertility in Taiwan. The aim of the present study was to find out whether family stigma attached to infertility has a direct effect on psychological well-being, or whether it is only when family stigma is internalized into self-stigma that psychological well-being is affected. PARTICIPANTS AND PROCEDURE: The present study had a cross-sectional design, approved by an institutional review board in Taiwan. 245 female participants with infertility completed measures on infertility stigma, self-esteem, and positive and negative affect. The main question of this study was analyzed by conducting structural equation modeling. RESULTS: The present study found that none of the direct effects of family stigma on self-esteem, negative affect, or positive affect were significant, while the indirect effects of family stigma on the three psychological well-being indexes through the mediator of self-stigma were significant. CONCLUSIONS: Self-stigma fully mediates the effect of family stigma on self-esteem, positive affect, and negative affect in women with infertility. Collectively, stigma endorsed by others does not necessarily lead to negative psychological well-being. The negative influence comes from internalizing public/family stigma into self-stigma.

The Double-Edged Sword of Reflective Pondering: The Role of State and Trait Reflective Pondering in Predicting Depressive Symptoms Among Women With Breast Cancer.

BACKGROUND AND PURPOSE: Prior research has debated whether reflective pondering is a more constructive form of rumination than brooding, which is generally considered maladaptive. This study sought to investigate whether reflective pondering predicts depressive symptoms and whether reflective pondering is adaptive under certain conditions. We predicted that the effectiveness of reflective pondering could depend on concurrent coping strategies and the trait-state distinction. METHOD: Women with breast cancer (N = 309; M age = 47.5) were assessed at four waves over 2 years. A time-lagged design was applied, with rumination (i.e., brooding and reflective pondering) and coping (i.e., engagement and disengagement) measured from T1 to T3, predicting depressive symptoms assessed from T2 to T4. These variables were measured by the Ruminative Response Scale, the Brief COPE, and the Hospital Anxiety and Depression Scale. RESULTS: Using hierarchical linear modeling, brooding, but not reflective pondering, predicted elevated depressive symptoms at both between- and within-person levels. The relationship between reflective pondering and depression was moderated by the coping strategies. Individual differences in reflective pondering predicted worse depressive symptoms, but higher use of engagement coping mitigated the detrimental effect. Within individuals, the co-occurrence of reflective pondering and disengagement coping predicted a subsequent decrease in depressive symptoms. CONCLUSIONS: The emerging role of reflective pondering in the face of breast cancer-related stress appears to be a double-edged sword. Its impact on depression may depend on concurrent coping strategies and whether reflective pondering is assessed at state and trait levels.

Symptoms of ADHD Affect Intrasubject Variability in Youths with Autism Spectrum Disorder: An Ex-Gaussian Analysis.

Increased intrasubject variability in reaction times (RT-ISV) is frequently found in individuals with autism spectrum disorder (ASD). However, how dimensional attention deficit/hyperactivity disorder (ADHD) symptoms impact RT-ISV in individuals with ASD remains elusive. We assessed 97 high-functioning youths with co-occurring ASD and ADHD (ASD+ADHD), 124 high-functioning youths with ASD only, 98 youths with ADHD only, and 249 typically developing youths, 8-18 years of age, using the Conners Continuous Performance Test (CCPT). We compared the conventional CCPT parameters (omission errors, commission errors, mean RT and RT standard error (RTSE) as well as the ex-Gaussian parameters of RT (mu, sigma, and tau) across the four groups. We also conducted regression analyses to assess the relationships between RT indices and symptoms of ADHD and ASD in the ASD group (i.e., the ASD+ADHD and ASD-only groups). The ASD+ADHD and ADHD-only groups had higher RT-ISV than the other two groups. RT-ISV, specifically RTSE and tau, was significantly associated with ADHD symptoms rather than autistic traits in the ASD group. Regression models also revealed that sex partly accounted for RT-ISV variance in the ASD group. A post hoc analysis showed girls with ASD had higher tau and RTSE values than their male counterparts. Our results suggest that RT-ISV is primarily associated with co-occurring ADHD symptoms/diagnosis in children and adolescents with ASD. These results do not support the hypothesis of response variability as a transdiagnostic phenotype for ASD and ADHD and warrant further validation at a neural level.

Regret about surgical decisions among early-stage breast cancer patients: Effects of the congruence between patients' preferred and actual decision-making roles.

OBJECTIVE: Early-stage breast cancer patients generally receive either a mastectomy or a lumpectomy, either by their own choice or that of their surgeon. Sometimes, there is regret about the decision afterward. To better understand regret about surgical decisions, this study examined 2 possibilities: The first is that women who take a dominant or collaborative role in decision making about the surgery express less regret afterward. The second is that congruence between preferred role and actual role predicts less regret. We also explored whether disease stage moderates the relationship between role congruence and decisional regret. METHODS: In a cross-sectional design, 154 women diagnosed with breast cancer completed a survey assessing decisional role preference and actual decisional role, a measure of post-decision regret, and a measure of disturbances related to breast cancer treatment. Hierarchical regression was used to investigate prediction of decisional regret. RESULTS: Role congruence, not actual decisional role, was significantly associated with less decisional regret, independent of all the control variables. The interaction between disease stage and role congruence was also significant, showing that mismatch relates to regret only in women with more advanced disease. CONCLUSIONS: Our findings suggest that cancer patients could benefit from tailored decision support concerning their decisional role preferences in the complex scenario of medical and personal factors during the surgical decision.

Buffering and direct effect of posttraumatic growth in predicting distress following cancer.

OBJECTIVE: Evidence regarding post traumatic growth (PTG) as a predictor of future reductions in distress has been inconclusive. The purpose of this study was to examine this relationship in a multiple-observation prospective study, to provide a more rigorous test of prediction over time. This longitudinal study extended previous work by taking into account perceptions of vulnerability and explored the buffering role of PTG on the links between vulnerability and psychological distress. We also explored whether individual differences in demographic and medical characteristics moderate the relationship of interests. METHOD: Participants were 312 Taiwanese women (Mage = 46.7 years) who underwent surgery for breast cancer. Measures of PTG, perceived vulnerability, and distress were assessed at Day 1 and 3, 6, 12, and 24 months after surgery. Hierarchical linear modeling was used to investigate whether PTG and vulnerability and their interaction predicted distress over time. RESULTS: A significant direct effect of PTG on distress was found: higher PTG was followed by lower distress. Analysis also yielded a significant buffering effect of PTG on vulnerability leading to distress. However, this effect was moderated by type of surgery. The buffering effect of PTG occurred only among women having mastectomy. CONCLUSIONS: We conclude that PTG tends to lead to less psychological distress overall but particularly so in a high impact context. (PsycINFO Database Record

Sustained visual attention for competing emotional stimuli in social anxiety: An eye tracking study.

BACKGROUND AND OBJECTIVES: Numerous studies have supported attentional biases toward social threats in socially anxious individuals. The aim of the present study was to investigate the time-course of sustained attention for multiple emotional stimuli using a free-viewing paradigm in social anxiety. METHODS: Thirty-two socially anxious (SA) and 30 non-anxious (NA) participants completed the free-viewing task. Participants were presented with a face array composed of angry, sad, happy and neutral faces for 10 s in each trial. Eye movements were recorded throughout the trial to assess the time-course of attentional processing. RESULTS: Although SA participants did not exhibit initial orienting bias, they had higher fixation probability for angry faces during the 250-1000 ms time intervals, relative to NA participants. SA participants also maintained their attention longer than NA participants did when angry faces were initially fixated upon. Moreover, NA participants showed higher fixation probability for happy faces during the 6-8 s after stimulus onset. We failed to observe attentional avoidance of threat in SA participants. LIMITATIONS: First, this study used a non-clinical sample. Second, the stimuli used in this study were static. CONCLUSIONS: The present findings suggest that, relative to non-anxious individuals, socially anxious individuals are characterized by enhanced engagement with social threat at an early stage of processing and difficulty in disengaging from social threat once their initial attention is located on it. Conversely, non-anxious individuals are characterized by enhanced engagement with positive stimuli at a later stage of processing.

Traditional Chinese version of the Mayer Salovey Caruso Emotional Intelligence Test (MSCEIT-TC): Its validation and application to schizophrenic individuals.

Schizophrenia is an illness that impairs a person's social cognition. The Mayer Salovey Caruso Emotional Intelligence Test (MSCEIT) is the most well-known test used to measure emotional intelligence (EI), which is a major component of social cognition. Given the absence of EI ability-based scales adapted to Chinese speakers, we translated the MSCEIT into a Traditional Chinese version (MSCEIT-TC) and validated this scale for use in schizophrenia studies. The specific aims were to validate the MSCEIT-TC, to develop a norm for the MSCEIT-TC, and use this norm to explore the EI performance of schizophrenic individuals. We included in our study seven hundred twenty-eight healthy controls and seventy-six individuals with schizophrenia. The results suggest that the MSCEIT-TC is reliable and valid when assessing EI. The results showed good discrimination and validity when comparing the two study groups. Impairment was the greatest for two branches Understanding and Managing Emotions, which implies that the deficits of schizophrenia individuals involve ToM (theory of mind) tasks. Deficits involving the negative scale of schizophrenia was related to impaired performance when the MSCEIT-TC was used (in branch 2, 3, 4, and the area Strategic). Our findings suggest that the MSCEIT-TC can be used for emotional studies in healthy Chinese and in clinical setting for investigating schizophrenic individuals.

Effects of attention bias modification with short and long stimulus-duration: A randomized experiment with individuals with subclinical social anxiety.

This study investigated the differential effects of two attention bias modification (ABM) with different stimulus durations. Seventy-two undergraduates with subclinical social anxiety were randomly assigned to one of four conditions: an ABM condition with either a 100-ms or a 500-ms stimulus duration (ABM-100/ ABM-500) or an attention placebo (AP) condition with either a 100-ms or a 500-ms stimulus duration (AP-100/ AP-500). Participants completed the pre-assessments, eight attentional training sessions, and post-assessments. A modified Posner paradigm was used to assess changes in attentional processing. After completion of attentional training, the ABM-100 group significantly speeded up their responses to 100-ms invalid trials, regardless of the word type. The ABM-100 group also exhibited significant reduced latencies to 500-ms invalid social threat trials and a marginally significant reduced latencies to 500-ms invalid neutral trials. The ABM-500 group showed significant reduced latencies to 500-ms invalid social threat trials. Both ABMs significantly reduced participants' fear of negative evaluations and interactional anxiousness relative to their comparative AP. The effects on social anxiety did not differ between the two ABMs. This study suggests that although both ABMs using short and long stimulus durations reduce some aspects of social anxiety, they influence participants' attentional disengagement in different ways.

One-year follow up of PTSD and depression in elderly aboriginal people in Taiwan after Typhoon Morakot.

AIM: This paper describes a 1-year follow-up of post-traumatic stress disorder (PTSD) symptomatology and depression in an elderly minority population who experienced Typhoon Morakot in Taiwan. METHODS: The PTSD Symptom Scale--Interview and the 10-item short form Center for Epidemiological Studies Depression Scale were used to examine PTSD symptomatology and depression in 120 victims at 3-6 months and in 88 victims (73.3% reinterview rate) at 11-12 months after the disaster. Further, we looked for associations between stress, prognosis, and development of PTSD symptomatology and depression. RESULTS: The prevalence of PTSD symptomatology decreased from 29.2% (35/120) at 3-6 months to 15.9% (14/88) at 11-12 months. The prevalence of depression, however, increased from 43.3% (52/120) to 46.6% (41/88). No factor was associated with follow-up PTSD symptomatology, and only the level of education was related to follow-up depression. Generally, the risk factors of age, sex, symptomatology of PTSD and depression at baseline, and stressor of unemployment predicted new-onset or chronic PTSD symptomatology and depression. Delayed-onset depression 48.0% (24/50) was more common than delayed-onset PTSD symptomatology 11.3% (7/62). Chronic and delayed-onset PTSD symptomatology were more easily developed with depression. CONCLUSION: Although PTSD and depression were separate consequences of trauma, they emerged and affected mental health together. We documented the courses of PTSD and depression among elderly aboriginal people, and the possible effects of demographic, symptomatology, and adverse life stressors were discussed.

Identification of posttraumatic growth trajectories in the first year after breast cancer surgery.

BACKGROUND: Empirical studies of the relationship between posttraumatic growth (PTG) and adjustment outcomes reveal a fairly inconclusive picture. We argue that the inconsistent findings are likely due to the heterogeneity of the PTG experience over time. In this regard, we predicted that individuals with different PTG trajectories vary in the level of adjustment and the correlational patterns between PTG and adjustment. METHODS: Participants were 124 Taiwanese women who underwent surgery for breast cancer. Measures of PTG and adjustment variables, including positive affect, negative affect, mental and physical quality of life, anxiety, and depression, were assessed at 1 day and 3, 6, and 12 months after surgery. A group-based trajectory model was used to identify subpopulations of individuals who shared homogenous growth patterns. Then, we determined whether the trajectory predicted adjustment at 12 months after surgery. The correlations between PTG and adjustment outcomes were computed in each subpopulation across every time point. RESULTS: The patients were categorized into the following four groups, which showed very different patterns of PTG change over the first year after breast cancer surgery: stable high (27.4%), high decreasing (39.4%), low increasing (16.9%), and low decreasing (16.9%). Differences in the level of adjustment at 12 months and the patterns of the correlations across time were found among these latent subgroups CONCLUSIONS: This study was the first longitudinal examination of PTG trajectories and their different levels of adjustment. The findings support our argument that identifying distinct PTG trajectories can better determine the nature of the relationship between PTG and adjustment.

Using cognitive modelling to investigate the psychological processes of the Go/NoGo discrimination task in male abstinent heroin misusers.

AIMS: To use cognitive modelling to investigate psychological processes underlying decision-making in male abstinent heroin misusers (AHMs). DESIGN: A case-control study design. SETTING: A drug misuse treatment centre in Taiwan. PARTICIPANTS: Eighty-eight male AHMs and 48 male controls. MEASUREMENTS: Four parameters representing the attention to wins, learning rate, response sensitivity and incentive of heroin-related stimuli from the modified Go/NoGo discrimination task. FINDINGS: A modified cue-dependent learning (CD) model with four parameters representing attention to wins, learning rate, response sensitivity and incentive of heroin-related stimuli had a lower value of the sum of Bayesian information criterion (showing a better fit) than the original CD model (9555.50 versus 11,192.22, P < 0.001). The AHM group had a higher value of the heroin-incentive parameter than the control group (0.26 versus -1.66, P < 0.05). The attention to wins and heroin-incentive parameters were associated positively with total commission rate and negatively with total omission rate in the AHM group (P < 0.001). CONCLUSIONS: Male abstinent heroin misusers appear to be more influenced by heroin-related stimuli during decision-making than males with no history of heroin misuse.

The ex-Gaussian distribution of reaction times in adolescents with attention-deficit/hyperactivity disorder.

We investigated the three parameters (mu, sigma, tau) of ex-Gaussian distribution of RT derived from the Conners' continuous performance test (CCPT) and examined the moderating effects of the energetic factors (the inter-stimulus intervals (ISIs) and Blocks) among these three parameters, especially tau, an index describing the positive skew of RT distribution. We assessed 195 adolescents with DSM-IV ADHD, and 90 typically developing (TD) adolescents, aged 10-16. Participants and their parents received psychiatric interviews to confirm the diagnosis of ADHD and other psychiatric disorders. Participants also received intelligence (WISC-III) and CCPT assessments. We found that participants with ADHD had a smaller mu, and larger tau. As the ISI/Block increased, the magnitude of group difference in tau increased. Among the three ex-Gaussian parameters, tau was positively associated with omission errors, and mu was negatively associated with commission errors. The moderating effects of ISIs and Blocks on tau parameters suggested that the ex-Gaussian parameters could offer more information about the attention state in vigilance task, especially in ADHD.

Mental adjustment at different phases in breast cancer trajectory: re-examination of factor structure of the Mini-MAC and its correlation with distress.

OBJECTIVE: The aim of this study is twofold. First, it aims to determine the factor structure of the Mini-Mental Adjustment to Cancer (Mini-MAC) Scale by using confirmatory factor analysis (CFA) to compare the three-factor, four-factor, and five-factor structures among 340 Taiwanese breast cancer patients. Second, it aims to test the difference in the correlations of coping strategies and the outcome measures between two populations: one-month newly diagnosed and five-year long-term survival patients. METHODS: Two samples, composed of 142 newly diagnosed and 198 long-term survival breast cancer patients, were recruited. Cancer-specific coping and distress were assessed via the Mini-MAC Scale and the Hospital Anxiety and Depression Scale (HADS), respectively. RESULTS: The CFA confirmed Watson's original five-factor structure fit the data best. The correlation difference between the two samples lies in the fighting spirit (FS), which correlated negatively with distress among the newly diagnosed sample but had no correlation among the long-term survivors. Moreover, fatalism (FA) was found to correlate positively with distress. CONCLUSIONS: The five-factor structure represents a more psychometrically sound measure of psychological adjustment in the current data set. The findings also support the argument that the relationships between coping and distress vary, to some degree, at different phases in the cancer trajectory. FS is only a positive predictor of psychological adjustment among newly diagnosed patients. Because of the exclusion of two items, FA showed a positive correlation with distress, a result that contradicts previous findings. Further theoretical and practical implications for FS and FA are discussed.

The hierarchical model of social interaction anxiety and depression: the critical roles of fears of evaluation.

In this paper, we articulate a hierarchical model of social interaction anxiety (SIA) and depression to account for their comorbidity and the uniqueness of SIA. First, negative affect (NA) and positive affect (PA) are conceptualized as general factors shared by SIA and depression; the fear of negative evaluation (FNE) is operationalized as the specific factor, which accounts for more of the variance in SIA than in depression, and the fear of positive evaluation (FPE) is operationalized as the factor unique to SIA. FPE is the key feature that differentiates SIA from depression. Second, the proposed hierarchical model describes structural relationships among these factors, in which the higher-level factors (i.e., high NA and low PA) represent the vulnerability markers of both SIA and depression and the lower-level factors (i.e., FNE and FPE) are the dimensions of specific cognitive features. In addition, an alternative model, in which all of the relationships are the same, except that FPE is operationalized as a specific factor, is proposed to clarify the role of FPE. The results from the hierarchical regression and the structural equation modeling support the hypothesized hierarchical model. Further theoretical and practical implications for FPE and the multilevel model are discussed.

Risk factors for PTSD after Typhoon Morakot among elderly people in Taiwanese aboriginal communities.

BACKGROUND: This study aimed to investigate the risk factors associated with post-traumatic stress disorder (PTSD) symptoms in a mid- and old-age population who experienced Typhoon Morakot in Taiwan. METHODS: One hundred and twenty people, who were mostly Taiwanese aboriginal people aged 55 years and above, were invited to participate in this study. PTSD symptoms were assessed using the PTSD Symptom Scale (PSS-I). Information regarding demographic characteristics, relocation, personal injury, family death, property damage, and self-perceived health was collected. RESULTS: 29.2% of study participants presented significant PTSD symptomatology during the previous month. Development of PTSD symptomatology after the disaster was significantly associated with being female (OR 3.63, 95% CI = 1.11-11.88), experiencing relocation (OR 5.64, 95% CI = 1.60-19.88), and having poorer self-perceived health (OR 4.24, 95% CI = 1.53-11.78) after controlling for age, education, personal injury, family death, and property damage. Further, by adding depression into the analysis, we found the risk factors were being female (OR 4.66, 95% CI = 1.16-18.80), experiencing relocation (OR 27.91, 95% CI = 3.74-229.80), family death (OR 67.62, 95% CI = 2.85-1063.68), and poorer self-perceived health (OR 28.69, 95% CI = 4.52-182.06). CONCLUSION: Nearly 30% of the elderly people studied who experienced Typhoon Morakot developed significant PTSD symptomatology. The risk factors for PTSD symptoms were female gender, poorer self-perceived health, relocation, family death, and depression. The elderly people who were relocated by governmental programs were more likely to develop PTSD symptomatology after experiencing trauma. Resettlement and rehabilitation programs after a disaster need to be more concerned with their psychological effects on victims.