Bidirectional associations of insomnia symptoms with somatic complaints and posttraumatic stress disorder in child and adolescent earthquake survivors: a longitudinal study

  • Ye Zhang
  • Jun ZhangEmail author
  • Rong Ren
  • Xiangdong Tang
Psychiatrics • Original Article



We aimed to explore insomnia symptoms among 2299 children and adolescents after an earthquake and their bidirectional relationship to somatic complaints and posttraumatic stress disorder (PTSD).


The Patient Health Questionnaire-15 scale, the Children’s Revised Impact of Event Scale, and three questions evaluating insomnia symptoms (including difficulty falling asleep, difficulty staying asleep, and early morning awakening) were administered to child and adolescent survivors 3 and 6 months after the Lushan earthquake.


The prevalence rates of insomnia symptoms among children and adolescents were 52 and 40% 3 and 6 months after the Lushan Earthquake, respectively. Insomnia symptoms evaluated after 3 months could significantly predict subsequent PTSD (odds ratio (OR), 1.476; 95% confidence interval (CI), 1.133–1.924) and all somatic symptoms, except for dizziness, evaluated after 6 months. PTSD (OR, 1.633; 95%CI, 1.315–2.027) and headache (OR, 1.545; 95%CI, 1.223–1.953) evaluated after 3 months significantly predicted insomnia symptoms evaluated after 6 months.


Insomnia symptoms, which were commonly seen after the earthquake, could longitudinally predict the development of PTSD and various somatic symptoms, and PTSD and headache could longitudinally predict the developments of insomnia symptoms among children and adolescent earthquake survivors. These findings highlight the importance of assessing and addressing insomnia symptoms in children and adolescents following a traumatic event.


Insomnia Posttraumatic stress disorder Somatic symptoms 



We thank the students who participated in this study. We thank Dr. Jason G. Weed at New York University Langone Medical Center for edits to the manuscript.


This work was supported by the National Natural Science Foundation of China (81900087, 81530002, 81629002, 81800093), the National Basic Research Program of China (2015CB856406), and the Strategic Priority Research Program of the Chinese Academy of Sciences (XDA23090502).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Disclosure of potential conflicts of interest

All authors including Dr. Ye Zhang, Dr. Jun Zhang, Dr. Rong Ren, and Professor Xiangdong Tang declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Monash Health, the National Health and Medical Research Council (NHMRC), and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of the West China Hospital of Sichuan University, the Education Bureau of the Baoxing County, and the Department of Health of Sichuan Province, China.

Informed consent

Informed consent was obtained from all individual participants included in the study. Written informed consent was also obtained from the principals and teachers in schools. In China, research projects do not need parental consent if local education authorities, such as the county Bureau of Education and school administrators, approve it as a service to the students [65]. The present study belonged to that category; thus, written informed consent from parents was not required [65].


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ye Zhang
    • 1
    • 2
  • Jun Zhang
    • 2
    • 3
    Email author
  • Rong Ren
    • 1
  • Xiangdong Tang
    • 1
  1. 1.Sleep Medicine Center, West China HospitalSichuan UniversityChengduChina
  2. 2.Disaster Medical CenterSichuan UniversityChengduChina
  3. 3.Mental Health Center, West China HospitalSichuan UniversityChengduChina

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