Bulletin of the World Health Organization

Effect of having a subsequent child on the mental health of women who lost a child in the 2008 Sichuan earthquake: a cross-sectional study

Yao Xu, Helen Herrman, Rebecca Bentley, Atsuro Tsutsumi & Jane Fisher


To assess whether having a subsequent child had an effect on the mental health of Chinese mothers who lost a child during an earthquake.


A cross-sectional survey of bereaved mothers was conducted 30 to 34 months after the 2008 Sichuan earthquake using individual structured interviews to assess sociodemographic characteristics, post-disaster experiences and mental health. The interviews incorporated standardized psychometric measures of anxiety, depression, post-traumatic stress disorder (PTSD) and complicated grief (CG). Social support was also assessed. An adjusted model taking potential confounders into account was used to explore any association between psychological symptoms and the birth of a subsequent child.


The prevalence of psychological symptoms was higher in mothers who did not have a child after losing the first one. In an adjusted model, symptoms of anxiety (odds ratio, OR: 3.37; 95% confidence interval, CI: 1.51–7.50), depression (OR: 9.47; 95% CI: 2.58–34.80), PTSD (OR: 5.11; 95% CI: 2.31–11.34) and CG (OR: 10.73; 95% CI: 1.88–61.39) were significantly higher among the 116 women without a subsequent child than among the 110 mothers who had another child after bereavement. More than two thirds of the mothers with new infants had clinically important psychological symptoms.


Women who have lost an only child in a natural disaster are especially vulnerable to long-term psychological problems, especially if they have reached an age when conception is difficult. Research should focus on developing and evaluating interventions designed to provide women with psychosocial support and reproductive services.