Impact of a technological disaster on young children: a five-year postdisaster multiinformant study

A Safe Home? A Qualitative Study into the Experiences of Adolescents Growing Up in the Dutch Area Impacted by Earthquakes Induced by Gas Extraction

For decades, the Netherlands has experienced minor earthquakes due to gas extraction. This study aims to obtain insight into the experiences of adolescents and the impact of these earthquakes on their well-being and living environment. Focus groups were held with 24 adolescents, and interviews were held with 3 adolescents (N = 27; M = 15 years). Through qualitative analysis, we identified six themes. The adolescents shared experiences of anxiety related to the earthquakes and their consequences and considered these to be a normal part of their life. Anxiety and feelings of endangerment not only related to their own experiences but were also connected to the impact of earthquakes on their social environment, such as the restoration of buildings. Several sources of support (e.g., talking, social cohesion) were mentioned to deal with the negative consequences of the earthquakes. A lack of trust in the government was an additional main theme, with adolescents mentioning several needs, potentially relevant to policymakers in the Netherlands. Growing up in the gas extraction area of Groningen had many consequences on the adolescents in the study, who felt inhibited from expressing feelings of anxiety and fear. To support their needs, interventions at the individual, family, educational, societal, and policy levels are recommended.

Estimation of Health-Related Quality of Life Losses Owing to a Technological Disaster in Brazil Using EQ-5D-3L: A Cross-Sectional Study

OBJECTIVES

In 2015, a dam collapsed at Samarco iron ore mine in the municipality of Mariana, Brazil, and contaminated more than 600 km of watercourses and destroyed almost 1600 acres of vegetation. Nineteen people died and more than 600 families lost their homes. This study aimed to estimate health-related quality of life (HRQoL) losses owing to this disaster.

METHODS

We collected data from a probabilistic sample of 459 individuals aged 15 years or older. Household face-to-face interviews were conducted in December 2018. Pre-event data were not available for this population, so respondents were asked to evaluate at present and in retrospect their health status using EQ-5D-3L. The Minas Gerais societal value sets for EQ-5D-3L health preferences, estimated in 2011, were used to calculate utility losses. The health loss estimation from EQ-5D will form the basis for the calculation of compensation payments for the victims.

RESULTS

Approximately 74% of the study population suffered some HRQoL loss. On average, EQ-5D index values decreased from 0.95 to 0.76. The greatest effects were observed for the anxiety/depression dimension, followed by pain/discomfort. Before the tragedy, the proportion of individuals with severe anxiety/depression and pain/discomfort was equal to 1% rising to 23% and 11%, respectively.

CONCLUSIONS

Catastrophic losses owing to the Samarco disaster were found. The EQ-5D-3L instrument showed feasibility and sensitiveness to measure HRQoL losses owing to a negative health shock in a low-income Brazilian population.

The Impact of Community Disaster Trauma: A Focus on Emerging Research of PTSD and Other Mental Health Outcomes

This paper reviews community residents' mental health following exposure to a community disaster trauma, with a focus on post-traumatic stress disorder (PTSD) and other mental health outcomes, such as emotional disorders, behavioral problems including addictive disorders, and personality as a maladaptive trait. This review concludes with recommendations to advance the field of community disaster research by exploring how natural and man-made disasters impact community residents across multiple domains. Moreover, this study suggests that residents impacted by community disaster trauma are frequently appropriate targets for mental health assessments or services in a community setting.

The Relationship Between Physical and Mental Health Outcomes in Children Exposed to Disasters

PURPOSE OF REVIEW

This paper reviews literature on the influence of disaster exposure on the intersection between physical and mental health in children, including risk and protective factors. We provide an update on recent studies and conclude with recommendations for future research.

RECENT FINDINGS

The limited existing research on this topic suggests that disasters can influence short and long-term physical and mental health of children. Although few studies explore both mental and physical health in the same study, studies that assess both show that they co-occur. Pre-existing conditions, severity of disaster exposure, socioeconomic status, and gender may influence the relation between disaster exposure and physical and mental health. Despite the growing number of studies exploring mental and physical health symptoms together in children post-disaster, a dearth of research examines this relationship in terms of nuances by age and developmental stage, longitudinal mechanisms, and risk and protective factors.

A systematic review and meta-analysis on the prevalence of depression in children and adolescents after exposure to trauma

BACKGROUND

Depression is often reported as co-occurring with post-traumatic stress disorder in children and adolescents, but its prevalence within trauma-exposed child and adolescent samples is not well understood.

METHODS

Our meta-analyses addressed two questions: I. What is the prevalence of depression (either based on structured interview or cut-off on a self-report measure) in children and adolescents after exposure to trauma? II. Does trauma exposure increase the severity or rates of depression comparative to another comparison group of children and adolescents with milder exposure or no exposure to trauma?

RESULTS

Fifty-six studies reported depression prevalence. A random effects meta-analysis suggested that 24.2% [95% CI 20.6-28.0] of children and adolescents exposed to a traumatic event met criteria for depression. Our second meta-analysis across 30 studies found that the effect of trauma exposure (relative to unexposed or less exposed children and adolescents) on depression scores was medium in size (d = 0.51, 95% CI 0.41-0.61). The odds of a diagnosis of depression were 2.6 times greater [95% CI 2.0-3.3] for children and adolescents exposed to trauma as compared to those unexposed or less exposed. Participants exposed to interpersonal violence (IPV) had a higher prevalence and level of depression compared with those exposed to non-IPV trauma.

LIMITATIONS

Results should be interpreted with caution due to high levels of heterogeneity.

CONCLUSION

Depression in trauma-exposed children and adolescents is a common response to trauma that is not solely reflective of pre-traumatic difficulties. Post-traumatic depression merits serious consideration in trauma-exposed children and adolescents.

A latent profile analysis of co-occurring youth posttraumatic stress and conduct problems following community trauma

Although most research with youth exposed to violent manmade disasters has focused on internalizing problems, recent work suggests conduct problems (CPs) may also manifest in exposed youth. However, the extent to which youth postevent CPs present independently, versus co-present in conjunction with PTSD symptoms, remains unclear. The present study examined PTS and CP symptom profiles among affected Boston-area youth following the 2013 Boston Marathon bombing. This study used latent profile analysis to identify distinct PTS and CP symptom profiles among Boston-area youth ages 4-19 years (N=344) affected by the Boston Marathon bombing events. PTS and CPs were measured using the UCLA-PTSD-RI and the SDQ parent reports, respectively. Analyses identified 3 distinct profiles: presentations characterized by (a) low PTS, low CPs, (b) moderate PTS, low CPs, and (c) high PTS, elevated CPs. The profile characterized by the highest PTS was the only profile with elevated CPs; hyperarousal and emotional numbing/avoidance symptoms showed the greatest distinguishing properties among profiles with and without elevated CP. Types of traumatic exposure experienced by youth were differentially associated with profiles. Specifically, direct (but not relational) exposure distinguished youth classified in the profile showing elevated CPs. Findings suggest interventions following violent manmade disasters may do well to incorporate CP modules when working with youth showing the greatest hyperarousal and emotional numbing, and/or who have directly witnessed the most violence.

Assessment Tools for the Mental Health of School-Aged Children and Adolescents Exposed to Disaster: A Systematic Review (1988-2015)

Objectives

In this study, we aimed to conduct a systematic review of studies investigating psychosocial factors affecting children exposed to disasters.

Methods

In total, 140 studies were retrieved. The studies were published from 1988 to 2015. A systematic review was performed using the PRISMA guidelines. MEDLINE, EMBASE, Cochrane Central, Web of Science, PsycINFO, PubMed, and Google Scholar were searched. Each database was searched using the following terms: 'Child,' 'Adolescent,' 'Youth,' 'Disaster,' 'Posttraumatic,' 'Psychosocial,' 'Assessment,' 'Evaluation,' and 'Screening.' The identified studies were subjected to data extraction and appraisal.

Results

The database search identified 713 articles. Based on the titles and abstracts, the full texts of 118 articles were obtained. The findings of this review can be used as a basis for the design of a psychosocial evaluation tool for disaster preparedness.

Conclusion

Given the paramount importance of post-disaster evaluation and the weaknesses of current disaster evaluation tools, the need to develop valid and reliable tools and psychometric evaluations cannot be overstated. Our findings provide current evidence supporting various assessments in children, who are very vulnerable psychologically following disasters.

The Impact of Natural Disasters on Youth: A Focus on Emerging Research beyond Internalizing Disorders

PURPOSE OF REVIEW

This paper reviews youth outcomes following exposure to natural disaster, with a focus on three relatively understudied outcomes: externalizing behavior problems, physical health, and posttraumatic growth. Recent, high-impact studies focusing on each outcome are summarized.

RECENT FINDINGS

Studies highlighted in this review utilize innovative and comprehensive approaches to improve our current understanding of youth broad-based physical and mental health outcomes beyond PTSD. The review concludes with recommendations to advance the field of youth disaster research by exploring how disasters may impact children across multiple domains, as well as using cutting edge ecobiological approaches and advanced modeling strategies to better understand how youth adjust and thrive following natural disaster.

Approaches to the Assessment of Children in the Context of Disasters

Children exposed to disasters are a vulnerable population, making the assessment of children post-disaster an important issue. Utilizing a Multiple Gating Stepped Care framework, we highlight recent literature related to post-disaster assessment and intervention for children. In particular, we focus on screening, clinical evaluation, and feedback-informed service delivery. Screening allows large populations of children to be assessed at a relatively low cost. Children identified by screening as being at risk may then be assessed through more in-depth clinical evaluations, in order to assess clinical symptoms, strengths, and stressors, and to make determinations about appropriate interventions. Continued assessment during therapy provides important feedback for the delivery of appropriate care. New formats for assessment, as well as issues related to identifying sources for assessment, are discussed. Recommendations for future directions are provided.

Children's disaster reactions: the influence of exposure and personal characteristics

This paper reviews children's reactions to disasters and the personal and situational factors that influence their reactions. Posttraumatic stress disorder (PTSD) and posttraumatic stress reactions are the most commonly studied outcomes, though other conditions also occur including anxiety, depression, behavior problems, and substance use. More recently, traumatic grief and posttraumatic growth have been explored. New research has delineated trajectories of children's posttraumatic stress reactions and offered insight into the long-term consequences of their disaster experiences. Risk factors for adverse outcomes include pre-disaster vulnerabilities, perception of threat, and loss and life disruptions post-disaster. Areas in need of additional research include studies on the timing and course of depression and anxiety post-event and their interactions with other disorders, disaster-related functional and cognitive impairment, positive outcomes, and coping.

Parent-Child Relationship Quality and Gender as Moderators of the Influence of Hurricane Exposure on Physical Health Among Children and Youth

OBJECTIVE

To investigate the long-term influence of disaster exposure, parent-child relationship quality (PCRQ), and gender on child and youth physical health.

METHODS

Parent-child dyads (N = 1,886) were randomly selected and interviewed approximately 18 months after Hurricane Georges hit Puerto Rico (1998), and reinterviewed 12 months later. The outcome variables were parent report of a global rating of children's physical health, and frequency of medical problems and medical visits in the past year.

RESULTS

Conservative analyses that accounted for a host of postdisaster health-relevant factors showed that hurricane exposure exerted detrimental influence on physical health at both 18 and 30 months after the event. The moderating role of PCRQ in the relation between hurricane exposure and physical health varied by gender.

CONCLUSION

Disasters have long-term potential to influence the physical health of children and adolescents. PCRQ serves as resource but its role in the context of disasters is complex.

Bounce Back Now! Protocol of a population-based randomized controlled trial to examine the efficacy of a Web-based intervention with disaster-affected families

Disasters have far-reaching and potentially long-lasting effects on youth and families. Research has consistently shown a clear increase in the prevalence of several mental health disorders after disasters, including depression and posttraumatic stress disorder. Widely accessible evidence-based interventions are needed to address this unmet need for youth and families, who are underrepresented in disaster research. Rapid growth in Internet and Smartphone access, as well as several Web based evaluation studies with various adult populations has shown that Web-based interventions are likely to be feasible in this context and can improve clinical outcomes. Such interventions also are generally cost-effective, can be targeted or personalized, and can easily be integrated in a stepped care approach to screening and intervention delivery. This is a protocol paper that describes an innovative study design in which we evaluate a self-help Web-based resource, Bounce Back Now, with a population-based sample of disaster affected adolescents and families. The paper includes description and justification for sampling selection and procedures, selection of assessment measures and methods, design of the intervention, and statistical evaluation of critical outcomes. Unique features of this study design include the use of address-based sampling to recruit a population-based sample of disaster-affected adolescents and parents, telephone and Web-based assessments, and development and evaluation of a highly individualized Web intervention for adolescents. Challenges related to large-scale evaluation of technology-delivered interventions with high-risk samples in time-sensitive research are discussed, as well as implications for future research and practice.

Disasters and Depressive Symptoms in Children: A Review

BACKGROUND

Disasters are destructive, potentially traumatic events that affect millions of youth each year.

OBJECTIVE

The purpose of this paper was to review the literature on depressive symptoms among youth after disasters. Specifically, we examined the prevalence of depression, risk factors associated with depressive symptoms, and theories utilized in this research area.

METHODS

We searched MEDLINE, PsycInfo, and PubMed electronic databases for English language articles published up to May 1, 2013. Reference lists from included studies were reviewed to capture additional studies. Only quantitative, peer reviewed studies, conducted with youth under the age of 18 years, that examined postdisaster depressive symptoms were included. Seventy-two studies met inclusion criteria. Prevalence of depressive symptoms, disaster type, correlates of depressive symptoms, and theories of depressive symptoms were reviewed.

RESULTS

Only 27 studies (38%) reported on prevalence rates among youth in their sample. Prevalence rates of depression among youth postdisaster ranged from 2% to 69%. Potential risk factors were identified (e.g., female gender, exposure stressors, posttraumatic stress symptoms). Theories were examined in less than one-third of studies (k = 21).

CONCLUSIONS

Given the variability in prevalence rates, difficulty identifying a single profile of youth at risk for developing depressive symptoms, and lack of a unifying theory emerging from the studies, recommendations for future research are discussed. Use of established batteries of assessments could enable comparisons across studies. Merging existing theories from children's postdisaster and depression literatures could aid in the identification of risk factors and causal pathways.

Correlates of persisting posttraumatic symptoms in children and adolescents 18 months after a cyclone disaster

OBJECTIVE

To describe PTSD symptom persistence and resolution, including the potential phenomenon of late-onset PTSD, in children and adolescents 18 months after a cyclone disaster; and to investigate factors that predict longer-term symptom outcome.

METHOD

71 children and 191 adolescents who were screened three months after a Category 5 Cyclone were re-screened 18 months post-disaster. Child-report measures included the PTSD Reaction Index, measures of event exposure and social connectedness.

RESULTS

Approximately 1-in-5 children and 1-in-12 adolescents endorsed cyclone-related PTSD symptoms at the moderate to severe level 18 months post-disaster. Of these approximately one-half (44.8%) of children were in the 'high-persister' group at 18-month follow-up. Persistence of low symptoms was very common (97.6%) and late-onset PTSD was a rare phenomenon. This pattern was similar in adolescents: 25.0% were in the 'high-persister' group and few students experienced late-onset PTSD. In multivariate analysis, only initial severe to very severe PTSD category made a significant independent contribution to explaining persisting moderate to severe PTSD symptoms in primary school students (ORadj=8.33, 95% CI=1.45-47.84). There was a trend for a similar result in secondary students.

CONCLUSION

A child or adolescent with few PTSD symptoms three months post-disaster is likely to remain so unless a further traumatic event occurs. However, if symptomatic at three months, there is approximately a 30-45% chance that the child or adolescent will still be symptomatic 18 months after the disaster. Given the high rate of students in the 'resolver' group, initial posttraumatic symptoms are a necessary but not sufficient condition for predicting chronic symptomatology. Other targets for predictive modelling include initial threat perception and high and low social connectedness.

Psychosocial effects of disaster in children and adolescents: significance and management

This article provides a synthesis of the literature addressing the psychological and social effects on children and adolescents after disasters, and the factors that contribute to protecting this population from experiencing related symptoms. Clinical implications are presented for health care providers to reduce the possibility of long-term psychopathologies based on the National Commission on Children and Disasters 2010 Report.

Family functioning in the aftermath of a natural disaster

BACKGROUND

Increased understanding of the complex determinants of adverse child mental health outcomes following acute stress such as natural disasters has led to a resurgence of interest in the role of parent psychopathology and parenting. The authors investigated whether family functioning in the post-disaster environment would be impaired relative to a non-exposed sample and potential correlates with family functioning such as disaster-related exposure and child posttraumatic mental health symptoms.

METHODS

Three months after a category 5 tropical cyclone that impacted north Queensland Australia, school-based screening was undertaken to case identify children who may benefit from a mental health intervention. Along with obtaining informed consent, parents completed a measure of family functioning.

RESULTS

Of 145 families of children aged 8 to 12 years, 28.3% met criteria for dysfunction on the Family Adjustment Device, double the frequency in a community sample. The dysfunction group was significantly more likely to have experienced more internalising (anxiety/depression) symptoms. However, in an adjusted logistic regression model this group were not more likely to have elevated disaster-related exposure nor did children in these families validate more PTSD symptoms.

CONCLUSIONS

The implications of post-disaster discordant family functioning and possible different causal pathways for depressive and PTSD-related symptomatic responses to traumatic events are discussed.

The psychological impact of an adenoidectomy and adenotonsillectomy on young children

OBJECTIVE

Children react differently to surgeries. The purpose of this study is to examine the stress response in young children after an adenoidectomy and adenotonsillectomy, and whether child characteristics of behavioural and neurophysiological nature can predict this stress response.

METHODS

In this prospective cohort study 43 children, aged 2-7 years, scheduled for adenoidectomy or adenoitonsillectomy (response rate 43%) were recruited from the Ear, Nose and Throat Department of the Academic Medical Centre in Amsterdam, the Netherlands. Parents completed questionnaires about temperament 4 weeks before surgery, about behaviour and sleeping problems 4 weeks before and 6 weeks after surgery, and about posttraumatic stress symptoms 6 weeks after surgery. Neurophysiological measurements (cortisol and Respiratory Sinus Arrhythmia) were performed 4 weeks before, directly after and 6 weeks after surgery. Results were compared with a control group of healthy children. The data was analysed with paired t-tests and one-way repeated ANOVA.

RESULTS

Most children with an indication for an adenoidectomy and adenotonsillectomy had more behavioural and emotional problems before surgery then the control group. After surgery there was an improvement in behaviour and sleep, in respectively 75% and 68% of the children, especially in boys. Posttraumatic stress symptoms were rare. Emotional temperament was associated with more behavioural problems before surgery (r=0.53, P=0.02), after surgery (r=0.38, P<0.000), lower cortisol directly after surgery (r=-0.49, P=0.05) and lower Respiratory Sinus Arrhythmia at follow-up (r=-0.33, P=0.06). Other temperament styles and pre-surgery levels of Respiratory Sinus Arrhythmia and cortisol did not show associations with any behavioural or neurophysiological measures.

CONCLUSIONS

An adenoidectomy and adenotonsillectomy appear not to be stressful, but rather seems helpful for reducing pre-existing behavioural and emotional problems, possibly associated with the indication for surgery. For those children with an increase of behavioural and sleeping problems after surgery, this can only be partly explained by emotional temperament. There are indications that boys and girls react differently; boys tend to show a better behavioural and emotional improvement after an adenoidectomy and adenotonsillectomy. Other behavioural or neurophysiological child characteristics do not have a predictive value on the outcome.