A study of posttraumatic disorders in children who experienced an industrial disaster in the Briey region

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.

Factors associated with post-traumatic stress symptoms among adolescents exposed to the Sewol ferry disaster in Korea

This study evaluated the factors associated with post-traumatic stress symptoms in Korean adolescents who lived in a disaster-affected community. A total of 1101 students attending secondary and high schools in Jindo, the location of the Sewol ferry disaster, were enrolled in a cross-sectional survey. The Child Report of Post-traumatic Symptoms (CROPS), the Center for Epidemiological Studies Depression Scale (CES-D), and the State Anxiety Inventory for Children (SAIC) were administered. Female gender, older children, poor academic achievement, and directly witnessing the rescue scene were associated with post-traumatic stress symptoms. The CES-D and SAIC scores of subjects with witness of the rescue were significantly higher than those of respondents without such experiences. The regression analysis revealed that directly witnessing the rescue scene was significantly associated with post-traumatic stress symptoms after adjusting for other variables. The results of this study suggest that witnessing the rescue scene following a disaster might be a risk factor for post-traumatic stress symptoms in adolescents in disaster-affected communities.

Paternal Mental Health: Why Is It Relevant?

Father's mental health is an emerging area of interest that is beginning to be recognized in research, and to a lesser extent in clinical practice and society. Fathers are part of a parenting dyad with 2 partners who are responsible for their children's emotional development. Similar to mothers, the risk for mental health problems increases once a male becomes a father, but there is limited research examining this issue. The purpose of this review is to present the available literature on father's mental health and its effect on child emotional health through various mechanisms. In general, father's mental health was found to be related to increased child internalizing and externalizing behaviors, but each disorder had different risk factors, and a unique effect on parenting behaviors and the child's emotional health. The most developed paternal mental health literature is focused on depression. However, key conceptual and methodological problems exist that may limit our understanding of paternal depression. Additionally, the focus on paternal depression may not accurately represent the largest risk for paternal psychopathology and the resultant child mental health outcomes because men have an increased likelihood of displaying externalizing behaviors. Implications for research, clinical practice, and policy are discussed.

Psychometric Properties of Disaster Event Reaction Items From the Crisis Counseling Individual/Family Encounter Log

OBJECTIVE

The purpose of this article was to examine the psychometric properties of the Crisis Counseling Assistance and Training Program (CCP) data collection instrument, the Individual/Family Encounter Log (IFEL). Data collected from disaster survivors included how they reacted to events in emotional, behavioral, physical, and cognitive domains. These domains are based on conceptual categorization of event reactions and allow CCP staff to provide survivors with referrals to appropriate behavioral health support resources, if warranted.

METHODS

This study explored the factor structure of these survey items to determine how best to use the available information as a screen of disaster-related behavioral health indicators. Specifically, our first research question explored and confirmed the optimal factor structure of the event reaction items, and our second question examined whether the new factor structure was similar across disaster types: hurricanes, tornadoes, floods, and wildfires. Using a factor analytic technique, we tested whether our event reaction outcomes achieved consistent and reliable measurement across different disaster situations. Finally, we assessed how the new subscales were correlated with the type of risk to which CCP disaster survivors were exposed.

RESULTS

Our analyses revealed 3 factors: (1) depressive-like, (2) anxiety-like, and (3) somatic. In addition, we found that these factors were coherent for hurricanes, floods, and wildfires, although the basic factor structure was not equivalent for tornadoes.

CONCLUSION

Implications for use of the IFEL in disaster preparedness, response, and recovery are discussed. (Disaster Med Public Health Preparedness. 2016;10:822-831).

[Inclusion - pediatric and adolescent psychiatry aspects]

The Convention on the Rights of Persons with Disabilities became legally binding in Germany in March 2009. “Inclusion” is the major concept–all people with any kind of handicap must have the same rights to full and effective participation and inclusion in society. Preceding inclusion come adjustments in society with regard to ethical, legislative, administrative, conceptual, structural, economical, and thus also to healthcare-political frameworks, in order to make disabilities are as far as possible no longer a handicap in an individual’s everyday life. This review first outlines the present social status influencing the development of children, a child’s welfare, and especially the healthcare of children and adolescents with psychiatric disorders and conditions indicating barriers to inclusion. It focuses on those articles of the UN convention which are relevant with regard to ethical attitude, epidemiology, healthcare framework, diagnostics, therapy, teaching, and research with respect to child and adolescent psychiatry. The analysis points to a significant backlog demand in child psychiatric healthcare, teaching, and research.

The parent ratings of traumatized children with or without PTSD

Two clinical and 2 structured clinical interviews were used to identify children with posttraumatic stress disorder (PTSD), traumatized children without PTSD, and nontraumatized controls. Parents evaluated child conduct by marking the Conners' Parent Rating Scale-48 (CPRS-48; Conners, 1989). Data analysis indicated that the CPRS-48 Total scores and the Anxiety and Psychosomatic subscales scores of the PTSD group significantly exceeded the scores of the comparison groups. Children with PTSD and traumatized children without PTSD did not significantly differ on the Hyperactivity Index. The Hyperactivity Index scores of traumatized children without PTSD and nontraumatized controls were not significantly different. Nonsignificant differences were observed between groups on the CPRS-48 Impulsivity-Hyperactivity, Conduct Problems, and Learning subscales. Overall, PTSD was marked by higher internalizing scores and trauma exposure without PTSD was not associated with increased psychological morbidity.

Long-term outcomes among child and adolescent survivors of the 2010 Haitian earthquake

BACKGROUND

We examined the prevalence and predictive factors of PTSD and depression in relation with peritraumatic distress, trauma exposure, and sociodemographic characteristics among children and adolescent who survived the 2010 Haiti's earthquake.

METHODS

We analyzed data collected between June and July 2012 from a sample of 872 participants aged 7 to 17 in 12 schools, door-to-door canvassing and two centers for street children at Port-au-Prince. Participants completed the Impact of Event Scale Revised (IES-R), Peritraumatic Distress Inventory, Child Depression Inventory 2 (CDI), and sociodemographic and traumatic exposure questionnaires.

RESULTS

Of 872 participants, respectively 322 (36.93%); and 403 (46.21%) reported a clinically significant symptoms of PTSD and depression, which were significantly higher among girls. The best predictive variables are peritraumatic distress for PTSD (β=0.53,P<.0001) a traumatic exposure for depression (β=0.23,P<.0001). The comorbidity between PTSD and depression symptoms is 22.25%.

CONCLUSIONS

This first study in children on the prevalence of PTSD and depression resulting from the 2010 Haiti earthquake demonstrates a need for improvement in treatment aimed at reducing PTSD and depression. Such treatment should be geared primarily toward girls, adolescents between the ages of 14 and 17 and those children and adolescents who have lost a family member in the earthquake.

Prevalence of psychiatric symptoms in children and adolescents one year after the 2009 L'Aquila earthquake

BACKGROUND

In 2009, an earthquake devastated the Abruzzo region in Italy. Despite the occurrence of several disasters in this country, no study on mental health of Italian children has ever been conducted in complex emergencies. Objective of the study was to assess the prevalence of psychiatric symptoms among children in the affected area 12 to 17 months after the event.

METHODS

A community sample of 1839 3-14 years children was identified from the general population assigned to 37 paediatricians of the National Health System, including children living in the earthquake epicentre, the surrounding earthquake zone, and the adjacent non-affected areas. Psychiatric symptoms were assessed with the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR), completed by 452 children aged 11-14 years. The association between symptoms and sociodemographic, health, family, and earthquake-related factors was examined.

RESULTS

The prevalence of CBCL-defined cases was 14.9% in the epicentre, 13.0% in the remainder earthquake zone, 13.9% in the unaffected area (p = .876). No differences among areas were found when comparing the YSR results. Prevalence of CBCL-defined post-traumatic stress (PTS) cases was 8.4% in the epicentre, 4.0% in the remainder earthquake zone, 2.2% in the unaffected area (p = .002). PTS and anxiety were significantly more frequent in the epicentre than in other areas only in the 6-10 year-old children group (respectively p = .009 and p = .014). In multivariate logistic analyses, factors associated with PTS were living in the epicentre (OR = 3.6) and child or maternal history of mental health care prior to the earthquake (respectively OR = 7.1 and OR = 4.5).

CONCLUSIONS

Children living in the epicentre, particularly those 6-10 years old, had the highest prevalence of CBCL-defined cases, and of PTS and anxiety symptoms one year after the earthquake. No signs of increased psychopathology were detected in younger (3-5 years) or older children (11-14 years). Family and health related factors showed stronger association with psychiatric outcomes than earthquake-related factors. The identification of populations at higher risk of developing psychiatric symptoms has implications for public health interventions in complex emergencies.

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.

Psychological Consequences of Indirect Exposure to Disaster Due to the Haiti Earthquake

Introduction

Few studies have focused on the mental health consequences of indirect exposure to disasters caused by naturally occurring hazards. The present study assessed indirect exposure to the 2010 earthquake in Haiti among Haitian-Americans now living in Miami; these subjects had no direct exposure to the earthquake, but retained their cultural identity, language, and connection to family and friends in Haiti.

Methods

Two months following the earthquake a sample of Haitian-Americans was surveyed inquiring about: (1) their psychological reactions to the quake; (2) types of exposures experienced by their family members and friends in Haiti; and (3) symptom levels of (a) major depression, (b) generalized anxiety disorder, (c) complicated grief, (d) mental health status, and (e) physical health status.

Results

Haitian-Americans living in Miami experienced a broad spectrum of indirect exposures to the 2010 earthquake in Haiti. These exposures were strongly associated with psychological distress, trauma-related mental health consequences, and diminished health status. Most notable was the multiplicity of indirect exposures to the on-scene experiences of multiple family members and friends in Haiti.

Conclusions

Consideration should be given to the psychological impact and needs for support among indirectly-exposed populations with strong affiliation to directly-impacted victims.

Shultz JM, Besser A, Kelly F, Allen A, Schmitz S, Hausmann V, Marcelin LH, Neria Y. Psychological consequences of indirect exposure to disaster due to the Haiti earthquake.Prehosp Disaster Med.2012;27(4):1-10.

Psychological Impact of Disasters and Terrorism on Children and Adolescents: Experiences from Australia

Recent acts of terrorism have emphasised the need for research to further establish not only the nature of the impact of disaster and terrorism on the population, but also further define methods of effective intervention. Those affected, and often overlooked, include children and adolescents, yet, our knowledge of the impact upon the younger members of our community limited. The literature is evolving, and there are a small number of valuable studies that can inform a response to the mental health needs of this younger population.

This article reviews some of the psychological impacts of disaster and terrorism upon children and adolescents, and considers both risk and protective factors. The importance of a developmental approach to children's understanding of disaster, particularly death and the nature of grief and loss are discussed as is the distinction between the phenomenology of bereavement and trauma. Family and community support are highlighted as protective factors, and a number of recent, valuable recommendations for intervention including psychological first aid and cognitive-behavioral therapy are described. Finally, the complex role of the media and the degree that children should exposed to images of violence and disaster is considered. Disasters, whether they are natural or human-made always will be with us. It is necessary that a public-health approach that not only prepares for such scenarios, but responds by maximising the use of existing systems and agency linkages, taken.

Psychological health and coping strategy among survivors in the year following the 2008 Wenchuan earthquake

AIM

The powerful earthquake of 12 May 2008 wrought incalculable havoc on lives and properties in Wenchuan, Sichuan Province, China. The catastrophic earthquake not only created tremendous changes in the external environment, but also caused stress and difficulties for the people in the affected areas which were felt long after the event. In this study, we attempt to clarify the correlation between coping strategies and psychological well-being among survivors across sex and levels of exposure.

METHOD

A total of 2080 survivors from 19 counties freely participated in the survey which used self-report psychological questionnaires, the Short Form-12, version 2 Scale and Coping Scales. We estimated regression models to identify the coping factors associated with the presence of mental symptoms after the disaster.

RESULTS

Four main factors (middle-age, low educational level, low monthly income, and high exposure) were significantly related to poor health. Highly exposed survivors tended to problem-avoidance, fantasy, self-blame and seeking assistance, which was significantly different to those lowly exposed. Women tended to be more vulnerable than men and exhibited problem-avoidance and self-blame. Six coping styles were significant determinants and predicted 64.2% of health.

CONCLUSION

Post-disaster mental health recovery intervention, including early identification, ongoing monitoring, sustained psychosocial support and more mental health services, are required for the high-risk population, especially for women.

Family structure and posttraumatic stress reactions: a longitudinal study using multilevel analyses

BACKGROUND

There is limited research on the relevance of family structures to the development and maintenance of posttraumatic stress following disasters. We longitudinally studied the effects of marital and parental statuses on posttraumatic stress reactions after the 2004 Southeast Asian tsunami and whether persons in the same households had more shared stress reactions than others.

METHOD

The study included a tourist population of 641 Norwegian adult citizens, many of them from families with children. We measured posttraumatic stress symptoms with the Impact of Event Scale-Revised at 6 months and 2 years post-disaster. Analyses included multilevel methods with mixed effects models.

RESULTS

Results showed that neither marital nor parental status was significantly related to posttraumatic stress. At both assessments, adults living in the same household reported levels of posttraumatic stress that were more similar to one another than adults who were not living together. Between households, disaster experiences were closely related to the variance in posttraumatic stress symptom levels at both assessments. Within households, however, disaster experiences were less related to the variance in symptom level at 2 years than at 6 months.

CONCLUSIONS

These results indicate that adult household members may influence one another's posttraumatic stress reactions as well as their interpretations of the disaster experiences over time. Our findings suggest that multilevel methods may provide important information about family processes after disasters.

Construct validity of the childbirth trauma index for adolescents

The potentially traumatic nature of childbirth for adult mothers has been confirmed in research; however, adolescent childbirth trauma is unexplored. This article presents research on the construct validity of the Childbirth Trauma Index by providing a conceptual analysis of psychological childbirth trauma, factor validity of the Childbirth Trauma Index, and discussion of testing the Childbirth Trauma Index via contrasted-groups approach. Childbirth trauma can result in an acute stress reaction or actual posttraumatic stress disorder. Using subjective reports, the Impact of Event Scale, and the Childbirth Trauma Index, an appraisal of birth trauma, trauma impact, and indicators associated with childbirth trauma were revealed among 112 adolescents. Clinical implications and research recommendations are offered.

Impact of maternal posttraumatic stress disorder and depression following exposure to the September 11 attacks on preschool children's behavior

To evaluate whether conjoined maternal posttraumatic stress disorder (PTSD) and depression are associated with increased behavioral problems among terrorism-exposed preschool children (N = 116; 18-54 months), this study compared clinically significant child behavioral problem rates among the preschool children of mothers with PTSD and depression, depression alone, and neither disorder. Behavioral problems were independently rated by mothers and preschool teachers. Maternal depression and PTSD, relative to maternal depression alone, and to neither disorder, were associated with substantially increased child problems. Notably, maternal depression and PTSD were associated with increased emotional reactivity (relative risk [RR] = 5.9 by mother's and 3.4 by teacher's reports) and aggressive behavior problems (RR = 11.0 by mother's and RR = 5.9 by teacher's reports). This was corroborated by teacher ratings. Implications for intervening with terrorism-exposed preschool children are discussed.

Impact of traumatic birth experience on Latina adolescent mothers

BACKGROUND

The childbirth experience can be a wonderful event, or one of horror. One in 3 adult mothers appraises her childbirth experience as traumatic, with up to 10% of women reporting a severe traumatic stress response post-delivery. The impact of the birth experience on adolescents is unknown.

METHODS

Eighty-five Latinas ages 13 to 19 appraised their childbirth experience and reported symptoms of trauma impact as measured via the Impact of Event Scale (IES) within 72 hours of delivery. Descriptive statistics included demographic, obstetrical, and personal factors, and trauma scores. ANOVAs were used to examine differences in birth appraisal and trauma impact by demographic, obstetrical, and personal factors. Spearman rho and Pearson's r was used to compute correlations between birth appraisal, depression, and trauma impact.

RESULTS

One-third of adolescents appraised their childbirth as traumatic; one-half displayed symptoms of trauma impact. Items influencing appraisal of the birth experience included marital status, fear of dying, fear of loss of control, and partner violence. Birth appraisal and symptoms of depression were found to influence trauma impact.

CONCLUSIONS

One-third of teens appraised childbirth as traumatic with 50% displaying symptoms suggestive of acute trauma at immediate postpartum. Nursing recommendations focus on providing a non-traumatic birth experience and follow-up by mental health professionals for assessment of potential chronic trauma, posttraumatic stress and depression. Teens can enter labor and delivery with stressors, depression, and past traumas; collaboration of care between maternal-child and mental health professionals is encouraged.

Some clinical characteristics of children who survived the Marmara earthquakes

The Marmara earthquakes occurred in the Marmara Region (North West) of Turkey in 1999 and resulted in a death toll of approximately 20,000. This paper investigates the relationships between diagnoses and certain variables in children who developed emotional and/or behavioral disturbances in the aftermath of the Marmara earthquakes and were subsequently seen at a child psychiatry outpatient clinic. The variables evaluated are gender, age, the location where the earthquake was experienced, and the degree of losses, bodily injuries, and damage to the residence. Medical records of 321 children and adolescents ranging in age from 2 to 15 years who presented at the clinic due to problems associated with the earthquake between August 1999 and February 2000 were reviewed. Of the patients, 25.5% were diagnosed with post-traumatic stress disorder (PTSD), 16.5% with acute stress disorder (ASD) and 38% with adjustment disorder. No relationship is found between gender and diagnosis. Younger age groups tended to be diagnosed with adjustment disorder. Those who had lost relatives, friends or neighbors were more frequently diagnosed with ASD or PTSD. The same was true for children whose residence was heavily damaged. Children and adolescents constitute the age group that is most severely affected by natural disasters and display significant emotional-behavioral disturbances. The frequency of ASD and PTSD found in our study is considerably high. Although rarely mentioned in the literature, adjustment disorder appears to be one of the most common reactions of children to trauma.

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

Children exposed to a technological disaster during an understudied part of the lifespan, preschool age and early middle childhood, were assessed in a 5-year follow-up regarding mental health problems, anxiety disorder symptoms, depressive symptoms, physical symptoms, and posttraumatic stress symptoms. Exposed children and their parents (n = 264) reported significantly more problems than controls (n = 515). The differences were greater for conduct problems (including hyperactivity) and physical symptoms, than for anxiety and depression. The long-term effects of a technological disaster on children of pre-school age at exposure appear to differ from those in children, who were victimized at a later age. This may reflect interference with completion of specific developmental tasks.

Postmining management in france: situation and perspectives

Even if most French mines are definitively closed, potential risks remain above the abandoned sites. In addition to surface instability, some mining sites may be affected by dangerous gas emissions, flooding events, or environmental impacts. Those kinds of disorders strongly influence the land-use management of the concerned areas. The present article presents the French mining historical context and identifies the major kinds of residual risks and harmful effects that may affect abandoned mine sites. The prevention policy applied on the national territory is then discussed and prospects for further developments are proposed.

The role of couples' interacting world assumptions and relationship adjustment in women's postdisaster PTSD symptoms

This study examined 58 heterosexual couples' interacting assumptions about the world and relationship adjustment in predicting wives' posttraumatic stress disorder (PTSD) symptoms after severe flooding. Both partners completed the World Assumptions Scale (Janoff-Bulman, 1989), and wives reported on their intimate relationship adjustment and PTSD symptomatology. Neither husbands' nor wives' assumptions alone predicted wives' PTSD symptoms. However, the interaction of husbands' and wives' benevolent world assumptions significantly predicted wives' PTSD symptoms. When husbands held less benevolent world assumptions, there was a negative association between wives' assumptions and PTSD symptoms. Additionally, wives' relationship adjustment predicted their PTSD symptomatology when taking into account individual and interacting self-worth assumptions. Implications for understanding the role of intimate relationships in postdisaster mental health and interpersonally oriented prevention efforts are discussed.

Impact of traumatic life events in a community sample of toddlers

Toddlers may be at particularly high risk for a number of psychiatric, developmental and neurobiological consequences in the aftermath of trauma. The social and emotional impact of potentially traumatic life events experienced between 6 and 36-months of age was assessed in an epidemiological birth cohort of 18- to 36-month-olds from the Greater New Haven Area. Event-exposed toddlers evidenced greater symptom severity on the ITSEA Internalizing, Externalizing, Dysregulation, Atypical and Maladaptive scales, as well on the CBCL Internalizing and Externalizing scales than those not exposed. Approximately one-fifth of event-exposed toddlers were reported by their parents to have experienced a dramatic change in functioning following the event, and were described as experiencing higher levels of symptoms consistent with Post-Traumatic Stress Disorder (PTSD), namely re-experiencing and arousal, than exposed toddlers whose parents did not report a change in their functioning. Implications for clinicians and child care providers working with toddlers and their parents are discussed.

Ecological predictors of traumatic stress symptoms in caucasian and ethnic minority children exposed to intimate partner violence

Traumatic stress symptoms were assessed for 218 children ages 5 to 13 following exposure to intimate partner violence: 33% of Caucasian and 17% of minority children were diagnosed with posttraumatic stress disorder. A risk and protective factors model was used to predict traumatic stress symptoms. For Caucasian children, the best predictors were mothers' mental health and low self-esteem. For minority children, the amount of violence, mothers' low self-esteem, and low income predicted traumatic stress. Social support to the mother, inclusive of friends, relatives, and religion, was a protective element. Implications for assessment and intervention are discussed in light of each group's experiences.

Psychological assessment of children in disasters and emergencies

Children and adolescents are among the most vulnerable members of communities affected by disasters and emergencies. There is a tremendous need for a systematic post-disaster psychological assessment of children and adolescents in order to understand better post-traumatic symptomatology in children and to identify populations that require an early intervention. This article reviews psychological instruments that are suitable for screening children and adolescents in emergency and disaster contexts for four different types of post-traumatic responses: post-traumatic stress disorder; depression; anxiety disorders; and behavioural disorders. A description of each instrument and psychometric data are provided, along with recommendations on the most appropriate instruments to be utilised in different emergency environments and a summary of previous post-disaster evaluations that have used each type. In addition to selecting apposite instruments, other important issues that should be taken into account when conducting post-emergency mental health needs appraisals of children and adolescents are discussed.

Thai School-Age Children’s Perception of Fear

Information about how Thai school-age children perceive fear is necessary for the development of culturally appropriate anxiety or fear measures. The purpose of this study was to describe Thai school-age children’s perceptions of fear from their own perspective. Qualitative data from 13 Thai students in Grades 3 to 6 in three schools in Bangkok were obtained by semistructured, formal interviews, combined with drawings. The data were analyzed using content analysis within the frame of category development in the grounded theory method. Several culturally specific aspects of fear were revealed. This information is useful for health care providers caring for Thai children. The results of this study also illustrate the importance of carefully assessing children from culturally diverse backgrounds related to manifestations of anxiety or fear.

Stress response symptoms in adolescent and young adult children of parents diagnosed with cancer

The aim of this study was to assess stress response symptoms in children of parents diagnosed with cancer 1-5 year prior to study entry. The impact of event scale was used to measure stress response symptoms in terms of intrusion and avoidance; the youth self-report assessed emotional and behavioural functioning; the state-trait anxiety inventory for children measured trait-anxiety. Participants included 220 adolescents (aged 11-18 years) and 64 young adults (aged 19-23 years) from 169 families. Twenty-one percent of the sons and 35% of the daughters reported clinically elevated stress response symptoms. Daughters, particularly those whose mothers were ill, reported significantly more intrusion and avoidance than did sons. Intrusion among daughters was positively related to age. Stress response symptoms in both sons and daughters were significantly associated with trait anxiety, but not with intensity of treatment or time since diagnosis. Daughters whose parents suffered from recurrent illness reported more symptoms than did daughters whose parents had a primary disease. Children (daughters in particular) with clinically elevated stress response symptoms reported significantly more problems of internalising and cognition than did their norm group peers. One-fifth of the sons and more than one-third of the daughters expressed clinically elevated stress response symptoms. These children also reported internalising and cognitive problems. Daughters appeared to be more at risk than sons.

Posttraumatic stress disorder after dog bites in children

Of 22 children who were victims of dog bite, 12 had symptoms of posttraumatic stress disorder 2 to 9 months after the bite. Violent dog attacks inflicting multiple and/or deep wounds were associated with risk of posttraumatic stress disorder.

Ten-year review of rating scales. IV: scales assessing trauma and its effects

OBJECTIVE

This article summarizes scales assessing trauma and its effects on youths.

METHOD

We sampled trauma-related articles published over the past 25 years, with an emphasis on the past decade, selected scales with at least several publications, and reviewed their properties. Those with minimally adequate psychometric properties and continued literature citations or a special niche are presented.

RESULTS

Most of trauma-related scales are relatively new, reflecting the evolving interest in juvenile trauma. Therefore, they do not have the depth of psychometric examination nor the breadth of applications described for previously reviewed scales. However, they have been applied to various traumatic situations. These scales assess a range of trauma-related symptoms and behaviors, including posttraumatic stress disorder, symptoms related to posttraumatic stress disorder, and dissociation. Additionally, several scales assess the trauma itself.

CONCLUSIONS

Trauma-related scales show promise for research and clinical use in understanding youths' responses to trauma. However, their utility for treatment planning and for accountability in practice is generally not as clear. The potential user must clearly define the goals of measurement and use these scales within their limited roles. With these caveats, trauma-related scales may assist our work with traumatized youths.

The aftermath of violence: children, disaster, and posttraumatic stress disorder

Terrorist attacks, situations of armed conflict, and all forms of catastrophe tax our abilities to cope, understand, and respond. Because of their developmental status, children are even more emotionally vulnerable to the devastating effects of a disaster. When tragedy strikes a family, community, or the nation, helping children cope and regain a sense of safety is critical. A child with posttraumatic stress disorder (PTSD) develops symptoms such as intense fear, disorganized and agitated behavior, emotional numbness, anxiety, or depression after being directly exposed to or witnessing an extreme traumatic situation involving threatened death or serious injury. Victims of repeated abuse or children who live in violent neighborhoods or war zones, or who have witnessed extensive media coverage of violent events, may experience PTSD.

60,000 disaster victims speak: Part II. Summary and implications of the disaster mental health research

On the basis of the literature reviewed in Part I of this two-part series (Norris, Friedman, Watson, Byrne, Diaz, and Kaniasty, this volume), the authors recommend early intervention following disasters, especially when the disaster is associated with extreme and widespread damage to property, ongoing financial problems for the stricken community, violence that resulted from human intent, and a high prevalence of trauma in the form of injuries, threat to life, and loss of life. Meeting the mental health needs of children, women, and survivors in developing countries is particularly critical. The family context is central to understanding and meeting those needs. Because of the complexity of disasters and responses to them, inter-agency cooperation and coordination are extremely important elements of the mental health response. Altogether, the research demands that we think ecologically and design and test societal- and community-level interventions for the population at large and conserve scarce clinical resources for those most in need.