Children exposed to disaster: II. Risk factors for the development of post-traumatic symptomatology

Post-traumatic stress and joint hypermobility in children and adolescents of Nepal after exposure to an earthquake

A substantial body of literature has traditionally addressed the connection between the exposure to catastrophic events and the development of Post-Traumatic Stress disorder (PTSD), especially in the vulnerable stratum of children and adolescents. However, little is known about their biological predisposing factors, and further research is needed, especially in the context of the recent earthquakes in Turkey and Syria. The data of this study was collected 4 months after the 2015 earthquakes in Nepal, with the objective of providing new evidence to the field and documenting the role of a new potential predisposing factor: the Joint Hypermobility Syndrome (JHS). 941 subjects from three different regions of the country, aged 8-18 years, were assessed in a school-based cross-sectional investigation. PTSD, as the main response variable, was assessed using the Child PTSD Symptom Scale (CPSS) questionnaire and analysed considering three sub-dimensions: the severity of symptoms, the severity of impairment, and both taken together. JHS was assessed using the Screening Questionnaire to detect Hypermobility (SQ-CH) questionnaire. The severity of symptoms was strongly predicted by the distance to the epicentre. Females showed more severe symptomatology, but a lower perturbation in the daily functioning. Younger children reported a greater functional impairment. JHS group showed more severe PTSD than non-JHS group. We observed variability in the severity of PTSD according to previously known risk factors such as the distance to the epicentre, sex, and age. We also found an association between PTSD and JHS, which is discussed in reference to the neuroconnective endophenotype. It might be useful to consider the role of each variable when planning a mass intervention after a disaster.

Mental health impact of the 2023 Kahramanmaraş earthquakes: Prevalence of PTSD, depression, anxiety, and stress among survivors

The aim of this study is to determine the prevalence of post-traumatic stress disorder (PTSD), depression, anxiety, and stress among earthquake survivors following the 2023 Kahramanmaraş earthquakes. This cross-sectional study included 461 earthquake survivors. The findings revealed prevalence rates of 17.4% for PTSD, 61.2% for depression, 79.4% for anxiety, and 58.4% for stress. A moderately significant positive correlation was found between PTSD and depression (r = 0.434), anxiety (r = 0.543), and stress (r = 0.534). Female participants had a higher risk for PTSD (OR = 2.144, p = 0.028) and anxiety (OR = 2.014, p = 0.005). Being unmarried was associated with increased risks for depression (OR = 1.597, p = 0.030) and anxiety (OR = 1.523, p = 0.045). Participants aged 33-67 had a significantly lower risk of developing PTSD (OR = 0.079, p = 0.022). Increased psychological support is essential for earthquake survivors' mental health recovery.

Alone on the frontline: The first report of PTSD prevalence and risk in de-occupied Ukrainian villages

IMPORTANCE

The ongoing Russian invasion of Ukraine marks a critical juncture in a series of events posing severe threat to the health of Ukrainian citizens. While recent reports reveal higher rates of PTSD in Ukrainian refugees following Russia's invasion - data for Ukrainians remaining at the warfront is inherently difficult to access. A primarily elderly demographic, Ukrainians in previously Russian-occupied areas near the front (UPROANF) are at particular risk.

DESIGN

Data was sourced from screening questionnaires administered between March 2022 and July 2023 by mobile health clinics providing services to UPROANF.

SETTING

Previously occupied villages in Eastern and Southern Ukraine.

PARTICIPANTS

UPROANF attending clinics completed voluntary self-report surveys reporting demographics, prior health diagnoses, and PTSD symptom severity (n = 450; Meanage = 53.66; 72.0% female).

EXPOSURE

Participants were exposed to Russian occupation of Ukrainian villages.

MAIN OUTCOME AND MEASURES

The PTSD Checklist for the DSM-V (PCL-5) with recommended diagnostic threshold (i.e. 31) was utilized to assess PTSD prevalence and symptom severity. ANCOVA was used to examine hypothesized positive associations between (1) HTN and (2) loneliness and PTSD symptoms (cumulative and by symptom cluster).

RESULTS

Between 47.8% and 51.33% screened positive for PTSD. Though cumulative PTSD symptoms did not differ based on HTN diagnostic status, those with HTN reported significantly higher PTSD re-experiencing symptoms (b = 1.25, SE = 0.60, p = .046). Loneliness was significantly associated with more severe cumulative PTSD symptoms (b = 1.29, SE = 0.31, p < .001), re-experiencing (b = 0.47, SE = 0.12, p < .001), avoidance (b = .18, SE = 0.08, p = .038), and hypervigilance (b = 0.29, SE = 0.13, p = .036).

CONCLUSIONS AND RELEVANCE

PTSD prevalence was higher than other war-exposed populations. Findings highlight the urgent mental health burden among UPROANF, emphasizing the need for integrated care models addressing both trauma and physical health. Given the significance of loneliness as a risk factor, findings suggest the potential for group-based, mind-body interventions to holistically address the physical, mental, and social needs of this highly traumatized, underserved population.

Health Effects of Cyclones: A Systematic Review and Meta-Analysis of Epidemiological Studies

BACKGROUND

More intense cyclones are expected in the future as a result of climate change. A comprehensive review is urgently needed to summarize and update the evidence on the health effects of cyclones.

OBJECTIVES

We aimed to provide a systematic review with meta-analysis of current evidence on the risks of all reported health outcomes related to cyclones and to identify research gaps and make recommendations for further research.

METHODS

We systematically searched five electronic databases (MEDLINE, Embase, PubMed, Scopus, and Web of Science) for relevant studies in English published before 21 December 2022. Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we developed inclusion criteria, screened the literature, and included epidemiological studies with a quantitative risk assessment of any mortality or morbidity-related outcomes associated with cyclone exposures. We extracted key data and assessed study quality for these studies and applied meta-analyses to quantify the overall effect estimate and the heterogeneity of comparable studies.

RESULTS

In total, 71 studies from eight countries (the United States, China, India, Japan, the Philippines, South Korea, Australia, Brazil), mostly the United States, were included in the review. These studies investigated the all-cause and cause-specific mortality, as well as morbidity related to injury, cardiovascular diseases (CVDs), respiratory diseases, infectious diseases, mental disorders, adverse birth outcomes, cancer, diabetes, and other outcomes (e.g., suicide rates, gender-based violence). Studies mostly included only one high-amplitude cyclone (cyclones with a Saffir-Simpson category of 4 or 5, i.e., Hurricanes Katrina or Sandy) and focused on mental disorders morbidity and all-cause mortality and hospitalizations. Consistently elevated risks of overall mental health morbidity, post-traumatic stress disorder (PTSD), as well as all-cause mortality or hospitalizations, were found to be associated with cyclones. However, the results for other outcomes were generally mixed or limited. A statistically significant overall relative risk of 1.09 [95% confidence interval (CI): 1.04, 1.13], 1.18 (95% CI: 1.12, 1.25), 1.15 (95% CI: 1.13, 1.18), 1.26 (95% CI: 1.05, 1.50) was observed for all-cause mortality, all-cause hospitalizations, respiratory disease, and chronic obstructive pulmonary disease hospitalizations, respectively, after cyclone exposures, whereas no statistically significant risks were identified for diabetes mortality, heart disease mortality, and preterm birth. High between-study heterogeneity was observed.

CONCLUSIONS

There is generally consistent evidence supporting the notion that high-amplitude cyclones could significantly increase risks of mental disorders, especially for PTSD, as well as mortality and hospitalizations, but the evidence for other health outcomes, such as chronic diseases (e.g., CVDs, cancer, diabetes), and adverse birth outcomes remains limited or inconsistent. More studies with rigorous exposure assessment, of larger spatial and temporal scales, and using advanced modeling strategy are warranted in the future, especially for those small cyclone-prone countries or regions with low and middle incomes. https://doi.org/10.1289/EHP12158.

Using social media Reddit data to examine foster families' concerns and needs during COVID-19

BACKGROUND

COVID-19 is likely to have negatively impacted foster families but few data sources are available to confirm this.

OBJECTIVE

The current study used Reddit social media data to examine how foster families are faring in the pandemic. Discussion topics were identified and examined for changes before and after COVID-19.

PARTICIPANTS AND SETTING

Comments were collected from three Reddit online discussion boards dedicated to foster families (N = 11,830).

METHODS

We used machine learning techniques, including Latent Dirichlet Allocation, for topic modeling and textual analysis for qualitative coding of the Reddit comments.

RESULTS

Results showed that three main topics had both significant quantitative and meaningful qualitative changes before and after COVID-19. There were significant increases in conversation about becoming a foster parent (F = 5.75, p = 0.02) and activities for foster children (F = 10.61, p = 0.001), whereas there was a significant decrease in discussing permanency (F = 9.46, p = 0.003) before and after the onset of COVID-19. Qualitative coding showed that regarding the topic of becoming a parent, excitement over approval of foster care license before COVID-19 shifted to foster families' increased anxieties about delays in their licensing cases after COVID-19. For permanency, content changed from the best interest of the child and reunifications before COVID-19 to concerns over family separations and permanency challenges after COVID-19. Regarding activities for foster children, content related to everyday activities before COVID-19 changed to specific activities foster children and families could do during lockdowns. Results suggest areas child welfare workers may focus on to better support foster families during and after the pandemic.

The challenges arising from the COVID-19 pandemic and the way people deal with them. A qualitative longitudinal study

The conducted qualitative research was aimed at capturing the biggest challenges related to the beginning of the COVID-19 pandemic. The interviews were carried out in March-June (five stages of the research) and in October (the 6th stage of the research). A total of 115 in-depth individual interviews were conducted online with 20 respondents, in 6 stages. The results of the analysis showed that for all respondents the greatest challenges and the source of the greatest suffering were: a) limitation of direct contact with people; b) restrictions on movement and travel; c) necessary changes in active lifestyle; d) boredom and monotony; and e) uncertainty about the future.

Impact of disaster exposure severity: Cascading effects across parental distress, adolescent PTSD symptoms, as well as parent-child conflict and communication

RATIONALE

Natural disasters are common and have potentially deleterious impacts on individuals, as well as on the relationships among family members (Adams et al., 2015; Paul, 2015). Additionally, caregiver-, offspring-, and family-level outcomes are often correlated following disaster.

OBJECTIVE

Thus, longitudinal work is needed to clarify the prospective associations among such constructs following severe disasters.

METHOD

The current study included 1,271 adolescents and investigated whether disaster exposure impacted adolescent posttraumatic stress disorder (PTSD) symptoms, parent distress, and family parent-child conflict and communication, as well as whether/how these factors influenced one another over time. This study used a dynamic cascade model and included adolescents (ages 12-17) and caregivers present for tornadoes in Missouri and Alabama in 2011. These participants were part of a larger study involving a web-based intervention.

RESULTS

Over and above covariates (i.e., adolescent age, gender, race, treatment, prior trauma, adolescent alcohol use and depressive symptoms, and household income), families who experienced greater severity of disaster exposure had adolescents who reported more baseline PTSD symptoms and caregivers who reported more distress at baseline.

CONCLUSIONS

Providing tangible resources (e.g., housing, food, transportation, essential possessions) to families post-disaster may reduce parent distress and adolescent PTSD symptoms. Additionally, reducing adolescent PTSD symptoms may prospectively improve relationships between parents and adolescents.

Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory

The State-Trait Anxiety Inventory - Trait version (STAI-T) was developed to measure an individual's tendency to experience anxiety, but it may lack discriminant evidence of validity based on strong observed relationships with measures of depression. The present series of meta-analyses compares STAI-T scores among individuals with depressive disorders, anxiety disorders, and nonclinical comparison groups, as well as correlations with measures of anxiety and depressive symptom severity, in order to further examine discriminant and convergent validity. A total of 388 published studies (N = 31,021) were included in the analyses. Individuals with an anxiety disorder and those with a depressive disorder displayed significantly elevated scores on the STAI-T compared to nonclinical comparison groups. Furthermore, anxiety and depressive symptom severity were similarly strongly correlated with the STAI-T (mean r = .59 - .61). However, individuals with a depressive disorder had significantly higher STAI-T scores than individuals with an anxiety disorder (Hedges's g = 0.27). Given these findings, along with previous factor analyses that have observed a depression factor on the STAI-T, describing the scale as a measure of 'trait anxiety' may be a misnomer. It is proposed that the STAI-T be considered a non-specific measure of negative affectivity rather than trait anxiety per se.

A spatial analysis of climate gentrification in Orleans Parish, Louisiana post-Hurricane Katrina

BACKGROUND

Hurricane Katrina made landfall in New Orleans, Louisiana as a Category 3 storm in August 2005. Storm surges, levee failures, and the low-lying nature of New Orleans led to widespread flooding, damage to over 70% of occupied housing, and evacuation of 80-90% of city residents. Only 57% of the city's black population has returned. Many residents complain of gentrification following rebuilding efforts. Climate gentrification is a recently described phenomenon whereby the effects of climate change, most notably rising sea levels and more frequent flooding and storm surges, alter housing values in a way that leads to gentrification.

OBJECTIVE

To examine the climate gentrification following hurricane Katrina by (1) estimating the associations between flooding severity, ground elevation, and gentrification and (2) whether these relationships are modified by neighborhood level pre- and post-storm sociodemographic factors.

METHODS

Lidar data collected in 2002 were used to determine elevation. Water gauge height of Lake Ponchartrain was used to estimate flood depth. Using census tracts as a proxy for neighborhoods, demographic, housing, and economic data from the 2000 decennial census and the 2010 and 2015 American Community Survey 5-year estimates US Census records were used to determine census tracts considered eligible for gentrification (median income < 2000 Orleans Parish median income). A gentrification index was created using tract changes in education level, population above the poverty limit, and median household income. Proportional odds ordinal logistic regression was used with product terms to test for effect measure modification by sociodemographic factors.

RESULTS

Census tracts eligible for gentrification in 2000 were 80.2% black. Median census tract flood depth was significantly lower in areas eligible to undergo gentrification (0.70 m vs. 1.03 m). Residents of gentrification-eligible tracts in 2000 were significantly more likely to be black, less educated, lower income, unemployed, and rent their home rather than own. In 2015 in these same eligible tracts, areas that underwent gentrification became significantly whiter, more educated, higher income, less unemployed, and more likely to live in a multi-unit dwelling. Gentrification was inversely associated with flood depth and directly associated with ground elevation in eligible tracts. Marginal effect modification was detected by the effect of pre-storm black race on the relationships of flood depth and elevation with gentrification.

CONCLUSIONS

Gentrification was strongly associated with higher ground elevation in New Orleans. These results provide evidence to support the idea of climate gentrification described in other low-elevation major metropolitan areas like Miami, FL. High elevation, low-income, demographically transitional areas in particular - that is areas that more closely resemble high-income area demographics, may be vulnerable to future climate gentrification.

Coping Strategies and Psychological Symptoms Among Children on St. Thomas in the Aftermath of Hurricanes Irma and Maria

Research has shown that experiencing a hurricane can lead to internalizing, externalizing, and posttraumatic stress (PTS) symptoms in children. However, the effects of experiencing two hurricanes within a short time frame have not been examined. Moreover, there is limited research examining how children's coping is linked to their psychological functioning and no research using the empirically supported conceptualization of coping that includes primary control coping (i.e., attempts to control the stressor) and secondary control coping (i.e., attempts to adapt to the stressor). This study examined the psychological functioning of 108 children and adolescents (69.7% Black, Non-Hispanic; 56.5% female; M age = 11.59 years, SD = 2.43) in Grades 3-12 as measured 3 months after experiencing Hurricanes Irma and Maria on the island of St. Thomas. Participants completed electronic questionnaires about their demographic characteristics, hurricane exposure (i.e., perceived life-threat, life-threatening events, loss/disruption after hurricanes), coping strategies utilized, and their psychological functioning (i.e., PTS, internalizing, and externalizing symptoms). A principal component analysis of the coping items determined four coping factors: primary control, secondary control, disengagement, and negative coping. Linear regressions, including children's age and aspects of hurricane exposure, found primary control coping was positively associated with PTS symptoms, β = .18, whereas secondary control coping was negatively associated with PTS and externalizing symptoms, βs = -.17 and -.19, respectively. Negative coping, but not disengagement coping, was positively associated with all three outcomes, βs = .31-.42. These findings suggest positive ways children can cope after experiencing a hurricane, informing possible early intervention efforts.

Overview of Children and Disasters

Currently, throughout the world, there are nearly 40 million children displaced by natural or man-made disasters. The special needs of children in disasters are often unrecognized, yet children comprise half of disaster victims. The purpose of this review is to provide information on (1) demographics related to children and disasters, both domestic and international; (2) risks for children who experience disasters; (3) programs that help children in disasters; and (4) training programs on the special needs of children in disasters. Children who are displaced by disasters are at risk of acute and long-term medical problems. Disaster experiences can also lead to acute and long-term psychological problems. Ultimately, these have worldwide negative implications for human society, including education, health care, security, and economic and political aspects of daily life. There is a compelling need for more services to help the children who have experienced disasters and for education to train more relief workers about the special needs of children in disasters.

Inhibited Personality Temperaments Translated Through Enhanced Avoidance and Associative Learning Increase Vulnerability for PTSD

Although many individuals who experience a trauma go on to develop post-traumatic stress disorder (PTSD), the rate of PTSD following trauma is only about 15-24%. There must be some pre-existing conditions that impart increased vulnerability to some individuals and not others. Diathesis models of PTSD theorize that pre-existing vulnerabilities interact with traumatic experiences to produce psychopathology. Recent work has indicated that personality factors such as behavioral inhibition (BI), harm avoidance (HA), and distressed (Type D) personality are vulnerability factors for the development of PTSD and anxiety disorders. These personality temperaments produce enhanced acquisition or maintenance of associations, especially avoidance, which is a criterion symptom of PTSD. In this review, we highlight the evidence for a relationship between these personality types and enhanced avoidance and associative learning, which may increase risk for the development of PTSD. First, we provide the evidence confirming a relationship among BI, HA, distressed (Type D) personality, and PTSD. Second, we present recent findings that BI is associated with enhanced avoidance learning in both humans and animal models. Third, we will review evidence that BI is also associated with enhanced eyeblink conditioning in both humans and animal models. Overall, data from both humans and animals suggest that these personality traits promote enhanced avoidance and associative learning, as well as slowing of extinction in some training protocols, which all support the learning diathesis model. These findings of enhanced learning in vulnerable individuals can be used to develop objective behavioral measures to pre-identify individuals who are more at risk for development of PTSD following traumatic events, allowing for early (possibly preventative) intervention, as well as suggesting possible therapies for PTSD targeted on remediating avoidance or associative learning. Future work should explore the neural substrates of enhanced avoidance and associative learning for behaviorally inhibited individuals in both the animal model and human participants.

Longitudinal cross-lagged relationships between mindfulness, posttraumatic stress symptoms, and posttraumatic growth in adolescents following the Yancheng tornado in China

Treatment of posttraumatic stress symptoms and facilitation of posttraumatic growth are two encouraging areas of research, yet little is understood about the relationships between trait mindfulness, posttraumatic stress symptoms, and posttraumatic growth. Previous work suggests the linkages among these variables, but most studies have been conducted in adult samples. The aim of this study was to examine longitudinal cross-lagged relationships between mindfulness, posttraumatic stress symptoms, and posttraumatic growth among adolescent survivors of the 2016 Jiangsu tornado in China. Data was collected at two secondary schools located in Yancheng city, where the severe catastrophic damage occurred during the tornado. The sample included 247 adolescent survivors (59.5% girls) aged 12-14 years who were directly affected by the tornado. Participants self-reported their trait mindfulness, posttraumatic stress symptoms, and posttraumatic growth at two time points: 6-month (T1) and 9-month post-tornado (T2; attrition rate 17.4%). Cross-lagged structural equation modelling analyses were conducted. Results showed that posttraumatic stress symptoms at T1 significantly predicted reduced trait mindfulness at T2 but not posttraumatic growth; trait mindfulness at T1 did not significantly predict posttraumatic stress symptoms nor posttraumatic growth at T2; and posttraumatic growth at T1 did not predict trait mindfulness nor posttraumatic stress symptoms at T2. These findings suggested that posttraumatic stress symptoms may negatively influence the development of trait mindfulness in disaster-affected adolescents in China, and that posttraumatic growth may have unique implications for this young population which was not associated with posttraumatic stress symptoms or trait mindfulness.

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.

Post traumatic stress disorder among school children of Army Public School Peshawar after Six month of terrorists attack

Background & Objectives:

Terrorist attack in Army Public School Peshawar, Pakistan left behind more than hundred children dead. It was the highest death toll of children in the world in a single terrorists attack. The attack dominated national and international news, high level security measures have been adopted in all school throughout Pakistan, which created fear and stress in children. The objective of the study was to determine post-traumatic stress disorder among children after six month of terrorist attack inspite of rigorous psychosocial support and rehabilitation.

Methods:

We wanted to determine Post Traumatic Stress Disorder (PTSD) among children of Army Public School of age range 10 to 18 years after 5 months of intervention and rehabilitation following terrorists attack. For this a self-report questionnaire, Child PTSD Symptom Scale (CPSS), which assess and identify symptoms matching DSM (Diagnostic and Statistical Manual of Mental Disorders) IV criteria for post-traumatic stress disorder of children, was filled. Informed consent was taken from school Principal and responders.

Results:

A total 205 students of age range 10 to 18 years participated in the study. The most frequent age group of the study were 16 years and 14 years students with frequency 58 (28.3%) and 46 (22.4%) respectively. Among 205 participated school children PTSD were found in 154 (75.2%) children while only 24.8% students had no PTSD symptoms. In more than 50% PTSD positive school children had functional impairment for each category of fun and hobbies, friendship, school work, family relation, doing chores, general happiness and saying prayers.

Conclusion:

Study found a very high prevalence of PTSD among 10 to 18 years age group students of Army Public School inspite of five months continuous intervention and rehabilitation services. Study showed that this age group needs long term psychosocial treatment in case of trauma.

Mental health in Syrian children with a focus on post-traumatic stress: a cross-sectional study from Syrian schools

PURPOSE

Studies show that conflict can negatively affect psychological health. The Syrian crisis is 8 years old and yet little is known about the impact of the conflict on the well-being of Syrians who remain. This gap was addressed by conducting an empirical study on the mental health burden of Syrian children in two areas of the country.

METHODS

492 children between 8 and 15 years were randomly selected from schools in Damascus and Latakia. The incidence of psychological disorder symptoms was measured using self-report screening instruments, the Children's Revised Impact of Event Scale (CRIES-8) and the Revised Children's Anxiety and Depression Scale (RCADS-25). Simultaneously, sociodemographic and traumatic event information was collected. Binary logistic regression was used to identify factors that influence the development of post-traumatic stress disorder (PTSD) symptoms.

RESULTS

In our sample, 50.2% of students were internally displaced and 32.1% reported a negative experience. 60.5% of those tested had at least one probable psychological disorder with PTSD the most common (35.1%), followed by depression (32.0%), and anxiety (29.5%). Binary logistic regression indicated that PTSD symptoms were predicted by: living in Damascus [odds ratio (OR) 2.36, 95% confidence interval (CI) 1.51-3.69], being female (1.54, 1.02-2.34), having depression and anxiety (2.55, 1.48-4.40), and the negative experiences; displacement and daily warzone exposure (1.84, 1.02-3.30 and 2.67, 1.08-6.60).

CONCLUSIONS

Syrian children are experiencing traumatic events and war-associated daily stresses that are hugely impacting psychological well-being. Our data offer guidance for mental health providers regarding risk factors and highlights the use of the school system to reach suffering children.

Relationship between Problematic Internet Use and Post-Traumatic Stress Disorder Symptoms among Students Following the Sewol Ferry Disaster in South Korea

We investigated the association between problematic internet use (PIU) and post-traumatic stress disorder (PTSD) symptoms in children and adolescents in South Korea. A cross-sectional survey was administered to community students who attended primary, secondary, and high schools in the Jindo area 1-2.5 months after the Sewol ferry disaster. Of the 1,744 respondents, 392 students who were exposed to the disaster, witnessing the rescue work directly, were evaluated. PTSD symptoms were measured using the University of California Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD-RI). The severity of impairment caused by excessive internet use was evaluated using Young's Internet Addiction Test. The Center for Epidemiological Studies Depression Scale (CES-D) and State Anxiety Inventory for Children (SAIC) were also used. Logistic regression analysis revealed that PIU was significantly and independently associated with a high level of PTSD symptoms. Our findings suggest that children and adolescents with PIU require intensive follow-up and special care to prevent the development of PTSD symptoms following a disaster.

Superstorm Sandy and the academic achievement of university students

Much of the literature on the consequences of natural disasters has focused on their physical and psychological ramifications. Few researchers have considered how the impacts of a natural disaster can influence academic achievement. This study analyses data collected from nearly 300 students at a mid-sized, private university in the northeast United States to determine if the effects of Cyclone Sandy in 2012 are associated with measures of academic achievement. The findings reveal that experiencing headaches after the event resulted in a higher likelihood of students suffering a loss of academic motivation. In addition, experiencing headaches and a loss of academic motivation were correlated with a lower grade point average (GPA) during the semester in which Sandy made landfall. However, the more direct effects of the superstorm, including displacement and a loss of power, did not have a significant bearing on academic achievement. Lastly, the paper examines the implications for higher education policy and future research.

School-Based Disaster Recovery: Promotion of Children's Mental Health Over the Long Haul

The February 2010 earthquake and tsunamis destroyed 80% of the coastal town of Dichato, Chile, displacing over 400 families for nearly 4 years. The coalition Recupera Chile (RC) participated in the town's integrated recovery process from January 2011 to the present with a focus on children's mental health. The multidisciplinary RC coalition emphasized community-led post-disaster recovery, economic capacity rebuilding, and community health promotion (www.recuperachile.org). RC's child health team fostered partnerships between the local elementary school, health clinic, Universidad de Concepcion, and Boston Children's Hospital. The team responded to priorities identified by the town with a three-pronged approach of (1) case management, (2) resource development, and (3) monitoring and evaluation. This work resulted in the development of a model school-based program: La Escuela Basada en Realidad, which encompassed (1) health and mental health, (2) language and literacy, and (3) love of the sea. Post-disaster programs targeting mental health require a multi-year approach that extends beyond the completion of the physical reconstruction. Recovery is an organic process that cannot be prescripted and depends on solutions that emerge from the community. Finally, partnerships between schools and universities can foster resiliency and sustainability of programs for children and families. (Disaster Med Public Health Preparedness. 2017;11:633-636).

Neural Reactivity to Emotional Stimuli Prospectively Predicts the Impact of a Natural Disaster on Psychiatric Symptoms in Children

BACKGROUND

Natural disasters expose entire communities to stress and trauma, leading to increased risk for psychiatric symptoms. Yet, the majority of exposed individuals are resilient, highlighting the importance of identifying underlying factors that contribute to outcomes.

METHODS

The current study was part of a larger prospective study of children in Long Island, New York (n = 260). At age 9, children viewed unpleasant and pleasant images while the late positive potential (LPP), an event-related potential component that reflects sustained attention toward salient information, was measured. Following the event-related potential assessment, Hurricane Sandy, the second costliest hurricane in United States history, hit the region. Eight weeks after the hurricane, mothers reported on exposure to hurricane-related stress and children's internalizing and externalizing symptoms. Symptoms were reassessed 8 months after the hurricane.

RESULTS

The LPP predicted both internalizing and externalizing symptoms after accounting for prehurricane symptomatology and interacted with stress to predict externalizing symptoms. Among children exposed to higher levels of hurricane-related stress, enhanced neural reactivity to unpleasant images predicted greater externalizing symptoms 8 weeks after the disaster, while greater neural reactivity to pleasant images predicted lower externalizing symptoms. Moreover, interactions between the LPP and stress continued to predict externalizing symptoms 8 months after the hurricane.

CONCLUSIONS

Results indicate that heightened neural reactivity and attention toward unpleasant information, as measured by the LPP, predispose children to psychiatric symptoms when exposed to higher levels of stress related to natural disasters, while greater reactivity to and processing of pleasant information may be a protective factor.

"That was the Last Time I Saw my House": The Importance of Place Attachment among Children and Youth in Disaster Contexts

Place attachment is important for children and youth's disaster preparedness, experiences, recovery, and resilience, but most of the literature on place and disasters has focused on adults. Drawing on the community disaster risk reduction, recovery, and resilience literature as well as the literature on normative place attachment, children and youth's place-relevant disaster experiences are examined. Prior to a disaster, place attachments are postulated to enhance children and youth's disaster preparedness contributions and reinforce their pre-disaster resilience. During a disaster, damage of, and displacement from, places of importance can create significant emotional distress among children and youth. Following a disaster, pre-existing as well as new place ties can aid in their recovery and bolster their resilience moving forward. This framework enriches current theories of disaster recovery, resilience, and place attachment, and sets an agenda for future research.

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).

Secondary Losses in Bereaved Children when Both Parents have Died: A Case Study

The death of a child's parent engenders many primary and secondary losses. In this article, a case study is used to examine secondary losses for two children following the sudden deaths of their parents. Childhood bereavement is described as comprised of prolonged pain, gradual acclimation, and tainted experiences. The framework is used to understand primary and secondary losses, as well as the effects of secondary losses and lack of control on the process of childhood bereavement. In this case, secondary losses, especially isolation, exacerbated the bereavement processes of these children. It is proposed that anticipating secondary losses, and minimizing them when possible, perhaps by providing bereaved children more control, is an appropriate framework for intervening with parentally bereaved children.

Posttraumatic stress symptoms, co-morbid psychiatric symptoms and distorted cognitions among flood victims of different ages

BACKGROUND

In literature, the effect of age on posttraumatic stress disorder (PTSD) is inconclusive; the effect on flood-related PTSD is particularly unclear. Little is known on distorted cognitions among flood victims, although cognition distortions and PTSD have been linked among victims of other traumas.

AIMS

To investigate: (1) whether flood-related PTSD, psychiatric co-morbidity and cognitive distortions would differ according to age and (2) distinctive patterns of association between the preceding variables for different age groups.

METHODS

One hundred and fifty-four flood victims of different ages completed standardized questionnaires measuring PTSD, psychiatric co-morbidity and cognitive distortions.

RESULTS

Adolescents and young adults reported significantly fewer PTSD, psychiatric co-morbidity and distorted cognition symptoms than people who were older. Preoccupation with danger and hopelessness were associated with both outcomes for adolescents, people in their thirties and middle-aged/older people. For young adults, helplessness was associated with PTSD; hopelessness and preoccupation with danger with psychiatric co-morbidity.

CONCLUSIONS

Adolescents and young adults buffered against flood-related psychological distress better than older people. Distorted cognitions related to distress outcomes differently depending on age.

The effects of relocation and level of affectedness on mood and anxiety symptom treatments after the 2011 Christchurch earthquake

In this longitudinal study, we compare the effects of different types of relocation and level of affectedness on the incidence and relapse of mood and anxiety symptom treatments identified by publicly funded care or treatment one year before and one and two years after the '2011 Christchurch earthquake' in New Zealand. Based on a subset of Christchurch residents from differently affected areas of the city identified by area-wide geotechnical land assessments (no to severe land damage) 'stayers', 'within-city movers', 'out-of-city movers' and 'returners' were identified to assess the interaction effect of different levels of affectedness and relocation on the incidence and relapse of mood and anxiety symptom treatments over time. Health and sample information were drawn from the New Zealand Ministry of Health's administrative databases allowing us to do a comparison of the pre-/post-disaster treatment status and follow-up on a large study sample. Moving within the city and returning have been identified as general risk factors for receiving care or treatment for mood or anxiety symptoms. In the context of the 2011 Christchurch earthquake, moving within the city showed a protective effect over time, whereas returning was a significant risk factor in the first post-disaster year. Additionally, out-of-city movers from minor, moderately or severely damaged Christchurch's plain areas were identified as especially vulnerable two years post-disaster. Generally, no dose-response relationship between level of affectedness and mood or anxiety symptom treatments was identified, but the finding that similarly affected groups from the city's plain areas and the more affluent Port Hills showed different temporal treatment trends highlights the importance of including socio-economic status in exposure assessment. High-risk groups included females, older adults and those with a pre-existing mental illness. Consequently, mental health intervention programs should target these vulnerable groups, as well as out-of-city movers from affected areas in the long run.

Mental Health Among Adolescents Exposed to a Tornado: The Influence of Social Support and Its Interactions With Sociodemographic Characteristics and Disaster Exposure

Approximately 25% of youths experience a natural disaster and many experience disaster-related distress, including symptoms of posttraumatic stress disorder (PTSD) and depression. This study contributes to the literature by examining PTSD and depressive symptoms among 2,000 adolescents (50.9% female, 70.5% White) assessed after exposure to tornadoes in 2011. The authors hypothesized that greater tornado exposure, female sex, and younger age would be associated with distress, and that social support would interact with these associations. Analyses showed that PTSD symptoms were associated with lower levels of social support (β = -.28, p < .001), greater tornado exposure (β = .14, p < .001), lower household income (β = -.06, p = .013, female sex (β = -.10, p < .001), and older age (β = .07, p = .002), with a 3-way interaction between tornado exposure, sex, and social support (β = -.06, p = .017). For boys, the influence of tornado exposure on PTSD symptoms increased as social support decreased. Regardless of level of tornado exposure, low social support was related to PTSD symptoms for girls; depressive symptom results were similar. These findings were generally consistent with the literature and provide guidance for intervention development focused on strengthening social support at the individual, family, and community levels.

Testing the validity and reliability of the shame questionnaire among sexually abused girls in Zambia

Purpose

The aim of the current study is to test the validity and reliability of the Shame Questionnaire among traumatized girls in Lusaka, Zambia.

Methods

The Shame Questionnaire was validated through both classical test and item response theory methods. Internal reliability, criterion validity and construct validity were examined among a sample of 325 female children living in Zambia. Sub-analyses were conducted to examine differences in construct validity among girls who reported sexual abuse and girls who did not.

Results

All girls in the sample were sexually abused, but only 61.5% endorsed or reported that sexual abuse had occurred. Internal consistency was very good among the sample with alpha = .87. Criterion validity was demonstrated through a significant difference of mean Shame Questionnaire scores between girls who experienced 0–1 trauma events and more than one traumatic event, with higher mean Shame Questionnaire scores among girls who had more than one traumatic event (p = .004 for 0–1 compared to 2 and 3 events and p = .016 for 0–1 compared to 4+ events). Girls who reported a history of witnessing or experiencing physical abuse had a significantly higher mean Shame Questionnaire score than girls who did not report a history of witnessing or experiencing physical abuse (p<.0001). There was no significant difference in mean Shame Questionnaire score between girls who reported a sexual abuse history and girls who did not. Exploratory factor analysis indicated a two-factor model of the Shame Questionnaire, with an experience of shame dimension and an active outcomes of shame dimension. Item response theory analysis indicated adequate overall item fit. Results also indicate potential differences in construct validity between girls who did and did not endorse sexual abuse.

Conclusions

This study suggests the general utility of the Shame Questionnaire among Zambian girls and demonstrates the need for more psychometric studies in low and middle income countries.

Does exposure type impact differentially over time on the development of mental health disturbances after a technological disaster?

Background

A longitudinal study was conducted in order to assess the impact of the Ghislenghien disaster (July 30th, 2004) on physical, mental and social health in the affected population. The present study explored the risk for the development of four types of mental health disturbances (MHD) due to exposure to different aspects of this technological disaster in comparison with data obtained from previous health surveys among the population of the same province.

Methods

Surveys were conducted 5 months (T1) and 14 months (T2) after the disaster. Potential adult victims (≥15 years) were included (n = 1027 and 579 at T1 and T2 respectively). The “Symptom Checklist-90-Revised” (SCL-90-R) has been used in order to compute actual prevalence rates of somatization-, depression-, anxiety- and sleeping disturbances for three defined exposure categories: direct witnesses who have seen human damage (SHD), direct witnesses who have not seen human damage (NSHD) and indirect witnesses (IW). Those prevalence rates were compared with overall rates using the inhabitants of the province of Hainaut (n = 2308) as reference population. A mental health co-morbidity index was computed. Relative risks were estimated using logistic regression models.

Results

Prevalence rates of the four MHD were much higher for the SHD than for the other exposure groups, at T1 and T2. Moreover, NSHD and IW had no increased risk to develop one of the 4 types of MHD compared to the reference population. The SHD had at T1 and T2 good 5-times a higher risk for somatization, about 4-times for depression and sleeping disorders, and 5- to 6-times for anxiety disorders respectively. Further, they suffered 13 times, respectively 17 times more from all mental disorders together.

Conclusions

The present study calls attention to the fact that mental health problems disturbances are significantly more prevalent and long-lasting among survivors who have directly been exposed to human damage.

Flooding and schools: experiences in Hull in 2007

Hull, a city in the East Riding of Yorkshire, United Kingdom, suffered severe flooding in June 2007, affecting some 8,600 households and most schools. Despite the potential for damage in such disasters, no studies of the effects of floods on teachers and schools in the UK appear to have been published previously. This study analysed the impacts of the floods on teachers in Hull in two stages: first through correspondence with Hull City Council and a mailed questionnaire to 91 head teachers of primary, secondary, and special schools; and second, through in-depth interviews with head teachers from six flooded schools, representing different degrees of flood experience, and a questionnaire completed by eight teachers from the same schools. The findings reveal the importance and the complexity of the role of the school in the wider community in a time of crisis. The study highlights issues concerning preparedness for floods, support for schools, and flood protection for schools.

Resilience and trajectories of posttraumatic stress among youth exposed to disaster

OBJECTIVE

Multiple trajectories of posttraumatic stress (PTS) symptoms are hypothesized following disaster in a number of theoretical perspectives. Increasingly, those with rapidly declining, transient, or stable low symptoms are defined as resilient. This article examines trajectories to understand acute reactions to disaster, and explores the need to define resilience as more than just symptom trajectories.

METHODS

An urban school-based sample of youth exposed to both hurricanes Katrina and Gustav (n=141; grades 4 through 8) were assessed for PTS symptoms at 12 months and 6 months pre-Gustav (Times 1 and 2); and then again at 1 month post-Gustav (Time 3).

RESULTS

Data indicated that there were significant decreases in mean PTS symptoms post-Gustav, but individual trajectories were identified consistent with theory. Whereas an ostensibly resilient group was identified (stable low symptoms), results suggest that the group was heterogeneous in terms of disaster experiences, and that those with low symptoms but relatively high Katrina disaster exposure had a unique coping style.

CONCLUSIONS

Results provide prospective data to support theories of multiple trauma exposure trajectories, and highlight the importance of empirically identifying resilient youth in terms of both functioning and level of risk exposure in disaster samples.

Children's Coping in the Context of Disasters and Terrorism

Disasters and terrorism present significant and often overwhelming challenges for children and families worldwide. Individual, family, and social factors influence disaster reactions and the diverse ways in which children cope. This article links conceptualizations of stress and coping to empirical knowledge of children's disaster reactions, identifies limitations in our current understanding, and suggests areas for future study of disaster coping. Coping strategies, developmental trajectories influencing coping, and the interplay between parent and child coping represent critical areas for advancing the field and for informing programs and services that benefit children's preparedness and foster resilience in the face of mass trauma.

Risk factors predicting posttraumatic stress reactions in adolescents after 2011 Van earthquake

OBJECTIVE

Our aims were to investigate the prevalence of PTSD, depression, anxiety-related disorders, and dissociative symptomotology, and to assess the risk factors for development of psychopathology among children and adolescents after the 2011 Van earthquake in Turkey.

METHODS

The screening was conducted among 738 participants at 6months post-earthquake using the CPTSD-Reaction Index, State and Trait Anxiety Inventory for Children, Screen for Child Anxiety Related Emotional Disorders, Child Depression Inventory, Childhood Anxiety Sensitivity Index, Metacognitions Questionnaire for Children, and Adolescent Dissociative Experiences Scale.

RESULTS

Less than half (40.69% of) of the participants reported severe levels of PTSD symptoms, 53.04% were at greater risk for developing an anxiety-related disorder, 37.70% met the criteria for clinical depression, and 36.73% revealed pathological levels of dissociative symptomotology. State-trait anxiety, and anxiety sensitivity were significant antecedents of psychopathology.

CONCLUSION

We concluded that anxiety sensitivity is a significant risk factor in various types of psychopathology, but metacognitions seem to have a limited utility in accounting for poor psychological outcomes in young survivors of earthquake.

The effect of long-term relocation on child and adolescent survivors of Hurricane Katrina

The current study is designed to increase knowledge of the effects of relocation and its association with longer-term psychological symptoms following disaster. Following clinical observations and in discussions held with school officials expressing concerns about relocated students, it was hypothesized that students who relocated to a different city following Hurricane Katrina in 2005 would have more symptoms of posttraumatic stress compared to students who returned to New Orleans. The effect of Hurricane Katrina relocation was assessed on a sample of child and adolescent survivors in 5th through 12th grades (N = 795). Students with Orleans Parish zip codes prior to Hurricane Katrina were categorized into relocation groupings: (a) relocated to Baton Rouge, (b) returned to prior zip code, and (c) moved to a different zip code within Orleans Parish. Overall results revealed more trauma symptoms for relocated students. Results also revealed that younger relocated students had fewer symptoms compared to older students. The opposite was found for students who returned to their same zip code, with older students having fewer symptoms. This study supports the need for school-based services not only in disaster areas, but also in schools where survivors tend to migrate.

A theoretical model of continuity in anxiety and links to academic achievement in disaster-exposed school children

This study tested a theoretical model of continuity in anxious emotion and its links to academic achievement in disaster-exposed youth. An urban school based sample of youths (n = 191; Grades 4–8) exposed to Hurricane Katrina were assessed at 24 months (Time 1) and then again at 30 months (Time 2) postdisaster. Academic achievement was assessed through end of the school year standardized test scores (~31 months after Katrina). The results suggest that the association of traumatic stress to academic achievement was indirect via linkages from earlier (Time 1) posttraumatic stress disorder symptoms that predicted later (Time 2) test anxiety. Time 2 test anxiety was then negatively associated with academic achievement. Age and gender invariance testing suggested strong consistency across gender and minor developmental variation in the age range examined. The model presented advances the developmental understanding of the expression of anxious emotion and its links to student achievement among disaster-exposed urban school children. The findings highlight the importance of identifying heterotypic continuity in anxiety and suggest potential applied and policy directions for disaster-exposed youth. Avenues for future theoretical refinement are also discussed.

Predictors of acute stress disorder severity

BACKGROUND

The DSM-IV diagnosis of acute stress disorder (ASD) describes a posttraumatic reaction that occurs two to twenty-eight days following a trauma and involves symptoms of intrusion, avoidance, hyper-arousal and dissociation. A better understanding of ASD and its pathogenesis could lead to improved post-trauma health care interventions. The aim of this study was to determine prospectively whether a combination of clinical, cognitive and demographic variables were predictive of ASD severity in an acutely traumatized sample.

METHODS

We assessed demographic (e.g. age, gender, education), clinical (e.g. sleep quality, trait anxiety, previous psychiatric diagnoses), and cognitive (e.g. negative cognitions following trauma) variables in a sample of 125 adult motor vehicle accident survivors (age: 32.26±9.99; gender: 56.6% male) approximately 10 days after the accident. Univariate analyes and stepwise linear regression were performed to identify variables predictive of ASD severity.

RESULTS

Although a number of factors were individually associated with ASD severity, in a regression model only 3 factors, trait anxiety, suicide risk and post-traumatic cognitions, emerged as predictive of the severity of the disorder.

LIMITATIONS

The cross-sectional nature of the study and use of self-report measures are important to bear in mind.

CONCLUSIONS

Higher levels of trait anxiety, risk for suicide and negative appraisals of the traumatic event were predictive of ASD severity. As these factors may help to identify those who may be at risk of more severe responses after a traumatic event, and who may benefit from secondary prevention strategies, they should be assessed for in acute trauma survivors.

Characteristics of Wenchuan earthquake victims who remained in a government-supported transitional community

INTRODUCTION

The Chinese government and provincial authorities built a large number of temporary communities to shelter survivors after the May 2008 Wenchuan earthquake. Most residents left within a few months but others remained. This study describes the characteristics and psychological status of those victims who remained in a government-supported transitional community 12 months post-earthquake compared to residents who departed prior to that time.

METHODS

Two groups of survivors of Wenchuan earthquake who resided in a transitional community were enrolled: 86 in December 2008 and 151 in February 2009. We assessed their mental distress, symptoms of depression and post-traumatic stress disorder and suicide risk. Forty-three and 46 members of the two groups, respectively, had departed the transitional community at 1 year post-earthquake.

RESULTS

In both groups, most of the survivors who remained in the community 1 year post-earthquake were older, female, with a lower education level and more serious personal losses. They had scored higher on self-report measures reflecting distressing symptoms and impairment as compared with their departed neighbors, and had a higher prevalence of depression and suicide risk at the time of enrollment.

DISCUSSION

Survivors who come to live in a transitional community following a disaster are heterogeneous. Remaining survivors were apparently more vulnerable and had a lower capacity to seek work and return to a more self-sustaining life outside the transitional community. Such vulnerable survivors require distinctive strategies for making a successful return to independent living.

Children's Postdisaster Trajectories of PTS Symptoms: Predicting Chronic Distress

BACKGROUND

There are no studies of the distinct trajectories of children's psychological distress over the first year after a destructive natural disaster and the determinants of these trajectories.

OBJECTIVE

We examined these issues using an existing dataset of children exposed to Hurricane Andrew, one of the most devastating natural disasters in US history.

METHODS

At 3-months postdisaster, 568 children (55 % girls; grades 3-5) residing in areas most directly affected by the hurricane completed measures of hurricane exposure and stressors, social support, coping, and general anxiety. Children also reported major life events occurring since the hurricane (at 7-months) and posttraumatic stress (PTS) symptoms at 3-, 7-, and 10-months postdisaster.

RESULTS

Latent growth mixture modeling identified three trajectories of PTS reactions: resilient (37 %), recovering (43 %), and chronic distress (20 %). Predictors of the trajectories were examined. Odds ratios indicated that, compared to the resilient trajectory, girls were more likely to be in the recovering and chronically distressed trajectories, as were children reporting higher anxiety and greater use of coping strategies that reflected poor emotion regulation. Compared to the recovering trajectory, children in the chronically distressed trajectory had greater odds of reporting high anxiety, less social support, more intervening life events, and greater use of poor emotion regulation strategies.

CONCLUSIONS

Hurricane exposure may be less effective in identifying children who develop chronic postdisaster distress than other child (anxiety, coping) and contextual variables (social support, life events). Effective screening after disasters is critical for identifying youth most in need of limited clinical resources.

Does a non-destructive earthquake cause posttraumatic stress disorder? A cross-sectional study

This study evaluated the prevalence and symptoms of posttraumatic stress disorder (PTSD) among adolescents who experienced non-destructive, moderate magnitude earthquake. Four hundred and fifty students (214 girls and 236 boys between the ages of 12-14) were selected from secondary schools located within Konya province in Turkey, 6 months after the earthquake. They were chosen to participate in this cross-sectional study by simple random sampling. The students were evaluated by the child posttraumatic stress reaction index. Of all the students, we found that 3.5% had very severe, 20.8% had severe, 28.4% had moderate and 20% had mild symptoms of PTSD and that 24.3% had probable PTSD diagnoses. The most common PTSD symptoms were trauma-related fears, social avoidance, emotional detachment and the concentration difficulty. Limitations and implications for research studies are included in the discussion.

Academic Effects of the Prestige Oil Spill Disaster

The effect of a large scale oil spill disaster on the academic achievement and classroom behavior of children and adolescents who lived on the Galician coast (Spain) is studied from an ecological perspective. 430 participants divided into three age groups of 5, 10, and 15 years of age, were studied. The participants came from three areas differently affected by the disaster. Dependent variables were academic achievement and classroom behavior of the participants after the Prestige disaster. Degree of exposure and other protective or risk factors were investigated as well. Repeated measures ANOVA to assess the main effects of the oil spill and hierarchical regression analyses to assess the contribution of the protective/vulnerability factors were performed.

The results indicate that the effects of the disaster were relatively scarce. Some protective factors accounted for a certain degree of variance of different schoolroom behaviors. These results point to the intervention of protective factors in the adaptation to the disaster.

Predicting Mothers' Reports of Children's Mental Health Three Years after Hurricane Katrin

This study explored pathways through which hurricane-related stressors affected the psychological functioning of elementary school aged children who survived Hurricane Katrina. Participants included 184 mothers from the New Orleans area who completed assessments one year pre-disaster (Time 1), and one and three years post-disaster (Time 2 and Time 3, respectively). Mothers rated their children's behavior problems at Time 3 only (n = 251 children; 53.0% male; Mean age: 10.19 years, SD = 1.68 years). A path analytic model indicated that hurricane-related stressors were associated with increased maternal psychological distress and school mobility in the first post-disaster year, which were associated with higher child internalizing and externalizing symptoms three years post-disaster. Mediation analysis indicated that hurricane-related stressors were associated with child symptoms indirectly, through their impact on maternal psychological distress. Findings underscore the importance of interventions that boost maternal and child mental health and support children through post-disaster school transitions.

Posttraumatic stress disorder in children and adolescents: neuroendocrine perspectives

Posttraumatic stress disorder (PTSD) is a syndrome of distress that develops after exposure to traumatic life experiences. Dysregulation of both the hypothalamic-pituitary-adrenal (HPA) axis and the locus caeruleus/norepinephrine-sympathetic nervous system (LC/NE-SNS) is associated with the pathophysiology of the disorder. Studies have demonstrated a neuroendocrine profile unique to adults with PTSD, with centrally elevated corticotropin-releasing hormone (CRH), low cortisol in the periphery, and elevated catecholamines. Traumatic stress experiences in early life are strong predisposing factors for later PTSD development. In addition, early life stress programs the developing brain to overreact to future stressors. In children and adolescents involved in motor vehicle accidents, we found that high evening salivary cortisol and morning serum interleukin 6 concentrations were predictive of PTSD development 6 months later. We demonstrated a progressive divergence of the HPA and LC/NE-SNS axes of the stress system, which may be part of the pathophysiologic mechanism responsible for PTSD maintenance. An initial elevation of cortisol in the aftermath of the trauma, followed by a gradual normalization and finally low cortisol secretion, together with a gradual elevation of catecholamines over time, may represent the natural history of neuroendocrine changes in pediatric PTSD. Thus, the low cortisol concentrations found in adults with PTSD may reflect prior trauma and might represent a biologic vulnerability factor for later PTSD development.

Framework for research on children's reactions to disasters and terrorist events

Clinical work and research relative to child mental health during and following disaster are especially challenging due to the complex child maturational processes and family and social contexts of children's lives. The effects of disasters and terrorist events on children and adolescents necessitate diligent and responsible preparation and implementation of research endeavors. Disasters present numerous practical and methodological barriers that may influence the selection of participants, timing of assessments, and constructs being investigated. This article describes an efficient approach to guide both novice and experienced researchers as they prepare to conduct disaster research involving children. The approach is based on five fundamental research questions: "Why?, Who?, When?, What?, and How?" Addressing each of the "four Ws" will assist researchers in determining "How" to construct and implement a study from start to finish. A simple diagram of the five questions guides the reader through the components involved in studying children's reactions to disasters. The use of this approach is illustrated with examples from disaster mental health studies in children, thus simultaneously providing a review of the literature.