Relocation after a disaster: posttraumatic stress disorder in Armenia after the earthquake

Evaluating Community Resilience and Associated Factors One Year after the Catastrophic Fort McMurray Flood

BACKGROUND

Resilience after natural disasters is becoming an increasingly key area of research. In April 2020, parts of Fort McMurray were affected by severe floods. The flooding caused the loss of properties, evacuation of some residents, and effects on their mental health.

OBJECTIVE

This study explores the prevalence and associated factors between flood experience and low resilience a year after the 2020 floods in Fort McMurray.

METHOD

Data collection was accomplished one year after the flood, from 24 April to 2 June 2021, using an online survey. The data were analyzed with SPSS version 25 using univariate analysis with the chi-squared test and binary logistic regression analysis.

RESULTS

The prevalence of low resilience was 37.4%. Respondents under 25 years were nearly 26 times more likely to show low resilience (OR = 0.038; 95% CI 0.004-0.384) than respondents 40 years and above. Responders with a history of depression (OR = 0.258 95% CI: 0.089-0.744) and a history of anxiety (OR = 0.212; CI 95% 0.068-0.661) were nearly four to five times more likely to show low resilience than those without a history. Similarly, respondents willing to receive mental health counselling (OR = 0.134 95% CI: 0.047-0.378) were 7.5 times more likely to show low resilience. Participants residing in the same house before the flood were almost 11 times more likely to show low resilience (OR = 0.095; 95% CI 0.021-0.427) than those who relocated. Participants who received support from the Government of Alberta were less likely to express low resilience than those who received no or limited support (OR = 208.343; 95% CI 3.284-13,218.663).

CONCLUSION

The study showed a low resilience rate among respondents following the 2020 flooding in Fort McMurray. Factors contributing to low resilience include age, history of depression or anxiety, and place of residence after the flood. After the flood, receiving support from the government was shown to be a protective factor. Further studies are needed to explore robust risk factors of low resilience and measures to promote normal to high resilience among flood victims in affected communities.

Inconsistent trauma reporting is associated with emotional and behavioural problems and psychotic experiences in young people

BACKGROUND

Little is known about the prevalence of inconsistent trauma reporting in community samples and about its associations with psychopathology. This study aimed to assess for the first time the prevalence of inconsistent trauma reporting in a community sample of children/adolescents and to explore associations with both psychotic experiences and with psychopathology more generally.

METHOD

A community-based sample of 86 children/adolescents (baseline mean age 11.5) were interviewed at two time points with data collected in relation to potentially traumatic events through the K-SADS. Emotional and behavioural problems were assessed at follow-up (mean age 15.7) through the Youth Self Report questionnaire while the presence of psychotic experiences was based on expert consensus post interview. Logistic regression models were used to test associations between inconsistent reporting and psychotic experiences at baseline and follow-up, with associations with emotional and behavioral problems at follow-up also assessed.

RESULTS

Overall, 16.3% of adolescents failed to report previously reported potentially traumatic events at follow-up and were therefore defined as inconsistent trauma reporters. Inconsistent reporting was associated with emotional and behavioural problems as assessed by the Youth Self Report with the exception of rule breaking behaviour and with psychotic experiences as assessed on interview.

CONCLUSIONS

Inconsistent trauma reporting is associated with psychotic experiences and emotional and behavioural problems in young people and may represent an important marker for psychopathology in youth.

Psychosocial support during displacement due to a natural disaster: relationships with distress in a lower-middle income country

Background

Past studies show relationships between disaster-related displacement and adverse psychosocial health outcomes. The development of psychosocial interventions following displacement is thus increasingly prioritized. However, data from low- and middle-income countries (LMICs) are lacking. In October 2017, the population of Ambae Island in Vanuatu, a lower-middle income country, was temporarily displaced due to volcanic activity. We analyzed distress among adults displaced due to the event and differences based on the psychosocial support they received.

Methods

Data on experiences during displacement, distress and psychosocial support were collected from 443 adults 2–3 wk after repatriation to Ambae Island. Four support categories were identified: Healthcare professional, Traditional/community, Not available and Not wanted. We analyzed differences in distress by sex and group using one-way ANOVA and generalized linear models.

Results

Mean distress scores were higher among women (1.90, SD=0.97) than men (1.64, SD=0.98) (p<0.004). In multivariate models, psychosocial support group was associated with distress among women (p=0.033), with higher scores among women who reported no available support compared with every other group. Both healthcare professional and traditional support networks were widely used.

Conclusions

Women might be particularly vulnerable to distress during disaster-related displacement in LMICs, and those who report a lack of support might be at greater risk. Both healthcare professional and traditional networks provide important sources of support that are widely used and might help to ameliorate symptoms.

The Role of Relocation Patterns and Psychosocial Stressors in Posttraumatic Stress Disorder and Depression Among Earthquake Survivors

The psychological impact of relocation within and outside of a disaster region was examined in 541 survivors of the 2011 Van earthquake in Turkey at 16.5 months postdisaster. Relocation out of the region was determined by disaster-related property/financial losses and fear during the earthquake. Anticipatory fear of future earthquakes and less sense of control over life were the strongest predictors of posttraumatic stress disorder (PTSD) and depression symptoms. Relocation within the disaster region predicted PTSD but not depression. Dissatisfaction with emotional support received from close ones was significantly associated with depression, but it was associated with PTSD at a marginally significant level. Survivors who experienced more intense fear during the earthquake displayed higher levels of anticipatory fear in the long term, whereas avoidance of trauma reminders and fear-evoking situations sustained anticipatory fear of future earthquakes. These findings suggest that interventions that reduce fear and avoidance behaviors would help survivors overcome traumatic stress and depressive symptoms.

Effect of relocation after a natural disaster in Armenia: 20-year follow-up

BACKGROUND

This study is a 20-year follow-up of individual's relocated from their home after the devastating earthquake in Armenia in 1988.

METHODS

Ninety-seven subjects who were exposed to the earthquake and thirty-seven subjects who were not exposed to the earthquake were administered the Symptom Checklist-90-R (SCL 90) and the UCLA PTSD Reaction in 2008. The exposed subjects comprised three groups: subjects who stayed in the earthquake city; those who relocated and returned; and a group who left permanently but were visiting family at the time of the study.

RESULTS

The Stayed group had significantly higher scores on the SCL-90-R when compared to the other three groups. The Stayed group and the Relocated group had significantly higher scores for partial and full PTSD than the Left group and the comparison group.

CONCLUSION

Permanent relocation to another country where one is able to start a new life in a safe environment provides the best adaptation for recovery when the destruction and delay in reconstruction lasted as long as it did in Armenia.

A post-earthquake psychopathological investigation in Armenia: methodology, summary of findings, and follow-up

The post-earthquake psychopathological investigation (PEPSI) was designed to probe the short-and long-term effects of the earthquake in northern Armenia on 7 December 1988 on survivors' mental and physical health. Four phases of this study have been conducted to date, and, overall, more than 80 per cent of a sub-sample of 1,773 drawn from an initial cohort of 32,743 was successfully followed during 2012. This paper describes the methodology employed in the evaluation, summarises previous findings, details the current objectives, and examines the general characteristics of the sample based on the most recent follow-up phase outcomes. Despite a significant decrease in psychopathology rates between 1990 and 2012, prevalence rates of post-traumatic stress disorder and depression among study participants in 2012 were greater than 15 and 26 per cent, respectively. The paper also notes the strengths and limitations of the study vis-à-vis future research and highlights the importance and potential practical implications of similar assessments and their outcomes.

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.

The role of natural disaster in individual and relational adjustment in Sri Lankan mothers following the 2004 tsunami

The purpose of this study is to examine the associations between maternal mental health distress symptoms, including depression and post-traumatic stress disorder, the extent to which the presence of a child's disaster-related physical health problem(s) have interfered with daily functioning, and family cohesion over time among Sri Lankan mothers who survived the tsunami on 26 December 2004. Study variables were measured using a self-report questionnaire administered approximately four months after the event and three years later in summer 2008. Univariate, bivariate, and multivariate analyses were conducted. Path analysis was employed to assess the relationships between the key variables over time and the correlations in the study variables at each time point. Among other findings, the results of the path analysis indicated that post-traumatic stress symptom distress four months after the disaster significantly predicted variance in family cohesion three years later. Clinical and empirical research implications are presented and discussed.

Sequential population study of the impact of earthquakes on the emotional and behavioural well-being of 4-year-olds in Canterbury, New Zealand

AIM

Exposure to a large natural disaster can lead to behavioural disturbances, developmental delay and anxiety among young children. Although most children are resilient, some will develop mental health problems. Major earthquakes occurred in Canterbury, New Zealand, in September 2010 and February 2011. A community screening tool assessing behavioural and emotional problems in children, the Strengths and Difficulties Questionnaire, has been reported by parents (SDQ-P) and teachers (SDQ-T) of all 4-year-olds in the region since 2008.

METHODS

Mean total and subtest scores for the SDQ-P and SDQ-T were compared across periods before, during and after the earthquakes in sequential population cohorts of children. Comparisons across the periods were made in relation to the proportions of children defined by New Zealand norms as 'abnormal'. Results were also compared between zones considered to have been exposed to higher or lower impact from the earthquakes.

RESULTS

Parent mean total SDQ scores did not change between periods before, during and after the earthquakes. Teacher mean SDQ total scores significantly reduced (improved) when compared between baseline and post-earthquake periods. Mean SDQ pro-social scores from both teachers and parents increased (strengthened) when compared between baseline and post-earthquake periods. Results did not significantly vary according to a measure of impact from the earthquakes.

CONCLUSION

The main finding that a population-based measure of behavioural and emotional problems among children was not deleteriously impacted by the earthquakes is surprising and is not consistent with other research findings. Further work is needed to explore the health needs of children in Canterbury based on methodological improvements.

Well-being and perceived quality of life in elderly people displaced after the earthquake in L'Aquila, Italy

On 6 April 2009, the city of L’Aquila was hit by a violent earthquake that destroyed almost all of its medieval centre, and the surviving inhabitants were evacuated and relocated in temporary quarters or undamaged homes. The aim of this study was to investigate the perceived quality of life of the elderly population 3 years after the earthquake in relation to the social and logistic issues of new housing. The study was carried out between October 2011 and March 2012, and involved 571 subjects aged over 65 years living in the municipality of L’Aquila. The interviews took place in the surgeries of general practitioners and the city’s Department of Prevention and Vaccination in the anti-influenza immunisation period. The instrument used was a 36-item questionnaire with closed, multiple choice answers divided into the following sections: demographics, everyday activities, health and perceived health, and the quality of life in the city. The results show that, 3 years after the earthquake, the elderly population living in the new towns and temporary housing of L’Aquila have a worse perception of their quality of life than the others. They feel a certain social isolation and wish to live elsewhere. Governments faced with the problems arising from a natural calamity should take into account all of the elements making up a good quality of life and, before making choices whose impact cannot be changed, consider both their immediate and long-term social consequences.

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.

Persistent fear of aftershocks, impairment of working memory, and acute stress disorder predict post-traumatic stress disorder: 6-month follow-up of help seekers following the L'Aquila earthquake

The aim of our 6-month follow-up study was to assess predictors of post-traumatic stress disorder (PTSD) among individuals seeking treatment at the General Hospital Psychiatric Unit within the first month following the L'Aquila earthquake. Clinical, trauma-related and neurocognitive variables were considered. At the 6-month follow-up, 91 (74.5%) out of 122 subjects were re-assessed and administered the Impact of Events Scale-revised (IES-R) for the detection of PTSD according to DSM-IV criteria. Within 4 weeks following the earthquake, patients were assessed with a checklist of traumatic-event-related variables, along with the Stanford Acute Stress Disorder Questionnaire (SASDQ) for the detection of ASD, with a short battery on working (Wechler Memory Scale-R, Digit Forward and Backward) and verbal memory (subtest of Milan Overall Dementia Assessment, MODA). A statistically significant higher proportion of subjects affected by 'partial' ASD showed a PTSD diagnosis (80.6%, N = 29) compared to not diagnosed subjects (40%, N = 22) and a PTSD diagnosis was shown by all the 4 subjects (4.4%) affected by 'full' ASD at the entry in the study. At the 6-month follow-up 56% of the sample could be considered affected by PTSD on the IES-R scale. The results of the logistic regression analysis on our selected predictors indicated that the persistent fear of aftershocks seemed to increase by over 57 times the likelihood of positive estimate of PTSD, followed by impairment of working memory backward (OR 48.2), and having being diagnosed as ASD case in the first 4 week after the earthquake (OR 17.4). This study underlines the importance of identifying PTSD predictors, in order to planning early treatment interventions after natural disasters.

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.

Prevalence and predictors of posttraumatic stress disorder and depressive symptoms among child survivors 1 year following the Wenchuan earthquake in China

The purpose of this study was to estimate the prevalence rates of probable posttraumatic stress disorder (PTSD) and depression and to explore potential risk factors among child and adolescent survivors 1 year following the 2008 Wenchuan earthquake. 3052 participants were administered the Child PTSD Symptom Scale, the Center for Epidemiologic Studies Depression Scale for Children, and the earthquake experience scale. Results indicated that the prevalence rates of probable PTSD and depression were 8.6 and 42.5%, respectively. Demographic variables (i.e., age and gender) and most aspects of earthquake experiences (i.e., direct exposure, close ones' exposure, fear for the safety of close ones, prior exposure to trauma, living location, and house damage, with the exception of type of housing) made unique contributions to PTSD and depressive symptoms. In addition, the moderating effect of gender on the relationships between age and PTSD and depressive symptoms was significant. In conclusion, depression was a more common psychological response than was PTSD among child survivors 1 year following the Wenchuan earthquake. Age and gender were risk factors for both PTSD and depressive symptoms. Furthermore, older female survivors exhibit more severe PTSD and depressive symptoms. Additionally, several aspects of earthquake experiences (i.e., direct exposure, close ones' exposure, fear for the safety of close ones, prior exposure to trauma, living location, and house damage) was also important for the development and maintenance of PTSD and depressive symptoms.

Mental health approaches to child victims of acts of terrorism

It has long been recognized that human beings exposed to severe stress may develop psychological symptoms. With recent terrorist acts around the world including the New York City World Trade Center September 11, 2001 atrocity, there has been a growing interest in the specific impact of terrorist acts on the victims and witnesses. One area that has received less study is the specific impact on children. This paper reviews some of the general effects of traumatic stress on children and the history of the research in this area including a specific discussion of post-traumatic stress disorder in children. This is followed by a review of how children might react to the trauma of a terrorist attack differentiating between three different subgroups of children (preschool age children, school-age children, and adolescents). Then there is a review of what a comprehensive evaluation of childhood victims of terrorism should entail. Finally, treatment modalities that have been shown to be effective are reviewed.

Acute stress reactions and associated factors in the help-seekers after the L'Aquila earthquake

BACKGROUND

The assessment of acute stress reactions and psychiatric symptomatology shortly after the occurrence of a traumatic catastrophic event, like an earthquake, is essential for implementing relief activities and for the identification of the long-term aftermath. The aim of our study was to assess the psychological distress and the occurrence of acute stress disorder (ASD) among individuals seeking help at the General Hospital Psychiatric Unit at San Salvatore Hospital following the earthquake at L'Aquila. Factors (sociodemographic, coping strategies, event-related and postevent variables) associated with the acute stress reactions were also assessed.

METHODS

For the first 4 weeks following the earthquake, 122 help-seekers were assessed with a checklist of traumatic-event-related variables. Measurement instruments included the Stanford Acute Stress Reaction Questionnaire (SASRQ) for the detection of ASD according to DSM-IV criteria, the 12-item General Health Questionnaire (GHQ-12) for assessing psychological distress, and the Brief Cope questionnaire for assessing coping strategies.

RESULTS

Despite the high level of psychological distress (GHQ-12 ≥20, cut-off value) found in 65.6% of the subjects, only 6 subjects (4.9%) could be considered affected by 'full' ASD, whereas 48 subjects (39.3%) could be considered affected by 'partial' ASD, which is defined as showing at least one symptom on each DSM-IV criterion as evidenced by scoring higher than 3 on each SASRQ scale. The strongest predictor of traumatic stress reactions among all the predictor variables included in our study was having been trapped/injured under rubble during the earthquake, and among earthquake stressors (explaining 20% of variance in our model), a weaker predictor was the loss of personal privacy because of home displacement. In our model, more variance (39%) was explained when individual psychopathological variables and coping styles were also included as predictors. Showing coping strategies as exhibiting 'behavioural disengagement' or 'requesting emotional support from others' were found to increase the likelihood of a positive estimate of being an 'ASD case', while the adoption of an 'acceptance' coping style seemed to reduce the likelihood of the positive estimate of being an 'ASD case'.

CONCLUSIONS

This study underlines the importance of identifying ASD subsyndromal cases and taking appropriate intervention/prevention measures that focus on giving psychological support to individuals trapped/injured under rubble, showing a low acceptance of reality. A relevant underestimated source of distress was the dislocation in large accommodation settings (such as large tent camps) in which individuals lack privacy.

Disaster Intervention: Long-term Psychosocial Benefits in Armenia

This paper describes a unique situation in which disaster intervention following a massive earthquake led to significant, uninterrupted, psychosocial benefits to the entire country, and an intervention program that continues to evolve. The mental health program initially provided service to the victims, and then, training to local professionals during which personnel simultaneously conducted clinical research. Members of the mental health team made a life-long commitment to the country, and continue their activities to expand its impact on public health policy. The difficult history and life circumstances of the Armenian people provided the opportunity for disaster interventions to have extensive psychosocial benefits.

Psychological morbidity in children 18 months after Kashmir Earthquake of 2005

A severe earthquake occurred in Kashmir in 2005. The epicentre was close to Muzzafarabad. We collected data on over 1,100 children 18 months after the earthquake to look at symptoms of PTSD and behavioural and emotional problems using well established questionnaires. We found that 64.8% of children had significant symptoms of PTSD. Girls were more likely to suffer from these symptoms. The proportion of children suffering from emotional and behaviour difficulties was 34.6%. This percentage was not different from other studies of children from Pakistan within areas which were not affected by the earthquake. The rate of emotional symptoms was higher in girls while hyperactivity was more frequent in boys. This pattern is similar to other studies from across the world.

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.

Twenty-year follow-up of adults traumatized during childhood in Armenia

BACKGROUND

Most children who experience trauma recover and display resilience; however, there are few long-term follow-up studies of traumatized children and fewer still have examined factors that may lead to resilience. This study is a 20-year follow-up of adults who experienced an earthquake as children.

METHODS

Nineteen of 25 adults who experienced the earthquake in Armenia in 1988 and participated in the initial study approximately two years later (Time 1) were reinterviewed in 2008 (Time 2). Forty-four Armenian adults aged 22-37 who had not experienced the earthquake comprised the comparison group. All participants at Time 2 were administered the Symptom Checklist-90 Revised (SCL-90-R) and the UCLA PTSD Reaction Index (RI) and also received a clinical interview.

RESULTS

The earthquake group had clinically elevated SCL-90-R GSI, PSDI, PST and subscale scores for all but one subscale and had significantly more subscale clinical elevations than the comparison group. All earthquake survivors at Time 2 scored from 1 to 46 on the RI with 4 having probable PTSD. No comparison subjects had experienced an A1 trauma.

LIMITATIONS

The small number of subjects in this follow-up, our inability to follow the comparison group in the original study and the measures used at the two time points limits the applicability of the results.

CONCLUSIONS

Most of the earthquake survivors experienced anxiety disorders at follow-up but not high levels of PTSD or depression. Clinical interviews identified resilient factors that may have helped these subjects maintain functional and adaptive capacities despite clinical elevations on the SCL-90.

Risk factors for PTSD after Typhoon Morakot among elderly people in Taiwanese aboriginal communities

BACKGROUND

This study aimed to investigate the risk factors associated with post-traumatic stress disorder (PTSD) symptoms in a mid- and old-age population who experienced Typhoon Morakot in Taiwan.

METHODS

One hundred and twenty people, who were mostly Taiwanese aboriginal people aged 55 years and above, were invited to participate in this study. PTSD symptoms were assessed using the PTSD Symptom Scale (PSS-I). Information regarding demographic characteristics, relocation, personal injury, family death, property damage, and self-perceived health was collected.

RESULTS

29.2% of study participants presented significant PTSD symptomatology during the previous month. Development of PTSD symptomatology after the disaster was significantly associated with being female (OR 3.63, 95% CI = 1.11-11.88), experiencing relocation (OR 5.64, 95% CI = 1.60-19.88), and having poorer self-perceived health (OR 4.24, 95% CI = 1.53-11.78) after controlling for age, education, personal injury, family death, and property damage. Further, by adding depression into the analysis, we found the risk factors were being female (OR 4.66, 95% CI = 1.16-18.80), experiencing relocation (OR 27.91, 95% CI = 3.74-229.80), family death (OR 67.62, 95% CI = 2.85-1063.68), and poorer self-perceived health (OR 28.69, 95% CI = 4.52-182.06).

CONCLUSION

Nearly 30% of the elderly people studied who experienced Typhoon Morakot developed significant PTSD symptomatology. The risk factors for PTSD symptoms were female gender, poorer self-perceived health, relocation, family death, and depression. The elderly people who were relocated by governmental programs were more likely to develop PTSD symptomatology after experiencing trauma. Resettlement and rehabilitation programs after a disaster need to be more concerned with their psychological effects on victims.

Posttraumatic stress disorder among survivors of the Wenchuan earthquake 1 year after: prevalence and risk factors

Exposure to earthquakes has been associated with psychological distress in particular, the development of posttraumatic stress disorder (PTSD). The aims of this study are to estimate the prevalence of PTSD, explore the associated risk factors among survivors 1 year after the Wenchuan earthquake in China, and compare the findings in our study to other disasters. Cross-sectional sample survey was conducted to collect data in severely affected counties. We use the PTSD Check List-Civilian Version, which consists of 17 items corresponding to each symptom in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD criteria B, C, and D. The prevalence estimates of probable PTSD in our sample ranged from 21.5% (based on Check List-Civilian Version score of 50 or higher) to 40.1% (based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). The prevalence of PTSD was high, compared with rates of PTSD in previous studies. Low social support, feeling fear during the earthquake, female, young people, Han nationality, low monthly income, and low educational level were risk factors significantly related to the development of PTSD. Postdisaster mental health recovery interventions including early identification, ongoing monitoring, and sustained psychosocial support are required for the high-risk population with PTSD. Existing rural and urban health care services should be convenient for people, and special measures need to be designed, such as home visits and mobile clinics.

Effect of relocation and parental psychopathology on earthquake survivor-children's mental health

Earthquakes may increase the risk for psychopathology in children because the disaster may disrupt family functioning through causing psychopathology in the parents or disrupting social network through migration, school changes, or socioeconomic status changes caused by the job losses of the parents. This study aimed to investigate the effects of parental psychopathology on the traumatic stress and depression of earthquake survivor-children 4 years after the earthquake. A convenience sample of 104 earthquake survivor-children (43 boys, 61 girls) and their parents were assessed at their homes for earthquake experience and traumatic stress symptoms. The outcome variables were the factor scores of a child/adolescent traumatic stress questionnaire (Traumatic Stress Symptom Checklist for Children and Adolescents). The predictors of child's factor scores were examined using linear regression analyses. The traumatic stress factor score of the children was predicted two variables: the child's reported fear during the earthquake and the father's traumatic stress factor score. The depression factor score, on the other hand, was predicted using the depression factor score of the mother only. Demographic variables or relocation status were not predictive for either of children's factor scores. The results of the present study show that maternal and paternal psychopathologies have differential effects on the psychological status of earthquake survivor-children. Traumatic stress in the child is predicted using the traumatic stress of father, whereas depression in the child is predicted by mother's depression levels. Social network disruption does not seem to have a negative effect on children once parental psychopathology is taken into account.

Social Indicators Affecting Post-Tsunami Trauma of Survivors

The study examines whether widow/widower status, educational level and family income influence post-tsunami trauma of survivors. The data were collected 14 months after the tsunami from 416 adult survivors in nine semi-urban habitations of Nagapattinam district in the state of Tamilnadu (India). Post-tsunami trauma was assessed using inventories of post-traumatic stress, depression, negative and positive affectivity, physical health symptoms and anxiety. Post-tsunami trauma of survivors has increased with increasing age, female gender and more exposure. Controlling the confounding effects of age, gender, and exposure; widow/widower status, illiteracy and lower family income are found to intensify trauma and are the risk factors for post-tsunami morbidity. Only illiterates do not report more physical health symptoms than literates, and lower family income neither heightens depression and negative affectivity nor lessens positive affectivity.

The effects of the 1999 Turkish earthquake on young children: analyzing traumatized children's completion of short stories

The purpose of this exploratory study was to determine whether projective techniques could identify long-term consequences among children stemming from exposure to a traumatic event. The first group of children (n = 53; 26 female, 27 male) experienced 2 major earthquakes at age 7, 3 months apart, in Turkey, while a similarly matched control group (n = 50; 25 female, 25 male) did not. Both groups of children (current age: 9) completed a series of short stories related to disastrous events. Results indicated that the traumatized group evinced a range of trauma-related symptoms 2 years after experiencing the earthquakes.

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.

Developmental differences in children's and adolescents' post-disaster reactions

Disaster literature suggests that children's and adolescents' post-disaster reactions vary according to their developmental levels. Preschool children show less psychological problems as compared to older children and adolescents, but they have a higher incidence of trauma-specific fears and behavioral problems (e.g., dependency, clinging). School-age children's disaster responses include sleep and eating disturbances, behavioral problems, and poor school performance. Adolescents tend to exhibit symptoms such as posttraumatic stress disorder, depression, anxiety, belligerence, and pessimistic views about the future (Korol, Green, & Gleser, 1999 ).

Prevalence and risk factors for posttraumatic stress disorder: a cross-sectional study among survivors of the Wenchuan 2008 earthquake in China

BACKGROUND

The impact of the May 2008 Wenchuan earthquake, measuring a massive 8.0 on the surface wave magnitude scale, on public health in China has been significant and multifaceted. In light of extant data on prevalence and risk factors for posttraumatic stress disorder (PTSD) after other natural diasters, we collected data from the Wenchuan earthquake survivors to estimate the prevalence of PTSD and to characterize a range of PTSD risk factors.

METHODS

A cross-sectional multicluster sample survey of 446 respondents (201 from the Qiang ethnic-minority group, 245 the majority Han Chinese group) was conducted in August 2008 in Beichuan county, Sichuan province, a region that was severely affected by the earthquake. In total, 240 households were represented, with a mean of 2.2 respondents per household. Data were collected from structured interviews and the Harvard Trauma Questionnaire (HTQ) and DSM-IV criteria were used to diagnose PTSD.

RESULTS

The prevalence of PTSD was 45.5% (203/446). Low household income, being from an ethnic minority, living in a shelter or temporary house, death in family, and household damage were factors significantly related to increased odds of PTSD.

CONCLUSIONS

PTSD is common after a major disaster. Postdisaster mental health recovery programs that include early identification, ongoing monitoring, preventive and intervention programs, and sustained psychosocial support are needed for the highest-risk population, namely, the bereaved, people without incomes and those with serious household damage. These populations may also benefit from governmental and nongovernmental programs that provide social and economic support, as suggested by earlier studies.

Earthquakes and Children: The Role of Psychologists with Families and Communities

The 2008 Sichuan Province earthquake and 2005 Pakistan earthquake are examples of natural disasters that took an unimaginable toll on children. In such disaster management contexts, family members as well as health care and school personnel are the first-line responders and are natural sources of continued social support as children recover. Although psychologists have increasingly sophisticated understandings of post-disaster reactions and strategies for helping children and adolescents cope with trauma, models for responding to mass catastrophes are limited, particularly in geographically remote communities and in regions where mental health services are stigmatizing. With children's well-being subsequent to earthquakes inextricably linked to family and community, psychologists can make important contributions in three spheres: (a) coordinating and activating collaborations within children's existing social contexts to develop post-earthquake interventions; (b) designing prevention and preparedness programs focused on the emotional needs of children in earthquake-prone communities; and (c) conducting research on interventions and recovery with particular attention to developmental stage, socio-cultural-economic contexts, and the similarities versus differences across various types of disasters.

Serious emotional disturbance among youths exposed to Hurricane Katrina 2 years postdisaster

OBJECTIVE

To estimate the prevalence of serious emotional disturbance (SED) among children and adolescents exposed to Hurricane Katrina along with the associations of SED with hurricane-related stressors, sociodemographics, and family factors 18 to 27 months after the hurricane.

METHOD

A probability sample of prehurricane residents of areas affected by Hurricane Katrina was administered a telephone survey. Respondents provided information on up to two of their children (n = 797) aged 4 to 17 years. The survey assessed hurricane-related stressors and lifetime history of psychopathology in respondents, screened for 12-month SED in respondents' children using the Strengths and Difficulties Questionnaire, and determined whether children's emotional and behavioral problems were attributable to Hurricane Katrina.

RESULTS

The estimated prevalence of SED was 14.9%, and 9.3% of the youths were estimated to have SED that is directly attributable to Hurricane Katrina. Stress exposure was associated strongly with SED, and 20.3% of the youths with high stress exposure had hurricane-attributable SED. Death of a loved one had the strongest association with SED among prehurricane residents of New Orleans, whereas exposure to physical adversity had the strongest association in the remainder of the sample. Among children with stress exposure, parental psychopathology and poverty were associated with SED.

CONCLUSIONS

The prevalence of SED among youths exposed to Hurricane Katrina remains high 18 to 27 months after the storm, suggesting a substantial need for mental health treatment resources in the hurricane-affected areas. The youths who were exposed to hurricane-related stressors, have a family history of psychopathology, and have lower family incomes are at greatest risk for long-term psychiatric impairment.

Over-time changes in PTSD and depression among children surviving the 1999 Istanbul earthquake

OBJECTIVE

To follow-up on child and adolescent victims with full criteria of PTSD and depression, and to examine the impact of treatment.

METHOD

One to two months following a 7.4-magnitude quake in Turkey, 160 students were examined by self-report questionnaire, psychiatric interview, clinician-administered post-traumatic stress disorder scale (CAPS), and depression and anxiety inventories. At baseline, 96 students were diagnosed with PTSD, and 49 had comorbid depression with anxiety symptoms. After 18-20 months, 74 of 96 students were found and reassessed by psychiatric interview and CAPS; 25 had been treated with cognitive-behavioral therapy (CBT) and pharmocotherapy, and 49 did not have any treatment. Binary logistic regression was used to identify significant predictors of persistent PTSD. Variables entered included pre-quake, quake and post-quake factors, having co-morbid depression upon initial interview, receipt of drug therapy, and number of months of CBT.

RESULTS

At follow-up, many had symptoms of PTSD with anxiety, but only 14 subjects met the full criteria of PTSD, and four students had major depression with anxiety symptoms. Only one variable--having been in serious personal danger during the quake (e.g., trapped in the house or under rubble)--was significantly associated with being symptomatic at follow-up.

CONCLUSION

Regardless of receipt of treatment, diagnoses of PTSD and depression were much reduced. More research is needed about resiliency factors.

Health effects of relocation following disaster: a systematic review of the literature

This paper reviews the literature on the effects of post-disaster relocation on physical and mental heath, and develops a conceptual framework to guide future research. Forty articles were selected for full-text review and incorporation into the conceptual framework. Twenty-four articles were reviewed for results and methodology. These overwhelmingly tracked mental health outcomes. Only four (16 per cent) focused on physical health. Eight of ten showed an association between relocation and psychological morbidity. Certain outcomes (such as mortality, injury and cardiovascular disease risk factors) revealed inconsistent results, but these were rarely studied. Despite the frequency of post-disaster relocation and evidence of its effect on psychological morbidity, there is a relative paucity of studies; the few examples in the literature reveal weak study designs, inconsistent results, and inattention to physical health impacts and the challenges facing vulnerable populations. Further research guided by theory is needed to inform emergency preparedness and recovery policy.

The potential for PTSD, substance use, and HIV risk behavior among adolescents exposed to Hurricane Katrina

Adverse psychosocial outcomes can be anticipated among youth exposed to Hurricane Katrina. Adolescents are particularly vulnerable to the consequences of this natural disaster and may suffer lasting consequences in the form of psychological morbidity and the development of negative health behaviors due to their exposure. We review existing literature on the effects of exposure to natural disasters and similar traumas on youth and, where data on youth are unavailable, on adults. The effect of natural disasters is discussed in terms of risk for three negative health outcomes that are of particular concern due to their potential to cause long-term morbidity: post-traumatic stress disorder, substance use disorder, and HIV-risk behavior. Where available, data from studies of the effects of Hurricane Katrina are included.

Risikofaktoren der Posttraumatischen Belastungsstörung nach Trauma-Typ-I bei Kindern und Jugendlichen

Es wird ein Überblick zu Risikofaktoren einer Posttraumatischen Belastungsstörung (PTB) nach einem einmaligen traumatischen Ereignis in Kindheit und Jugend gegeben. Dazu wurde eine umfangreiche Literaturrecherche durchgeführt, als deren Ergebnis 55 Einzelstudien identifiziert werden konnten. Die berücksichtigten Studien sollten sowohl eine quantitative Erfassung der posttraumatischen Symptomatik als auch der Prädiktoren beinhalten. Prädiktoren wurden in prä-, peri- und posttraumatische Faktoren eingeteilt, wobei sich die folgenden als besonders vielversprechend herausstellten: Prätraumatische psychische Morbidität, Stressorschwere, Lebensgefahr, Ressourcenverlust und peritraumatische emotionale Reaktion, sowie eine Akute Belastungsstörung bzw. PTB nach dem Ereignis, Komorbidität, weitere kritische Lebensereignisse und mangelnde soziale Unterstützung.

Psychosocial Effects of War Experiences among Displaced Children in Southern Darfur

This study focused on assessing the psychosocial effects of the long standing, high intensity, and guerrilla-style of warfare among displaced children in Southern Darfur. The goal was to better understand the etiology, prognosis, and treatment implications for traumatic reactions, depression, and grief symptoms in this population. Three hundred thirty-one children aged 6–17 from three IDP Camps were selected using a quota sampling approach and were administered a Demographic Questionnaire, Child Post Traumatic Stress Reaction Index, Child Depression Inventory, and the Expanded Grief Inventory. Forty-three percent were girls and 57% were boys. The mean age of the children was 12 years. Results found that children were exposed to a very large number of war experiences with no significant differences between genders for types of exposure, including rape, but with older children (13–17 years) facing a larger number of exposures than younger children (6–12 years). Out of the 16 possible war experiences, the mean number was 8.94 ( SD = 3.27). Seventy-five percent of the children met the DSM-IV criteria for PTSD, and 38% exhibited clinical symptoms of depression. The percentage of children endorsing significant levels of grief symptoms was 20%.

Increased exposure to war experiences led to higher levels of: 1) traumatic reactions; 2) depression; and 3) grief symptoms. Of the 16 war experiences, abduction, hiding to protect oneself, being raped, and being forced to kill or hurt family members were most predictive of traumatic reactions. Being raped, seeing others raped, the death of a parent/s, being forced to fight, and having to hide to protect oneself were the strongest predictors of depressive symptoms. War experiences such as abduction, death of one's parent/s, being forced to fight, and having to hide to protect oneself were the most associated with the child's experience of grief. In addition to Total Grief, Traumatic Grief, Existential Grief, and Continuing Bonds were measured in these children. Although trauma, depression, and grief often exist as co-morbid disorders, the mechanisms and pathways of these is less understood. In this study we used Structural Equation Modeling to better understand the complex interaction and trajectories of these three symptoms evolving from war exposure and loss. This study is the first of its kind to assess the psychosocial effects of war experiences among children currently living in war zone areas within Sudan. It identifies some of the most prevalent war-related atrocities and their varying impact on the children's psychological well-being and overall adjustment. Implications for planning mental health interventions are discussed.

Psychosocial determinants of relocation in survivors of the 1999 earthquake in Turkey

Large-scale earthquakes in urban areas displace many people from their homes. This study examined the role of conditioned fears in determining survivors' tendency to live in shelters after the 1999 earthquake in Turkey. A total of 1655 survivors living in prefabricated housing compounds or residential units in the epicenter zone were screened using a reliable and valid instrument. Among participants whose houses were rendered uninhabitable during the earthquake 87.7% relocated to shelters, whereas others remained in the community by moving to a new house. In contrast, 38.7% of the participants whose houses were still inhabitable after the earthquake lived in the shelters. Relocation was predicted by behavioral avoidance, material losses, and loss of relatives. These findings suggested that a multitude of factors played a role in survivors' displacement from their houses and the elevated rates of mental health problems could constitute a cause rather than an effect of relocation.

Risk factors for the development of PTSD and depression among child and adolescent victims following a 7.4 magnitude earthquake

Objective. PTSD and major depression occur frequently following traumatic exposure, both as separate disorders and concurrently. Although much of Turkey is under threat of severe earthquakes, risk factors for developing psychiatric disorders among Turkish children have not yet been studied. The aim of the study was to examine risk factors for PTSD and depression develpoment in children. Method. A total of 160 survivors (102 girls and 58 boys) severely impacted by Turkey's 7.4-magnitude quake participated in a psychiatric interview 6-20 weeks after the disaster. The mean age was 14.43. Logistic regression was used to test effects of pre-disaster, disaster-related and post-disaster factors on diagnoses, yielding odds ratios (OR). Results. CAPS indicated that 96 (60%) had PTSD, and psychiatric interview found 49 (31%) with depression. Children diagnosed with PTSD were more likely to have witnessed death (OR=2.47) and experienced an extreme parental reaction (OR=3.45). Children with depression were more likely to be male (OR=4.48), have a higher trait anxiety score (OR=1.12 for every additional point), sustain injury (OR=4.29), and have lost a family member in the quake (OR=10.96). Focusing on the 96 children with PTSD, those with comorbid depression were more likely male, have a higher trait anxiety score, and have lost of family member. Conclusions. Mental health professionals should offer support to children witnessing death or losing a family member in a disaster. The ability of the family to remain calm and reassuring also may be a key factor in preventing PTSD.

Family context of mental health risk in Tsunami-exposed adolescents: findings from a pilot study in Sri Lanka

Using survey data from 325 Tsunami-exposed adolescents and mothers from two villages in southern Sri Lanka, this pilot study investigated influences of Tsunami exposure and subsequent psychosocial losses on adolescent depressive and post-traumatic stress disorder (PTSD) symptoms. Findings generally support the study hypotheses: disaster exposure (for example experiences of property destruction and deaths of close others) contributes to depressive and PTSD symptoms in adolescents. Findings also show that psychosocial losses associated with Tsunami exposure, such as prolonged displacement, social losses, family losses, and mental health impairment among mothers, contribute to depressive and PTSD symptoms in adolescents. Results suggest that the influence of Tsunami exposure on adolescent mental health operates partially through Tsunami-related psychosocial losses. As expected, positive mother-child relationships provide a compensatory influence on both depressive and PTSD symptoms of adolescents. In addition, high levels of depressive symptoms among mothers increases the detrimental influence of other Tsunami-related psychosocial losses on adolescent mental health. These preliminary findings suggest ways to improve ongoing recovery and reconstruction programs and assist in formulating new programs for families exposed to both the Tsunami and other natural disasters. More importantly, findings from this pilot study emphasize the urgent need for larger systematic studies focusing on mental health following disaster exposure.

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.