Children's adjustment following Hurricane Katrina: the role of primary caregivers

'Life should go on': a qualitative inquiry of parental reactions, experiences, and perceived needs following adolescents' recent traumatic exposure

Background: Parents have a significant role in supporting children who have been exposed to traumatic events. Little is known about parental experiences and needs in the wake of traumatic exposure, which could help in designing tailored early interventions.Objective: This qualitative study explored experiences, perceived needs, and factors impacting those needs being met, in parents of adolescents aged 11-16 years who had been exposed in the past 3 months to a potentially traumatic event, in the city of Montpellier, France.Method: We purposively sampled 34 parents of 25 adolescents aged 11-16 years meeting the inclusion criteria and used semi-structured in-depth interviews. Thematic analysis was applied using a multistage recursive coding process.Results: Parents lacked trauma-informed explanations to make sense of their child's reduced functioning. They experienced stigma attached to the victim label and were reluctant to seek help. School avoidance and lack of collaboration with schools were major obstacles experienced by parents. Parents trying to navigate conflicting needs fell into two distinct categories. Those who experienced distressing levels of shame and guilt tended to avoid discussing the traumatic event with their child, pressuring them to resume life as it was before, despite this perpetuating conflictual interactions. Others adapted by revisiting their beliefs that life should go on as it was before and by trying to come up with new functional routines, which improved their relationship with their child and helped them to restore a sense of agency and hope, but at the cost of questioning their parental role.Conclusions: Key domains of parental experiences could provide potential early intervention targets, such as psychoeducation on traumatic stress, representations about recovery and the victim status, parent-child communication, and involvement of schools and primary caregivers. Further research is needed to validate the impact of these domains in early post-traumatic interventions.

A systematic literature review of the relationship between parenting responses and child post-traumatic stress symptoms

Background: Parents are a key source of support for children exposed to single-incident/acute traumas and can thereby play a potentially significant role in children's post-trauma psychological adjustment. However, the evidence base examining parental responses to child trauma and child posttraumatic stress symptoms (PTSS) has yielded mixed findings.Objective: We conducted a systematic review examining domains of parental responding in relation to child PTSS outcomes.Method: Studies were included if they (1) assessed children (6-19 years) exposed to a potentially traumatic event, (2) assessed parental responses to a child's trauma, and (3) quantitatively assessed the relationship between parental responses and child PTSS outcomes. A systematic search of three databases (APAPsycNet, PTSDpubs, and Web of Science) yielded 27 manuscripts.Results: Parental overprotection, trauma communication, avoidance of trauma discussion and of trauma reminders, and distraction were consistently related to child PTSS. There was more limited evidence of a role for trauma-related appraisals, harsh parenting, and positive parenting in influencing child outcomes. Significant limitations to the evidence base were identified, including limited longitudinal evidence, single informant bias and small effect sizes.Conclusion: We conclude that key domains of parental responses could be potential intervention targets, but further research must validate the relationship between these parental responses and child PTSS outcomes.

Universal crisis psychoeducational interventions in schools: A scoping review

In times of crisis, schools are expected to help students deal with the situation and any help offered should consider the social and emotional problems arising from the critical event. Therefore, school-based activities enabling children to recognize the experience and work through it are essential to sustain their normal development and prevent academic and mental health problems. This paper provides an overview of the literature on universal school crisis interventions. We performed a scoping literature search in Scopus, ERIC, and Psych Info for articles published between January 2000 and May 2021 and identified 32 universal school-based crisis interventions based on three main crisis types (armed conflict, natural disaster, and Covid-19). Analysis of the methodologies and theoretical backgrounds generated six key psychoeducational factors commonly adopted. Comparing the different programmes in terms of topics, course content, duration, and methodology can help administrators and educators select the most appropriate crisis intervention for their school and situation. We also discuss the collaboration between mental health care specialists, school teams, and other important factors needed to implement these programmes and ensure their effectiveness under real-life conditions.

Coping with COVID: pandemic narratives for Australian children

The experience of the COVID-19 pandemic can be recognised as traumatic for the way in which its sudden and unexpected onset disrupted a sense of ordinary life for so many around the world. Adults, and far less so children, were unable to prepare for the danger of the rapidly spreading disease. As such, both were left vulnerable to the experience of trauma and anxiety that surrounds the threat of COVID. Whereas adults, however, have access to a range of resources and strategies for mental health protection, children of various ages need targeted resources to enable them to understand, prepare for, and come to terms with a trauma situation. A great deal of research exists around the value of children developing their own narratives as a means of coming to terms with trauma, such that storytelling is identified as a primary coping device. Similarly, literature exists that compares parental narratives of trauma with those of their children. Moreover, the use of the fairy tale as a cautionary tale has long been examined. What has not been established is the way in which contemporary multimedia narratives – such as television programmes, animations, and digital stories – can be used to develop coping strategies in children and to mitigate anxiety in young people experiencing global or collective trauma. This article examines a selection of such narratives produced for Australian children during the COVID-19 pandemic. Through a cross-disciplinary framework, this work considers how these resources can help (or hinder) mental health recovery in young children under the age of five, as well as strategies for best practice in the future development of trauma-informed resources for this age group.

Climate change impacts on the mental health and wellbeing of young people: A scoping review of risk and protective factors

BACKGROUND/RATIONALE

The impact of climate change on the mental health of young people is poorly understood. Emerging evidence suggests that exposure to climate change exerts a disproportionate mental health burden on young people. An understanding of the risk factors (RFs) and protective factors (PFs) that affect the likelihood of mental health impacts arising from exposure to climate change is required to support youth wellbeing.

AIMS/OBJECTIVES

This review scopes the current research on what and how RFs and PFs are related to the mental health impacts of both direct and indirect exposure to climate change for young people. RFs and PFs were reviewed through the lens of ecological system theory.

METHODS

We conducted systematic searches in four databases: PubMed, PsycInfo, Web of Science, and Scopus. Grey literature searches were conducted in ProQuest Dissertations, GreyLit.org, OpenGrey, and relevant organisations' websites. We included 92 empirical studies focused on the RFs and PFs of the mental wellbeing under the impact of climate change of young people (0-24). We extracted data on study characteristics, type of climate change event, mental health outcomes, RFs and PFs, and associated ecological system level.

RESULTS

The current evidence base focuses predominantly on young people's experience of PTSD (k = 59), depression (k = 26), or anxiety (k = 17) mainly following exposure to singular climate change-related natural disaster events. Only four studies explored the impacts of climate change in general. Majority of the studies investigated RFs and PFs at the individual level and at the micro-system level.

CONCLUSIONS

Several RFs and PFs were identified, such as coping strategies, family factors (e.g. parenting style), social support, community connection, and cultural identity. Positioning the mental health impacts of singular events within the broader context of ongoing and escalating climate change impacts will better inform the development of interventions that seek to build resilience among young people.

Longitudinal transactional relationships between caregiver and child mental health during the COVID-19 global pandemic

BACKGROUND

Emerging work examining the psychological impact of COVID-19 on children and families suggests that the relationship between pandemic-related stress, child psychosocial functioning, and caregiver mental health are interrelated. However, much of this research is unidirectional and thus little is known about the bidirectional cascading effects children and caregivers may experience. The current study examined the transactional relationships between caregiver and child mental health over time during the COVID-19 pandemic.

METHODS

Linguistically, racially, and ethnically diverse caregivers (N = 286) of young children completed measures of caregiver mental health, caregiver pandemic-related stress, and child mental health (i.e., externalizing, internalizing, prosocial behavior) across three time points in the spring of 2020.

RESULTS

Using autoregressive cross-lagged analyses, impaired caregiver mental health at Time 1 (April 2020) predicted increased caregiver pandemic-related stress at Time 2 (May 2020). Caregiver pandemic-related stress at Time 1 predicted increased child internalizing symptoms at Time 2 which, in turn, predicted increased caregiver pandemic-related stress at Time 3 (July 2020). Lastly, impaired caregiver mental health at Time 2 (May 2020) predicted increased child externalizing symptoms at Time 3 (July 2020).

CONCLUSIONS

Assessing transactional relationships between child and caregiver mental health during the COVID-19 pandemic is important to inform models of risk and resilience. Interventions at the level of the caregiver, the child, and/or the family should be considered as a way to interrupt potential negative developmental cascades.

Mediation of Mothers' Anxiety and Parenting in Children's Behavior Problems during COVID-19

The outbreak of COVID-19 is affecting the lives of millions of families around the world. The current study was carried out in Israel, following the pandemic's initial outbreak and during the resulting enforced quarantine, confining parents and children to their homes. A sample of 141 Israeli mothers with at least one child between the ages of 3 and 12 (M = 6.92, SD = 2.55) participated as volunteers. About half the sample (50.7%) consisted of girls. Most mothers were cohabiting with a spouse (93%). Mothers completed online questionnaires about their perceptions about the health and economic threats of COVID-19, availability of social support, their anxiety symptoms, hostile/coercive and supportive/engaged parenting behavior, and their children's behavior problems. Results showed expected significant associations between the mothers' reports about having little social support, their anxiety symptoms, hostile/coercive and supportive/engaged parenting behavior, and children's externalizing problems. Likewise, expected significant associations were found between mothers' perceptions about the health and economic threats of COVID-19, their anxiety symptoms, hostile/coercive parenting behavior, and children's internalizing and externalizing problems. Importantly, maternal anxiety and hostile/coercive parenting behavior mediated the associations between lack of support, negative perceptions about the health and economic threats of COVID-19, and children's behavior problems. These findings stress the importance of mothers' mental health and parenting behaviors for children's socioemotional adaptation in the context of COVID-19. Implications of the findings for family interventions intended to help parents and children at this time are suggested.

Creating "a Safe Haven": Emotion-Regulation Strategies Employed by Mothers and Young Children Exposed to Recurrent Political Violence

Growing evidence underscores the need to counteract the mental health risks for children growing up in traumatic situations of political violence. This study examined the concurrent emotional regulation (ER) strategies employed by mothers and their children in meeting this challenge. Following several incidents of rocket attacks, in southern Israel, we conducted semi-structured interviews with 30 mothers and their children (ages 5-7). Additionally, mothers completed the Emotion Regulation Questionnaire (Gross and John 2003). The main theme emerging from the qualitative analyses of the interviews with the children was adherence to the perception of the shelter room in the home as a "safe haven", supported by constructed knowledge and acquired skills related to physical safety, as well as the sense of emotional availability of their caregivers. The children used imagination, play and physiological regulation modeled by the mothers. The interviews with the mothers revealed their effort to convey a sense of calm and routine, even when these were interrupted. They used self-talk concerning the children's needs and tried to regulate their own physiological and psychological arousal. Mothers who expressed in the interviews satisfaction with the management of their ER reported significantly higher use of cognitive reappraisal strategies than those expressing dissatisfaction. Mothers help children construct meanings related to stressful events and teach and model evidence-based tactics for ER. Interventions for coping with a toxic reality should involve both psycho-education about children's needs and address mothers' own ER strategies, especially the use of cognitive reappraisal.

The Subjective Experiences and Reactions of Kindergarten Children during and after a Period of Continuous Missile Attacks

The current study focused on kindergarten children's coping strategies after trauma and PTSD resulting from exposure to emergency situations during the summer of 2014, when their town was under continuous missile attacks, in the south west part of Israel near the Gaza Strip. The study explored children's trauma by interviewing 150 kindergarten children (ages 4-6). We sought to present the children's voice and understand their point of view, their subjective experiences, and their ways of coping with traumatic situations. The interviews revealed that during and following the period of continuous missile attacks, the participants experienced fear and panic caused mainly by the strong and surprising noise of the alarm sirens, as well as difficulty sleeping. Engaging in activities, such as racing to and playing in the shelter, helped them cope with the fear. Furthermore, the presence of caregiving adults who provided calming information and emotional support helped the children's ability to cope with their anxiety.

A mixed-methods investigation of parent-child posttrauma discussion and the effects of encouraging engagement

Recent developments in the child trauma field include preventative interventions that focus on augmenting parental support. However, we have limited knowledge of how parents experience trauma conversations with children. We examined how parents and children experienced both spontaneous trauma conversations and a structured task in which they generated a joint trauma narrative, following the child's experience of an acute trauma. Parent and child ratings of distress during the structured narrative were low for all 127 families that took part, with child ratings of distress being lower overall than parent ratings. Task-related distress was positively associated with parent and child PTSD symptoms. Thematic analysis of semi-structured interviews conducted with a subset of twenty parents identified both facilitators of (e.g. open and honest relationship with child) and barriers to (e.g. parent/child avoidance of discussion) spontaneous trauma-related conversations with their child. Additionally, parents described the structured trauma narrative task as an opportunity to start the conversation with their child, to understand their child's feelings, and for the child to process the trauma. However, the task was also uncomfortable or upsetting for some parents/children, and resulted in parents becoming more overprotective. The findings can inform development of low-dose interventions that encourage families to engage in trauma-related conversations following child experiences of trauma.

Parent-Reported Child Reactions to the September 11, 2001 World Trade Center Attacks (New York USA) in Relation to Parent Post-Disaster Psychopathology Three Years After the Event

IntroductionParents are a primary support for children following disasters, even though they face numerous challenges in addressing the physical and social consequences of an event. Parents who are directly exposed to a disaster and those who develop psychiatric disorders post-event are likely to be especially challenged and may be limited in their ability to support their children. This Brief Report describes a pilot study of survivors of the September 11, 2001 World Trade Center (New York USA) attacks who reported their own psychosocial consequences and the reactions of their children three years post-event.HypothesesThe primary hypothesis of the study was that children's September 11th reactions would be associated with their parents' psychiatric status. Secondary hypotheses were that the children's disaster reactions would be associated with direct exposure to the disaster in children and/or their parents, parent-child separation due to the disaster, and disaster-related school absence.

METHODS

Approximately three years after the 2001 World Trade Center attacks, 116 parents recruited from disaster-affected or disaster-related organizations were assessed using structured diagnostic interviews and queried about their children's (188 youths, aged three to 17 years at the time of the attacks) posttraumatic stress symptoms and behavioral changes.

RESULTS

Almost one-half of the parents had a post-disaster psychiatric disorder, including major depression in 27% and disaster-related posttraumatic stress disorder (PTSD) in 11%. More than three-fourths of the children had at least one disaster-related posttraumatic stress symptom, and more than one-half experienced at least one post-disaster behavior change. A minority of the children were reported to have increased school behavior problems or a decline in their grades. Key correlates of children's disaster-related posttraumatic stress symptoms and post-disaster behavior changes were parent-child separation due to the disaster and parental post-disaster psychiatric disorders.

CONCLUSION

Because parents provide primary caretaking and support for children post-disaster, addressing the needs of parents is critical to their ability to assist their children. Reducing parents' symptoms should increase their emotional availability and enhance their ability to address the needs of their children. Given the challenges in providing disaster interventions directly to children, especially when resources are limited, addressing parent psychopathology and distress (even in the absence of focusing on children's symptoms) may benefit children. PfefferbaumB, SimicZ, NorthCS. Parent-reported child reactions to the September 11, 2001, World Trade Center attacks (New York USA) in relation to parent post-disaster psychopathology three years after the event. Prehosp Disaster Med. 2018;33(5):558-564.

Communication With Children and Families About Disaster: Reviewing Multi-disciplinary Literature 2015-2017

PURPOSE OF REVIEW

To identify strategies for communicating with youth and children pre- and post-disaster in the context of a broader survey of child participation in disaster risk reduction as well as methods for communication with children.

RECENT FINDINGS

Youth and children are capable of peer and community education and activism concerning disaster issues and such participation benefits the young actors. Family and sibling support are important in easing the impact of trauma on children. Contemporary forms of psychological first aid appear to do no harm and in line with current evidence. Generally, more evidence from evaluations is necessary to guide the development of communication strategies. Children are growing up in increasingly urban environments with less contact with nature and greater reliance on techno-social systems. Thus, young people may misunderstand natural hazards. Schools and conscious parenting can play important roles in building understanding and psychological resilience.

Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquakes

BACKGROUND

In 2015, Nepal was hit by two major earthquakes, which caused 8900 deaths and displaced more than 450,000 people. We assessed the prevalence of post-traumatic stress symptoms (PTSS) and depressive symptoms and explored potential risk factors among adolescents.

METHODS

This cross-sectional study comprised 893 students aged 11-17 in school grades 7-10. They lived in two districts affected by the earthquakes: Sindhupalchok and Kathmandu. Psychiatric symptoms were assessed using Child PTSD symptom scale and Depression Self-Rating Scale. Multiple logistic regression analysis examined the associations between demographic, earthquake-related factors and psychiatric symptoms.

RESULTS

The prevalence of PTSS in the Sindhupalchok and Kathmandu districts were 39.5% and 10.7%, and depression symptoms were 40.4% and 23.2% respectively. The moderating effect of gender on the relationship between age and PTSS was significant. In the multivariate logistic analyses, the factors associated with PTSS and depression were: being female, prior exposure to trauma and being directly affected by the earthquakes.

LIMITATIONS

Due to the lack of pre-earthquake prevalence rates, our estimates may have been due to chronic long-lasting problems of poverty and lack of access to physical and mental health services. The use of self-reported questionnaires might have overestimated the prevalence rates compared to psychiatric interviews.

CONCLUSIONS

One year after the earthquakes, adolescents living in Sindhupalchok had a higher prevalence of PTSS and depressive symptoms than those living in Kathmandu. Socio-economic and earthquake-related factors were associated with psychiatric outcomes. The findings indicate the need for early psychosocial interventions, prevention and future research after emergency relief.

A longitudinal investigation of the role of parental responses in predicting children's post-traumatic distress

BACKGROUND

While parental post-trauma support is considered theoretically important for child adjustment, empirical evidence concerning the specific aspects of parental responding that influence child post-traumatic distress, or the processes via which any such impacts occur, is extremely limited. We conducted a longitudinal examination of whether parental post-trauma appraisals, trauma-specific support style and general parenting style predicted child post-traumatic stress symptom severity (PTSS) following trauma; and whether such influences operated via the child's own appraisals and coping style.

METHOD

We recruited 132 parent-child pairs following children's experience of acute trauma. We examined whether parental responses assessed at 1-month post-trauma, predicted child PTSS at 6-month follow-up. Parental trauma-specific appraisals and responses, and general parenting style, were assessed via both self-report and direct observations. Child-report questionnaires were used to assess PTSS and potential mediators.

RESULTS

Initial parent negative appraisals and encouragement of avoidant coping were associated with higher child-reported PTSS at 6-month follow-up. Predictive effects were maintained even when controlling for initial child symptom levels. Observational assessments broadly supported conclusions from self-report. There was evidence that parental influences may operate, in part, by influencing the child's own appraisals and coping responses. In contrast, there was no evidence for an influence of more "adaptive" support or general parenting style on child PTSS.

CONCLUSIONS

Findings provide important insight into how elements of social support may influence child post-trauma outcomes.

Parental responses to child experiences of trauma following presentation at emergency departments: a qualitative study

OBJECTIVE

Parents are often children's main source of support following fear-inducing traumatic events, yet little is known about how parents provide that support. The aim of this study was to examine parents' experiences of supporting their child following child trauma exposure and presentation at an emergency department (ED).

DESIGN

Semistructured qualitative interviews analysed using thematic analysis.

SETTING

The setting for this study was two National Health Service EDs in England.

PARTICIPANTS

20 parents whose child experienced a traumatic event and attended an ED between August 2014 and October 2015.

RESULTS

Parents were sensitive to their child's distress and offered reassurance and support for their child to resume normal activities. However, parental beliefs often inhibited children's reinstatement of pretrauma routines. Support often focused on preventing future illness or injury, reflective of parents' concerns for their child's physical well-being. In a minority of parents, appraisals of problematic care from EDs contributed to parents' anxiety and perceptions of their child as vulnerable post-trauma. Forgetting the trauma and avoidance of discussion were encouraged as coping strategies to prevent further distress. Parents highlighted their need for further guidance and support regarding their child's physical and emotional recovery.

CONCLUSIONS

This study provides insight into the experiences of and challenges faced by parents in supporting their child following trauma exposure. Perceptions of their child's physical vulnerability and treatment influenced parents' responses and the supportive strategies employed. These findings may enable clinicians to generate meaningful advice for parents following child attendance at EDs post-trauma.

The Role of Parents, Parenting and the Family Environment in Children's Post-Disaster Mental Health

There is widespread support for the hypothesis that, post-disaster, children's mental health is impacted--at least in part--via the impact on parents, parenting, parent-child interactions, and the family environment. To some degree, the enthusiasm with which this hypothesis is held outstrips the evidence examining it. The current paper critically evaluates the empirical evidence for this hypothesis and concludes that although limited (both in terms of number of existing studies and methodological flaws), the extant literature indicates some parent-related variables, as well as some aspects of the family environment are likely to constitute risk or protective factors for children. Given that parenting is modifiable, it is proposed that the identified parent- and family-related factors represent important therapeutic targets, and a universal post-disaster parenting intervention (Disaster Recovery Triple P) is described.

Children's disaster reactions: the influence of family and social factors

This review examines family (demographics, parent reactions and interactions, and parenting style) and social (remote effects, disaster media coverage, exposure to secondary adversities, and social support) factors that influence children's disaster reactions. Lower family socioeconomic status, high parental stress, poor parental coping, contact with media coverage, and exposure to secondary adversities have been associated with adverse outcomes. Social support may provide protection to children in the post-disaster environment though more research is needed to clarify the effects of certain forms of social support. The interaction of the factors described in this review with culture needs further exploration.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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