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

Efficacy of repeated intravenous esketamine in adolescents with anxious versus non-anxious depression

Background

Patients with anxious major depressive disorder (MDD) are more likely to have poorer outcomes than those with non-anxious MDD. However, the effect of esketamine on adolescents with anxious versus non-anxious MDD has remained unknown.

Aims

We compared the efficacy of esketamine in adolescents with MDD and suicidal ideation, both anxious and non-anxious.

Methods

Fifty-four adolescents with anxious (n=33) and non-anxious (n=21) MDD received three infusions of esketamine 0.25 mg/kg or active-placebo (midazolam 0.045 mg/kg) over 5 days, with routine inpatient care and treatment. Suicidal ideation and depressive symptoms were assessed using the Columbia Suicide Severity Rating Scale and the Montgomery-Åsberg Depression Rating Scale. Multiple-sample proportional tests were used to compare the differences between groups on treatment outcomes 24 hours after the final infusion (day 6, primacy efficacy endpoint) and throughout the 4-week post-treatment (days 12, 19 and 33).

Results

In subjects who received esketamine, a greater number of patients in the non-anxious group than the anxious group achieved antisuicidal remission on day 6 (72.7% vs 18.8%, p=0.015) and day 12 (90.9% vs 43.8%, p=0.013), and the non-anxious group had a higher antidepressant remission rate compared with the anxious group on day 33 (72.7% vs 26.7%, p=0.045). No significant differences in treatment outcomes were observed between the anxious and non-anxious groups at other time points.

Conclusions

Three infusions of esketamine as an adjunct to routine inpatient care and treatment had a greater immediate post-treatment antisuicidal effect in adolescents with non-anxious MDD than in those with anxious MDD; however, this benefit was temporary and was not maintained over time.

Trial registration number

ChiCTR2000041232.

Beliefs About Traumatic Memories, Thought Control Strategies, and the Impact on PTSD Symptoms After a Natural Disaster

ABSTRACT

This study aimed to investigate the relationships among self-reported meta-memory beliefs, thought control strategies ( i.e. , distraction, reappraisal, worry, social control, and punishment), and posttraumatic stress disorder (PTSD) symptomology, among a sample of earthquake survivors ( N = 412). Correlational analysis and structural equation modeling were used on the responses and showed that stronger positive and negative meta-memory beliefs, and greater worry and punishment, were associated with greater PTSD symptom severity. The results also indicated that meta-memory beliefs had a prominent indirect influence toward PTSD symptomology via their effects toward thought control strategies. Follow-up analysis of variance indicated that those with a history of mental health difficulties reported higher levels of PTSD symptom severity, were more likely to score in the range of clinically relevant PTSD, and had a stronger tendency to negatively appraise unwanted thinking styles. The results of this research provide overall support for the validity of the metacognitive model for PTSD.

PTSD and depressive symptoms in Chinese adolescents exposed to multiple stressors from natural disasters, stressful life events, and maltreatment: A dose-response effect

Objectives

Little is known about the effects and the extent that childhood adversity has on post-traumatic stress disorder (PTSD) and depression.

Study design

A population-based, epidemiological study from the Wenchuan earthquake.

Methods

A total of 5,195 Wenchuan Earthquake adolescent survivors aged 11-18 years from nine high schools in southwest China completed questionnaires that assessed their PTSD and depression symptoms due to childhood maltreatment, stressful life events, and childhood earthquake exposure.

Results

The PTSD and depression prevalences were 7.1 and 32.4%. After controlling for age and gender, the multiple linear regressions revealed that stressful life events had the most significant direct effect on depression (β = 0.491), followed by childhood emotional abuse (β = 0.085), and earthquake exposure (β = 0.077). Similarly, stressful life events (β = 0.583) were found to have more significant direct effects on PSTD, followed by earthquake exposure (β = 0.140); however, childhood emotional abuse was not found to have an effect. The structural equation modeling (SEM) revealed that there were interactions between the three childhood adversities, with all three concurrently affecting both PTSD and depression.

Conclusion

These findings add weight to the supposition that psychological maltreatment, negative life events, and earthquake exposure contribute to PTSD and depression. In particular, the identification of subgroups that have a high prevalence of these childhood adversities could assist professionals to target populations that are at high risk of mental health problems.

Latent classes of posttraumatic stress disorder among survivors of the Bam Earthquake after 17 years

BACKGROUND

The purpose of this study was to identify latent classes of the severity of post-traumatic stress disorder (PTSD) among the survivors of the earthquake in Bam, south-eastern Iran, 17 years after the disaster. The most influential predictor variables of PTSD classes were also investigated.

METHODS

Eight hundred survivors of the Bam earthquake who were at least four years old in that disaster were selected by multistage sampling. The PTSD Checklist-Civilian Version was used. Latent class analysis was performed to identify subgroups of people with different PTSD symptom profiles. Latent class regression analysis was used to explore the influence of demographic and traumatic variables on each class membership.

RESULTS

We found three latent classes of PTSD, with the following profiles emerging: Low Symptom (56.6% of the participants), Moderate Symptom (23.5%), and Severe Symptom (19.9%). Old age [OR = 2.20, 95% CI = (1.46, 3.32)], physical injury [OR = 1.95, 95% CI = (1.24, 3.06)], being trapped under the rubble [OR = 1.81, 95% CI = (1.15, 2.86)], and death of a family member [OR = 1.86, 95% CI = (1.12, 3.09)] were positive risk factors for PTSD and increased the chance of being in classes having more severe symptoms. Having a high educational level was a negative risk factor [OR = 0.86, 95% CI = (0.67, 1.11)].

CONCLUSIONS

The severity of PTSD 17 years after the earthquake shows that natural disasters such as earthquakes have long-term consequences, and earthquake survivors must have psychological support and long term health care. After any catastrophic earthquake, governments should establish psychology and psychotherapy centers for earthquake victims, and these centers should support earthquake victims for a sufficiently long time.

Effects of Trait Anxiety on Error Processing and Post-error Adjustments: An Event-Related Potential Study With Stop-Signal Task

The present study aimed to use event-related potentials with the stop-signal task to investigate the effects of trait anxiety on inhibitory control, error monitoring, and post-error adjustments. The stop-signal reaction time (SSRT) was used to evaluate the behavioral competence of inhibitory control. Electrophysiological signals of error-related negativity (ERN) and error positivity (Pe) were used to study error perception and error awareness, respectively. Post-error slowing (PES) was applied to examine the behavioral adjustments after making errors. The results showed that SSRT and PES did not differ significantly between individuals with high trait anxiety (HTA) and those with low trait anxiety (LTA). However, individuals with HTA demonstrated reduced ERN amplitudes and prolonged Pe latencies than those with LTA. Prolonged Pe latencies were also significantly associated with poorer post-error adjustments. In conclusion, HTA led to reduced cortical responses to error monitoring. Furthermore, inefficient conscious awareness of errors might lead to maladaptive post-error adjustments.

The metacognitive model of post-traumatic stress disorder and metacognitive therapy for post-traumatic stress disorder: A systematic review

The metacognitive model of post-traumatic stress disorder (PTSD) implicates metacognitive beliefs, meta-memory beliefs and metacognitive control strategies in perpetuating and maintaining symptoms of PTSD. Despite this expanding area of research, the evidence for the metacognitive model of PTSD has not been reviewed. A systematic review according to the PRISMA statement was conducted. Searches across MEDLINE, PubMed and PsycNET, as well as reference lists of the included studies (2004 to March 2020), yielded 221 records. Two independent reviewers screened articles, which were included where the impact of the constructs of interest on PTSD symptoms was investigated within the framework of the metacognitive model for PTSD. Eighteen articles were included in the review. Eleven studies were determined to have good methodological robustness. Metacognitive therapy for PTSD demonstrated reductions in symptoms from pretreatment to post-treatment, which were maintained at follow-up. Predictors of greater PTSD symptom severity included metacognitive beliefs, meta-memory beliefs, and worry, punishment, thought suppression, experiential avoidance, and rumination. Overall, support was found for the validity of the metacognitive model of PTSD.

Evaluating the Prevalence of PTSD among Children and Adolescents after Earthquakes and Floods: a Systematic Review and Meta-Analysis

Our study systematically reviews articles about the prevalence of Post-traumatic Stress Disorder (PTSD) among children and adolescents, aiming to evaluate its prevalence after earthquakes and floods.Three databases (PubMed, Scopus, and Web of Science) were searched for articles published from 1981 to 2019 containing information on PTSD prevalence among survivors of earthquakes and floods. Articles with insufficient data on the prevalence of PTSD or without any available full-text were excluded. Major study variables consist of the prevalence of PTSD of the included studies, gender, and the elapsed time after the disaster. The overall PTSD prevalence was determined using a fixed-effect model for eligible studies. Of 4107 studies listed using our search strategy, 439 underwent full-text review, 59 records included in the systematic review, and 39 records met the criteria for meta-analysis. The pooled prevalence of PTSD among children and adolescent survivors after earthquakes and floods was 19.2% (95%CI = 18.6-19.7%), 30.0% (95%CI = 29.5-30.6%), 24.4% (95%CI = 23.4-25.4%) and 20.4% (95%CI = 19.1-21.7%), in the first, second, third and fourth six-month intervals after the disaster, respectively. Our analysis also revealed that PTSD was more prevalent among girls (p < 0.001). The absence of psychological support for affected areas considerably increases the risk of PTSD among survivors. Our results indicated that children and adolescents, especially girls, are more vulnerable and should be in top priority. The governments should refine their policies on post-disaster services and run early screening, immediate intervention, and ongoing monitoring for PTSD, as well as mental and emotional supports.

A network analysis of posttraumatic stress disorder and dissociation in trauma-exposed adolescents

Posttraumatic stress disorder (PTSD) and dissociation have long been recognized to co-occur, leading the DSM-5 to introduce a dissociative subtype of PTSD into its nomenclature. Most research to date on the dissociative subtype has focused on adults. The current study aimed to extend this research to an adolescent sample and to examine symptom-level associations between PTSD and dissociation using network analysis. The analysis was conducted with 448 trauma-exposed detained US adolescents (24.55% female; mean age 15.98 ± 1.25 years). A network consisting of 20 DSM-5 PTSD symptoms was constructed, followed by a network consisting of 20 PTSD symptoms and five dissociative items. Expected influence bridge centrality was estimated to examine items with the most/strongest cross-construct connections (i.e. between PTSD and dissociation). The PTSD symptoms concentration problems, amnesia and recurrent memories and the dissociative items depersonalization, derealisation and can't remember things that happened had the highest bridge centrality values. These symptom-level associations extend our understanding of the PTSD-dissociation relationship by pointing to specific symptoms of PTSD and dissociation that may drive the co-morbidity between the two constructs. These findings may inform future intervention efforts.

The Association between General and Pathological Dissociation and Disaster-Related Psychopathology in Directly Exposed Survivors

Objective: Dissociation and trauma have a well-documented relationship, and dissociation is assumed to result from trauma exposure. If trauma generates dissociative psychopathology, it should be observed after exposure to disaster and be associated with disaster-related psychopathology. Few studies have focused specifically on dissociation as an outcome of disaster trauma. This study examined dissociation and its association with disaster-related psychopathology in survivors of five different disasters. Methods: In the first 6 postdisaster months, directly exposed survivors (N = 216) of mass shootings, floods, or a firestorm completed structured diagnostic interviews providing lifetime predisaster and postdisaster prevalent/incident psychiatric diagnoses and the Dissociative Experiences Scale (DES) 1-3 years after baseline. Results: DES scores were very low; only 1% met the DES Taxon signifying pathological dissociation. In multivariate models including predisaster lifetime major depression, lifetime panic disorder, lifetime generalized anxiety disorder, and lifetime alcohol use disorder; disaster-related PTSD; and number of incident somatoform symptoms as independent covariates, predisaster lifetime major depression and alcohol use disorder were independently associated with both general (DES score) and pathological (DES Taxon) dissociation, and postdisaster incident somatization symptoms were also associated with general dissociation, but postdisaster psychopathology including disaster-related PTSD was not associated with general or pathological dissociation. Conclusions: Neither general nor pathological dissociation was independently associated with disaster-related PTSD or other incident psychopathology. The only psychiatric disorders associated with dissociation were present before the disasters. Coupled with the low dissociation rates, these findings indicate that dissociation does not appear to be a mental health outcome of disaster trauma.

Dissociation and disasters: A systematic review

BACKGROUND

Dissociation, which is defined as the failure to associate consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior into an integrated whole, has long been assumed to be generated by trauma. If dissociation is a product of trauma exposure, then dissociation would be a major mental health outcome observed in studies of disaster survivors. Although some studies have examined dissociation in disasters, no systematic literature reviews have been conducted to date on the topic.

AIM

To systematically evaluate the literature on the association between disaster and dissociation to determine the prevalence and incidence of dissociation after exposure to disaster and further examine their relationship.

METHODS

EMBASE, Medline, and PsychINFO were searched from inception to January 1, 2019 to identify studies examining dissociative disorders or symptoms related to a disaster in adult or child disaster survivors and disaster responders. Studies of military conflicts and war, articles not in English, and those with samples of 30 or more participants were excluded. Search terms used were “disaster*” and dissociation (“dissociat*,” “multiple personality,” “fugue,” “psychogenic amnesia,” “derealization,” and “depersonalization”). Reference lists of identified articles were scrutinized to identify studies for additional articles.

RESULTS

The final number of articles in the review was 53, including 36 articles with samples of adults aged 18 and above, 5 of children/adolescents under age 18, and 12 of disaster workers. Included articles studied several types of disasters that occurred between 1989 and 2017, more than one-third (38%) from the United States. Only two studies had a primary aim to investigate dissociation in relation to disaster and none reported data on dissociative disorders. All of the studies used self-report symptom scales; none used structured interviews providing full diagnostic assessment of dissociative disorders or other psychopathology. Several studies mixed exposed and unexposed samples or did not differentiate outcomes between exposure groups. Studies examining associations between dissociation and disaster exposure have been inconclusive. The majority (75%) of the studies compared dissociation with posttraumatic stress, with inconsistent findings. Dissociation was found to be associated with a wide range of other psychiatric disorders, symptoms, and negative emotional, cognitive, and functional states.

CONCLUSION

The studies reviewed had serious methodological limitations including problems with measurement of psychopathology, sampling, and generation of unwarranted conclusions, precluding conclusions that dissociation is an established outcome of disaster.

The Metacognitions Questionnaire and Its Derivatives in Children and Adolescents: A Systematic Review of Psychometric Properties

Background: The Metacognitions Questionnaire (MCQ) and its derivatives have been instrumental in research examining the Self-Regulatory Executive Function Model in adults. Studies testing whether findings are applicable to children and adolescents have been increasing and several different measures adapting the MCQ for younger populations have been developed. The current study aimed to systematically review the psychometric properties of MCQ measures or derivatives used in young people (aged 18 or less), to help assess current findings in this population and to guide future research in this growing area of investigation. Method: Systematic searches were carried out on PubMed and PsycINFO of studies published up to June 2018. Additional studies were identified through Google Scholar and article references. Validity, reliability, range and responsiveness of measures were examined as well as analyses of age and gender differences on scores. Results: Forty-five articles were identified. The total sample consisted of 7,803 children and adolescents (6,922 non-clinical, 881 clinical) aged 7-18. Studies used one of seven versions of the questionnaire, five adapted from the MCQ for younger populations: (1) The Metacognitions Questionnaire-Adolescent version; (2) The Metacognitions Questionnaire-Child version; (3) The Metacognitions Questionnaire-Child Version-Revised; (4) The Metacognitions Questionnaire-Child-30; and (5) The Metacognitions Questionnaire-65 Positive Beliefs Scale Revised; and two adult versions used without adaptation: (1) The Metacognitions Questionnaire-30 and (2) The Cognitive Self Consciousness Scale-Expanded. The validity and reliability of the Metacognitions Questionnaire-Adolescent version had the most extensive support. Other questionnaires had either mixed psychometrics or promising initial findings but more limited data. Conclusions: It is recommended that studies using adolescents (age 12-18) consider using the Metacognitions Questionnaire-Adolescent version. Based on initial data, it is suggested studies using younger populations should consider the Metacognitions Questionnaire-Child-30 but further psychometric research into this and other measures is needed.

A study of dissociation in survivors of 5 disasters

This study examined dissociation as an outcome to disaster in dissociative data collected from 423 highly-exposed survivors of 5 different disasters using consistent methodology. Ten items selected for conceptual relevance to disaster experience were administered from the Dissociative Disorders Interview Schedule, a structured interview for lifetime dissociative disorders. Structured psychiatric interviews provided data on incident somatization symptoms, disaster-related PTSD, and lifetime predisaster psychopathology. The Temperament and Character Inventory assessed personality. Observed levels of dissociation were low and not usually postdisaster. Dissociation level was associated with female sex, number of incident somatization symptoms, personality (underdeveloped executive functioning), PTSD, and predisaster psychopathology in bivariate analyses. In multiple linear regression models, dissociation was associated with the low number of incident somatoform symptoms observed independent of the effects of PTSD, hyperarousal specifically (but not intrusion or avoidance/numbing), personality, predisaster psychopathology, and demographic variables which were not independently associated with dissociation. The low levels of dissociation found in this study and the lack of association between dissociation and indicators of psychopathology point to a largely nonpathological nature of the dissociative phenomena measured. These findings do not indicate the development of dissociative psychopathology as a prevalent mental health outcome of disasters.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

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

CONCLUSION

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

Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q)

A growing body of research evidence documents the substantial associations between obsessive-compulsive disorder (OCD) and dissociation. This article describes the development and preliminary psychometric properties of the Van Obsessional Dissociation Questionnaire (VOD-Q). Obsessional dissociation is defined as a tendency to dissociate in reaction to distressing, unwanted and intrusive thoughts, images and impulses. The screening tool is conceptualized to tap obsessional dissociation across three dimensions: obsessional absorption, obsessional depersonalization/ derealization and obsessional amnesia. The VOD-Q, the Padua Inventory-Revised (PI-R), the Dissociative Experiences Scale (DES), and the Obsessive Belief Questionnaire (OBQ-44) were administered in this study. The results showed that the VOD-Q had excellent test-retest reliability (ranging from 0.73 to 0.90) and internal consistency (ranging from 0.90 to 0.97). The VOD-Q total and subscale scores were significantly associated with measures of obsessive-compulsive symptoms and dissociative experiences. OCD patients scored significantly higher on the VOD-Q than community participants. Based on the present findings, the VOD-Q appears to be a reliable and valid instrument for the measurement of obsessional dissociative experiences.

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.

D allele of insertion/deletion polymorphism at angiotensin-converting enzyme gene is associated with reduced prevalence and severity of depression among Chinese adolescents at early stage after Wenchuan earthquake

OBJECTIVE

The purpose of the present study was to longitudinally investigate the association of insertion/deletion (I/D) polymorphism at angiotensin-converting enzyme gene (ACE) with depression in Chinese adolescents experiencing the 2008 Wenchuan earthquake.

METHODS

Variants of ACE I/D were identified by polymerase chain reaction and verified by DNA sequencing. Depression symptoms were assessed by the Beck Depression Inventory (BDI) among high school students at 6, 12 and 18 months after the earthquake.

RESULTS

The D-allele carriers had lower depression prevalence than II homozygotes at 6, 12 and 18 months after the earthquake only in females, but not in males. Meanwhile, BDI scores were reduced in the female D-allele carriers when compared with those in the female II homozygotes at 6 and12 months after the earthquake. In addition, ACE I/D was found to be the predictors of BDI scores and depression prevalence at 6 and 12 months after the earthquake.

CONCLUSIONS

These results suggest that the association of ACE I/D with depression are longitudinally different in Chinese Han adolescents after the 2008 Wenchuan earthquake. The D allele may be associated with reduced depression prevalence and severity in female adolescents in the early stage of depression rehabilitation during the follow-up.

Reduced Recovery of Depression in Female T Allele Carriers of TNF-RII rs1061622 at Earlier Stage after Wenchuan Earthquake

Objective: The aim of current study was to explore longitudinally the prevalence, severity, potential factors, and predictors of depression among Chinese Han adolescent survivors with different genotypes of tumor necrosis factor receptor-II (TNF-RII) rs1061622 after the 2008 Wenchuan earthquake. Method: TNF-RII rs1061622 variants were examined by polymerase chain reaction–restriction fragment length polymorphism and verified by DNA sequencing. Depression symptoms were assessed by Beck Depression Inventory (BDI) among 439 high school students at 6, 12, and 18 months after the earthquake. Results: No significant differences were observed in depression prevalence and BDI scores between the TT homozygotes and the G allele carriers in both the male and female subjects. However, the female TT homozygotes had a higher depression prevalence than the male TT homozygotes at 6, 12, and 18 months, whereas the female G allele carriers had a higher depression prevalence than the male G allele carriers only at 6 and 12 months after the earthquake. Moreover, BDI scores declined in the male subjects with both genotypes and only in the female G allele carriers at 12 months when compared with those at 6 months. Furthermore, the predictors of depression severity or potential factors of depression prevalence were different between the G allele carriers and the TT homozygotes at different times after the earthquake. Conclusion: It is concluded that the association of TNF-RII rs1061622 with depression is longitudinally different in Chinese Han adolescents after the 2008 Wenchuan earthquake. The T allele may be associated with reduced recovery of depression in female adolescents in the earlier stage of depression rehabilitation.

A Meta-Analysis of Risk Factors for Post-Traumatic Stress Disorder (PTSD) in Adults and Children after Earthquakes

PTSD is considered the most common negative psychological reactions among survivors following an earthquake. The present study sought to find out the determinants of PTSD in earthquake survivors using a systematic meta-analysis. Four electronic databases (PubMed, Embase, Web of Science, and PsycInfo) were used to search for observational studies about PTSD following earthquakes. The literature search, study selection, and data extraction were conducted independently by two authors. 52 articles were included in the study. Summary estimates, subgroup analysis, and publication bias tests were performed on the data. The prevalence of PTSD after earthquakes ranged from 4.10% to 67.07% in adults and from 2.50% to 60.00% in children. For adults, the significant predictors were being female, low education level or socio-economic status, prior trauma; being trapped, experiencing fear, injury, or bereavement during the disaster. For children, the significant predictors were being older age, high education level; being trapped, experiencing fear, injury, or bereavement, witnessing injury/death during the earthquakes. Our study provides implications for the understanding of risk factors for PTSD among earthquake survivors. Post-disaster mental health recovery programs that include early identification, on-going monitoring, and sustained psychosocial support are needed for earthquake survivors.

Association of Val66Met polymorphism at brain derived neurotrophic factor gene with depression among Chinese adolescents after Wenchuan earthquake: An 18months longitudinal study

To longitudinally investigate the association of Val66Met polymorphism at brain derived neurotrophic factor (BDNF) gene (BDNF) with depression in Chinese Han adolescents after the 2008 Wenchuan earthquake, BDNF Val66Met was identified by polymerase chain reaction-restriction fragment length polymorphism analyses and verified by DNA sequencing. Depression was assessed by Beck Depression Inventory (BDI) among high school students at 6, 12 and 18months after the earthquake. The results showed that the females constantly had higher depression prevalence than the males during the follow-up in the Met allele carriers, but not in the Val/Val homozygotes. When compared to that at 6months, the prevalence was lowered at 12months in the male Met allele carriers, and at 18months in all the females and the male Met allele carriers. Moreover, the Met allele carriers had higher BDI scores than the Val/Val homozygotes only in the females at 18months. The females had higher BDI scores than the males constantly during the follow-up in the Met allele carriers and at 12months only in the Val/Val homozygotes. When compared to those at 12months, the scores decreased at 18months in all the females and the male Met allele carriers. In addition, the potential factors of prevalence or predictors of severity of depression were different between the Val/Val homozygotes and the Met allele carriers at different times after the earthquake. The results suggest that interactions may occur after stresses among BDNF Val66Met, gender and time course to influence depression. This may be one of the explanations for the inconsistent relationships reported before between depression and BDNF Val66Met and need to take into account for precision medical and more effective interference of depression in adolescents after disasters.

Mental health problems among children and adolescents experiencing two major earthquakes in remote mountainous regions: A longitudinal study

OBJECTIVE

Millions of children were exposed to major earthquake in China, with serious psychological and developmental consequences. To obtain accurate rate of post-disaster related disorder and identify predictors may help inform post-disaster rescue and rehabilitation efforts. The present longitudinal study explored correlations of demographic and socioeconomic characteristics of juvenile survivors of the Ya'an and Wenchuan earthquakes in China with their trajectories of post-disaster related disorder.

METHODS

A total of 435 Chinese children and adolescents who survived the 2013 Ya'an earthquake were recruited from six primary, secondary and high schools in Baoxing County. All survivors were assessed at 12months after the disaster, when a trained psychiatrist assessed mental health problems in a face-to-face structured interview, and 153 survivors were followed up at 30months after the earthquake via telephone.

RESULTS

The 12-month assessment indicated a post-traumatic stress disorder (PTSD) prevalence of 43.9% as well as depression (20.9%) or the criteria for both PTSD and depression (18.2%) and the other disorder (0.9%). The 30-month assessment indicated that 15.7% of subjects met the criteria for PTSD, 21.6% met the criteria for depression. No subjects met the criteria for other affective or anxiety disorders. Significant predictors of PTSD and depression were death in the family, previous earthquake experience, a poor parent-child relationship and economic pressure or poverty.

LIMITATIONS

Clinical interview face to face is quite different from via telephone and the attrition rate in the longitudinal cohort is high, which would directly affect our results of the assessment.

CONCLUSIONS

PTSD and depression may be as prevalent and persistent in disaster victims in China as elsewhere, and high co-comorbidities remain poorly understood. Although many adolescents recover over time, some exhibit chronic, delayed-onset PTSD and depression, especially those with poor relationships with their parents or those living in precarious economic conditions. Family-based therapy may be needed to support child and adolescent trauma survivors in order to prevent mental illness.

Long-Term Fluctuations in Traumatic Symptoms of High School Girls Who Survived from the 2011 Japan Tsunami: Series of Questionnaire-Based Cross-Sectional Surveys

On March 11, 2011, Japan was struck by a massive earthquake and tsunami. The tsunami caused tremendous damage and traumatized children. We aimed to evaluate and compare the changes in the traumatic symptoms of high school girls 8, 20, 30, and 42 months after the 2011 tsunami. The Post-Traumatic Stress Symptoms for Children 15 items (PTSSC-15), a self-rating questionnaire on traumatic symptoms, was administered to 811 high school girls at the above-mentioned intervals. We calculated the total score, post-traumatic stress disorder (PTSD) subscale, and depression subscale of PTSSC-15. The total score was correlated with house damage, evacuation experience, and bereavement experience. The PTSSC-15 total scores of high school girls with traumatic experience were significantly higher than the scores of children without these experiences (all p < 0.0001). The PTSSC-15 total score did not decrease significantly over time. Furthermore, the PTSD subscale of the PTSSC-15 did not significantly improved over the study duration. However, the depression subscale of the PTSSC-15 significantly improved at 30 months, but significantly worsened at 42 months (both p < 0.0001). This study demonstrates that the traumatic symptoms of high school girls who survived the massive tsunami fluctuated unpredictably with time. Nonetheless, high school girls continued to suffer depressive symptoms (insomnia, withdrawal, appetite loss, inattention, and physical symptoms) after 42 months.

Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

BACKGROUND

Post-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions.

METHODS

Self-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes.

RESULTS

PTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender.

LIMITATIONS

The unequal distribution of male (78%) and female patients (22%) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time.

CONCLUSIONS

In cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.

The incidence of post-traumatic stress disorder among survivors after earthquakes:a systematic review and meta-analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a common psychological disorder caused by unusual threats or catastrophic events. Little is known about the combined incidence of PTSD after earthquakes. This study aimed at evaluating the combined incidence of PTSD among survivors after earthquakes using systematic review and meta-analysis.

METHODS

The electronic databases of PubMed, Embase, Web of Science and PsycARTICLES were searched for relevant articles in this study. Loney criteria were used to assess the quality of eligible articles. The combined incidence of PTSD was estimated by using the Freeman-Tukey double arcsine transformation method. Subgroup analyses were conducted using the following variables: the time of PTSD assessment, gender, educational level, marital status, damage to one's house, bereavement, injury of body and witnessing death.

RESULTS

Forty-six eligible articles containing 76,101 earthquake survivors met the inclusion criteria, of which 17,706 were diagnosed as having PTSD. Using a random effects model, the combined incidence of PTSD after earthquakes was 23.66 %. Moreover, the combined incidence of PTSD among survivors who were diagnosed at not more than 9 months after earthquake was 28.76 %, while for survivors who were diagnosed at over nine months after earthquake the combined incidence was 19.48 %. A high degree of heterogeneity (I(2) = 99.5 %, p<0.001) was observed in the results, with incidence ranging from 1.20 to 82.64 %. The subgroup analyses showed that the incidence of PTSD after earthquake varied significantly across studies in relation to the time of PTSD assessment, gender, educational level, damage to one's house, bereavement, injury of body and witnessing death. However, stratified analyses could not entirely explain the heterogeneity in the results.

CONCLUSIONS

Given the high heterogeneity observed in this study, future studies should aim at exploring more possible risk factors for PTSD after earthquakes, especially genetic factors. In spite of that, the results of this study suggest that nearly 1 in 4 earthquake survivors are diagnosed as having PTSD. Therefore, the local government should plan effective psychological interventions for earthquake survivors.

Children's Cognitive Functioning in Disasters and Terrorism

A growing literature has begun to address the cognitions that influence children's disaster reactions as well as the effects of disasters on children's cognitions. These cognitions must be viewed in the context of developmental and cultural considerations as well as disaster-related factors such as exposure and secondary stressors. This review examines the extant literature on children's cognitions related to disasters and terrorism including threat appraisal, beliefs, attention and concentration, memory, academic achievement, and executive functioning. The review highlights areas where research is lacking such as the effect of disasters on children's attention, concentration, content of disaster memories, and executive functioning. It also notes findings that may advance post-disaster screening and intervention.

Relationships between posttraumatic stress disorder (PTSD), dissociation, quality of life, hopelessness, and suicidal ideation among earthquake survivors

Researches have demonstrated that Posttraumatic stress disorder (PTSD) is one of the most common stress reactions in the face of disasters and significantly associated with a broad range of trauma-induced sequelaes including anxiety, depression, suicidality as well as functional impairments. To date, though many aspects of risk factors with respect to the development and maintenance of PTSD have been addressed, mediating role of dissociation has received relatively less attention. In the present study, we examined relations of PTSD with quality of life, hopelessness, suicidal ideation, and mediational effect of pathological dissociation in these connections. 583 subjects most of whom experienced a severe earthquake participated in the study after two years of the disaster. We found that being female, being single, earthquake exposure, and having greater suicidal ideation were significant predictors of PTSD symptom severity. Role-Physical, Bodily-Pain, General Health and Role-Emotional subscales of the SF-36 were inversely associated with PTSD symptom severity. Pathological dissociation significantly mediated the substantial associations between predictors and PTSD symptom clusters. Chronic dissociation appears to put trauma exposed individuals in jeopardy of prolonged posttraumatic reactions by mediating the negative influences of risk factors in the face of experienced earthquake.

Relations between Post-traumatic Stress Disorder, Dissociation and Attention-Deficit/Hyperactivity Disorder among Earthquake Survivors

INTRODUCTION

There is a burgeoning interest in relations between post-traumatic stress disorder (PTSD) and attention-deficit/hyperactivity disorder (ADHD). Although few studies were conducted, weak evidence was found supporting the hypothesis that ADHD may be a risk factor for the development of PTSD. In addition, there is a paucity of research addressing the relations between dissociation and ADHD. In this study, our aim was to examine the relations between PTSD and ADHD combined with the mediating effect of dissociative psychopathology.

METHODS

The participants were 317 undergraduate students, a greater proportion of whom experienced the 2011 Van earthquake (66%). The participants were administered the Posttraumatic Diagnostic Scale, Dissociative Experiences Scale, Adult ADHD Self-Report Scale, Beck Depression Inventory and Beck Anxiety Inventory.

RESULTS

We found that ADHD symptoms and dissociation were significantly associated with PTSD. Considering the multivariate relations between ADHD, PTSD and dissociation, significant associations between PTSD and ADHD resulted from symptom overlaps. However, pathological dissociation mediated the relations between PTSD and ADHD.

CONCLUSION

We concluded that ADHD comorbidity was not a predominant vulnerability factor for the development of post-traumatic stress response but may be an exacerbating factor after the development of PTSD.

Decrease in the traumatic symptoms observed in child survivors within three years of the 2011 Japan earthquake and tsunami

BACKGROUND

On March 11, 2011, Japan was struck by a massive earthquake and tsunami. The tsunami caused tremendous damage and traumatized several people, including children. The aim of this study was to assess changes in traumatic symptoms 8, 20, and 30 months of the 2011 tsunami.

METHODS

The study comprised three groups. Copies of the Post-Traumatic Stress Symptoms for Children 15 items (PTSSC-15), a self-rating questionnaire on traumatic symptoms, were distributed to 12,524 children (8-month period), 12,193 children (20-month period), and 11,819 children (30-month period). An effective response of children 8 months, 20 months, and 30 month after the disaster was obtained in 11,639 (92.9%), 10,597 (86.9%), and 10,812 children (91.4%), respectively. We calculated the total score, PTSD subscale, and Depression subscale of PTSSC-15. We calculated the total score, PTSD subscale, and Depression subscale of PTSSC-15.

RESULTS

The PTSSC-15 total score and PTSD subscale of children belonging to 1st-9th grade groups who were tested 30 and 20 months after the tsunami significantly decreased compared with those of children tested 8 months after the tsunami. The PTSSC-15 total score and PTSD subscale of children in 1st-9th grade groups tested after 30 months did not decrease significantly compared with those of children tested after 20 months. The PTSSC-15 Depression subscale and PTSD subscale of children in 1st-9th grade groups tested after 30 months significantly decreased compared with those of children tested 8 months after the tsunami. The PTSSC-15 Depression subscale of children in 1st-9th grade groups evaluated after 30 months significantly decreased compared with those of children evaluated after 20 months.

CONCLUSIONS

This study demonstrates that the traumatic symptoms of children who survived the massive tsunami improved with time. Nonetheless, the traumatic symptoms, which in some cases did not improve with time.

A meta-analysis of risk factors for depression in adults and children after natural disasters

Background

A number of studies have shown a range of negative psychological symptoms (e.g. depression) after exposure to natural disasters. The aim of this study was to determine risk factors for depression in both children and adults who have survived natural disasters.

Methods

Four electronic databases (PubMed, Embase, Web of Science, and PsychInfo) were used to search for observational studies (case–control, cross-sectional, and cohort studies) about depression following natural disasters. The literature search, study selection, and data extraction were conducted independently by two authors. Thirty-one articles were included in the study, of which twenty included adult participants and eleven included child participants. Summary estimates were obtained using random-effects models. Subgroup analysis, sensitivity analysis, and publication bias tests were performed on the data.

Results

The prevalence of depression after natural disasters ranged from 5.8% to 54.0% in adults and from 7.5% to 44.8% in children. We found a number of risk factors for depression after exposure to natural disasters. For adults, the significant predictors were being female ;not married;holding religious beliefs; having poor education; prior trauma; experiencing fear, injury, or bereavement during the disaster; or losing employment or property, suffering house damage as a result of the disaster. For children, the significant predictors were prior trauma; being trapped during the disaster; experiencing injury, fear, or bereavement during the disaster; witnessing injury/death during the disaster; or having poor social support.

Conclusions

The current analysis provides evidence of risk factors for depression in survivors of natural disasters. Further research is necessary to design interventions to improve the mental health of survivors of natural disasters.

Trait Emotional Intelligence, Anxiety Sensitivity, and Experiential Avoidance in Stress Reactivity and Their Improvement Through Psychological Methods

Stress pervades daily society, often with deleterious consequences for those prone to react intensely to it. Intervention techniques to attenuate stress reactivity are thus paramount. With that goal in mind, researchers have sought to identify and alter malleable psychological dispositional variables that influence stress reactivity. Trait emotional intelligence (TEI), anxiety sensitivity (AS), and experiential avoidance (EA) are increasingly receiving attention in these research efforts. The self-reported emotional component of stress reactivity has been emphasized in investigations and is our focus. Specifically, this paper overviews the role of TEI, AS, and EA in self-reported stress responses. We also discuss empirically supported psychological methods to adjust suboptimal levels of these variables in normal populations. Both psycho-educational (information, skills) and mindfulness-based interventions (specific mindfulness therapies or components) are covered. Findings include that (1) TEI, AS, and EA are each correlated with the emotional component of stress reactivity to both naturalistic and lab-based stressors; (2) preliminary support currently exists for psycho-educational intervention of TEI and AS but is lacking for EA; (3) adequate evidence supports mindfulness-based interventions to target EA, with very limited but encouraging findings suggesting mindfulness methods improve TEI and AS; and (4) although more research is needed, stress management approaches based on mindfulness may well target all three of these psychological variables and thus appear particularly promising. Encouragingly, some methods to modify dispositional variables (e.g., a mindfulness-based format of guided self-help) are easily disseminated and potentially applicable to the general public.