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Gkintoni E, Kourkoutas E, Yotsidi V, Stavrou PD, Prinianaki D. Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:579. [PMID: 38790574 PMCID: PMC11119036 DOI: 10.3390/children11050579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74100 Rethymno, Greece;
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University, 17671 Athens, Greece;
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Huang JL, Zhou X. Posttraumatic stress disorder symptoms among parents and adolescents following Typhoon Lekima: Examination of the mother-daughter sex matching effect. Dev Psychopathol 2024; 36:709-718. [PMID: 36734237 DOI: 10.1017/s0954579422001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study aimed to examine the same-sex matching effect of posttraumatic stress disorder (PTSD) symptoms from parents to children and the mediating role of children' sense of security and catastrophization. Longitudinal data from 447 parent-child dyads were acquired using self-report scales. Parents (77.0% mothers; Mage = 40.15 years old) reported their PTSD symptoms 3 months after Super Typhoon Lekima, and children (55.9% girls; Mage = 13.40 years old) reported their PTSD symptoms, sense of security, and catastrophization 3 months and 15 months after the typhoon. Results showed that intrusion in mothers predicated intrusion, avoidance, and hyperarousal symptoms in daughters, while avoidance and hyperarousal in mothers predicted the same symptoms in daughters. This was not observed in any other parent-child dyads. Moreover, mothers' intrusion positively predicted daughters' PTSD symptoms via daughters' sense of security and then catastrophization, while mothers' hyperarousal showed the opposite prediction. These findings suggest that a same-sex matching effect occurs from mothers to daughters in terms of intrusion, avoidance, and hyperarousal symptoms of PTSD. Thus, clinical interventions that target daughters' PTSD symptoms should also consider mothers' intrusion and avoidance symptoms. Moreover, it may be possible to develop interventions to improve daughters' sense of security.
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Affiliation(s)
- Jia-Li Huang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China
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Peng Y, Lu B, Wen J. Assessment of post-traumatic stress disorder (PTSD) in elderly survivors of the Wenchuan earthquake: A cross-sectional study. J Evid Based Med 2023; 16:455-464. [PMID: 37795585 DOI: 10.1111/jebm.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is a prevalent condition characterized by prolonged psychological distress following traumatic events encompassing serious health threats, domestic abuse, and natural disasters. The onset and persistence of PTSD can be attributed to advanced age. This study aimed to explore the occurrence and influencing factors of enduring post-traumatic stress disorder (PTSD) in survivors aged 60 years and over in the main area of the 2008 Wenchuan earthquake 10 years after the disaster. METHODS Data were collected using a multistage sampling method from individuals aged 60 years and older living in the main impacted areas of Wenchuan 10 years after the Wenchuan earthquake. The PTSD Checklist-Civilian Version (PCL-C) was used to evaluate PTSD symptoms. We evaluated participants based on their PTSD symptoms: those exhibiting and those without. The latter group was four times the size of the former and was matched based on gender and age (within ± 2 years). Conditional logistic regression was used to discern the risk factors. RESULTS Out of the total, 56 participants were recognized as having probable PTSD as per the PCL-C checklist, leading to a rate of 9.4% (56/588). The univariate conditional logistic regression values showed that playing Mahjong/poker (odds ratio (OR) = 0.394, 95% confidence interval (CI) = 0.171-0.911) and displacement (OR = 0.446, 95% CI = 0.220-0.907) were protective factors for the long-term mental health of survivors in the hard-hit areas, while the presence of a 2-week illness (OR = 3.605, 95% CI = 1.751-7.424), possessing insurance (OR = 0.250, 95% CI = 0.072-0.864), suffering from a chronic ailment (OR = 3.132, 95% CI = 1.2-8.174), and having an injured family member (OR = 2.26, 95% CI = 1.136-4.496) emerged as risk factors for PTSD symptoms. Multivariate analysis indicated that the absence of insurance and prevalence of 2-week illness correlated with increased PTSD symptoms. CONCLUSIONS Ten years after the Wenchuan earthquake, the prevalence of probable PTSD remained significantly high in the elderly population. The major risk factors were the absence of insurance and the occurrence of a 2-week illness. Policymakers should incorporate these findings when devising strategies for aging societies.
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Affiliation(s)
- Yang Peng
- Office of the President, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bingqing Lu
- Hospital of Chengdu, University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Chen XY, Shi X, Li C, Fan F. Longitudinal associations between social support trajectories and quality of life mediated by depressive symptoms: A 10-year cohort study of Wenchuan earthquake. J Adolesc 2023; 95:1702-1714. [PMID: 37674388 DOI: 10.1002/jad.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Previous studies on associations between social support and quality of life (QoL) have usually employed a variable-centered approach, without considering individual variances in time-varying changes in social support. This study explores trajectories of social support and whether depressive symptoms mediate associations between social support trajectories and QoL 10 years after an earthquake. METHODS Seven hundred and forty-four Chinese adolescents exposed to the Wenchuan earthquake were surveyed on social support at 6-, 18-, and 24-months and depressive symptoms at 30-months postearthquake (T30m ). They provided valid data on QoL after 10 years of the earthquake (T10y ). The latent class growth analysis was used to estimate social support trajectories. Mediation analysis was then conducted to test whether depressive symptoms at T30m mediated associations between social support trajectories and QoL at T10y . RESULTS Three trajectories of social support were identified: low decreasing (31.6%), moderate decreasing (55.4%), and persistent high (13.0%) groups. Depressive symptoms significantly mediated the effects of social support trajectories (relative to the low support trajectory) on future QoL (95% CIs: 0.70-1.78 and 1.41-3.37 for moderate decreasing and persistent high groups, respectively). CONCLUSIONS Social support shows individual differences over time. Moderate and high social support trajectories improve 10-year QoL partly by reducing depressive symptoms. Therefore, interventions aimed at enhancing social support and reducing depressive symptoms may be more effective in enhancing QoL in the aftermath of disasters.
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Affiliation(s)
- Xiao-Yan Chen
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
| | - Xuliang Shi
- College of Education, Hebei University, Hebei, China
| | - Chao Li
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Fang Fan
- Guangdong Key Laboratory of Mental Health and Cognitive Science, School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, China
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Cadamuro A, Bisagno E, Trifiletti E, Di Bernardo GA, Visintin EP. Parental Support during the COVID-19 Pandemic: Friend or Foe? A Moderation Analysis of the Association between Maternal Anxiety and Children's Stress in Italian Dyads. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:268. [PMID: 36612589 PMCID: PMC9819444 DOI: 10.3390/ijerph20010268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
There is evidence that parental psychological disorders in stressful situations increase the risk of disturbance in child development. This has been investigated in disasters but not in pandemics, which are sensibly different from other types of traumatic events. We investigated the relationship between mothers' anxiety and their children's (self-reported) stress and the boundary conditions of this association during the first full COVID-19 lockdown in Italy. During the COVID-19 pandemic, mothers might have increased their protective attitudes to secure and support their children; we tested whether the relationship between mothers' anxiety and children's stress was weaker (buffer effect) or stronger (over-protection effect) when perceived parental support was high. We measured mothers' anxiety, children's perceived parental support, and children's stress in a sample of 414 8- to 11-year-old primary school children (229 females, Mage = 9.44) and 395 mothers (Mage = 42.84). Results supported the over-protection scenario and provided the first evidence for the "helicopter-parent effect" during the COVID-19 pandemic: mothers' anxiety was positively associated with children's stress only when perceived support was high. Our finding highlights the importance of educating parents (for example, via emotional training) to prevent the worst consequences of adverse events in children and promote their mental health.
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Affiliation(s)
- Alessia Cadamuro
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Elisa Bisagno
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Elena Trifiletti
- Department of Human Sciences, University of Verona, 37129 Verona, Italy
| | - Gian Antonio Di Bernardo
- Department of Education and Human Sciences, University of Modena and Reggio Emilia, 42121 Reggio Emilia, Italy
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Greene CA, Goldstein BL, McCarthy KJ, Grasso DJ, Wakschlag LS, Briggs-Gowan MJ. Maternal posttraumatic stress predicts Mother-Child Symptom Flare-Ups over Time. Res Child Adolesc Psychopathol 2022; 50:1619-1628. [PMID: 35763123 PMCID: PMC9940819 DOI: 10.1007/s10802-022-00939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/25/2022]
Abstract
Although concurrent associations between parent and child posttraumatic stress symptoms (PTSS) have been well-documented, few longitudinal studies have examined bidirectional influences by modeling the effects of both parent and child PTSS simultaneously over time. The current study examines patterns of PTSS in children and their mothers beginning in preschool and continuing through elementary school age (ages 4-9 years) in a large, heterogeneous sample (N = 331 mother-child dyads). Mothers reported on their own and their child's posttraumatic stress symptoms. A random intercept cross-lagged panel model (RI-CLPM) was used to examine associations between symptoms across six time points. Results indicated that maternal and child symptoms were associated with each other at concurrent time points and tended to fluctuate in a synchronized manner relative to their overall mean symptom levels. Longitudinal cross-lagged paths were significant from mother to child, but non-significant from child to mother, suggesting that mothers' symptom fluctuation at one time point predicted significant fluctuation in children's symptoms at the subsequent time point. The concurrent co-variation of maternal and child symptoms and the predictive nature of maternal symptom flare-ups have important implications for both maternal and child mental health interventions and underscore the importance of attending to mothers' symptomatology early in treatment.
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Affiliation(s)
- Carolyn A Greene
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA.
- Department of Psychiatry, School of Medicine, University of Connecticut, 65 Kane Street, 06119-7120, West Hartford, Connecticut, USA.
| | - Brandon L Goldstein
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
| | - Kimberly J McCarthy
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
| | - Damion J Grasso
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, and Institute for Innovations in Developmental Sciences, Northwestern University, 633 N. St. Clair, Suite 1900, 60611, Chicago, IL, USA
| | - Margaret J Briggs-Gowan
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
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Chan RCH. Dyadic associations between COVID-19-related stress and mental well-being among parents and children in Hong Kong: An actor-partner interdependence model approach. FAMILY PROCESS 2022; 61:1730-1748. [PMID: 35132637 PMCID: PMC9111617 DOI: 10.1111/famp.12760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 12/28/2021] [Accepted: 01/07/2022] [Indexed: 05/06/2023]
Abstract
The spread of COVID-19 and its subsequent social distancing policies have profoundly impacted the lives of parents and children. Prolonged exposure to parenting-related responsibilities and heightened levels of family conflict under stay-at-home orders coupled with reduced access to support systems and resources have rendered parents and children more prone to stress and mental health difficulties. Drawing on a transactional model of parent-child interactions, the present study applied an actor-partner interdependence model approach to examine the transactional relationship between COVID-19-related stress and mental well-being among parents and children. Data from 109 Chinese parent-child dyads in Hong Kong were included in the study. Parents and their 8- to 10-year-old children completed a questionnaire on COVID-19-related stress, parent-child relationships, and mental well-being. The results showed that 53.2% and 30.3% of the parents and children, respectively, showed poor mental well-being, indicating possible emotional problems. Both actor and partner effects of parent COVID-19-related stress were found. Parent COVID-19-related stress was indirectly related to lower levels of parent and child mental well-being, through the mediation of parent-child conflict. To facilitate psychological adjustment following the COVID-19 outbreak, effective family-based mental health and parenting interventions are needed to promote family cohesion and alleviate stress-induced psychological symptoms. Even in the time of social distancing, telepsychotherapy and other online non-psychotherapeutic interventions can serve as a valid alternative for parents and children who experience excessive distress. Implications for psychological services, family-friendly policies, and social protection measures are also discussed.
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Affiliation(s)
- Randolph C. H. Chan
- Department of Special Education and CounsellingThe Education University of Hong KongTai PoHong Kong
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Silverstein MJ, Herress J, Ostrowski-Delahanty S, Stavropoulos V, Kassam-Adams N, Daly BP. Associations between parent posttraumatic stress symptoms (PTSS) and later child PTSS: Results from an international data archive. J Trauma Stress 2022; 35:1620-1630. [PMID: 35932449 DOI: 10.1002/jts.22864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022]
Abstract
The extant literature indicates that parent and child posttraumatic stress symptoms (PTSS) are associated. However, the magnitude of this association at different time points and in the context of covariates has been difficult to quantify due to the methodological limitations of past studies, including small sample sizes. Using data from the Prospective studies of Acute Child Trauma and Recovery Data Archive, we harmonized participant-level parent and child data from 16 studies (N = 1,775 parent-child dyads) that included prospective assessment of PTSS during both the acute and later posttrauma periods (i.e., 1-30 days and 3-12 months after exposure to a potentially traumatic event, respectively). Parent and child PTSS demonstrated small-to-moderate cross-sectional, ρs = .22-.27, 95% CI [.16, .32], and longitudinal associations, ρ = .30, CI [.23, .36]. Analyses using actor-partner interdependence models revealed that parent PTSS during the acute trauma period predicted later child PTSS. Regression analyses demonstrated that parent gender did not moderate the association between parent and child PTSS. The findings suggest that parent PTSS during the acute and later posttrauma periods may be one of a constellation of risk factors and indicators for child PTSS.
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Affiliation(s)
| | - Joanna Herress
- Department of Psychology, The College of New Jersey, Ewing, New Jersey, USA
| | | | | | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian P Daly
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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Xue S, Xu W. Perceived social support and post-traumatic growth 12 years after the Wenchuan earthquake: a moderated mediation of belief in a just world and gender. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03843-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy. CHILDREN-BASEL 2021; 8:children8100930. [PMID: 34682196 PMCID: PMC8535087 DOI: 10.3390/children8100930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9-15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.
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The Association between Child and Parent Psychiatric Disorders in Families Exposed to Flood and/or Dioxin. Behav Sci (Basel) 2021; 11:bs11040046. [PMID: 33915718 PMCID: PMC8066693 DOI: 10.3390/bs11040046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 01/27/2023] Open
Abstract
Associations of disaster mental health sequelae between children and their parents have been demonstrated, but not using full diagnostic assessment. This study examined children and their parents after a series of disasters in 1982 to investigate associations of their psychiatric outcomes. Members of 169 families exposed to floods and/or dioxin or no disaster were assessed in 1986–1987 with structured diagnostic interviews. This vintage dataset collected several decades ago provides new information to this field because of the methodological rigor that is unparalleled in this literature. Disaster-related PTSD and incident postdisaster disorders in children were associated, respectively with disaster-related PTSD and incident postdisaster disorders in the chief caregiver and mother. More flood-only than dioxin-only exposed parents reported great harm by the disaster, but neither children nor parents in these two groups differed in incident psychiatric disorders. Although this study did not determine the direction of causal influences, its findings suggest that clinicians working with disaster-exposed families should work with children and adult members together, as their mental health outcomes may be intertwined.
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Lowe SR, Bonumwezi JL, Valdespino-Hayden Z, Galea S. Posttraumatic Stress and Depression in the Aftermath of Environmental Disasters: A Review of Quantitative Studies Published in 2018. Curr Environ Health Rep 2020; 6:344-360. [PMID: 31487033 DOI: 10.1007/s40572-019-00245-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW As interest in the mental health consequences of environmental disasters increases, this review aimed to summarize peer-reviewed studies published in 2018 on posttraumatic stress disorder (PTSD) and depression symptoms after such events. RECENT FINDINGS Notable trends in the past year of research included studies focusing on vulnerable populations (e.g., persons with preexisting physical health conditions), assessing the cumulative impact of exposure to multiple disasters, exploring pathway leading to PTSD and depression symptoms, and evaluating the effectiveness of post-disaster interventions. Over 100 articles were identified, focused on 40 disasters that occurred between 1982 and 2017. Prevalence estimates ranged from 0 to 70.51% for PTSD and 1.9 to 59.5% for depression. Consistent predictors of adverse outcomes included female gender, socioeconomic disadvantage, high disaster exposure, and low psychosocial resources. Further research that expands upon recent advances in the literature is critical given the large proportion of the world's population exposed to disasters and the increasing incidence of such events.
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Affiliation(s)
- Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St., New Haven, CT, 06510, USA.
| | | | | | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Chen XY, Chen J, Shi X, Jiang M, Li Y, Zhou Y, Ran M, Lai Y, Wang T, Fan F, Liu X, Chan CLW. Trajectories of maternal symptoms of posttraumatic stress disorder predict long-term mental health of children following the Wenchuan earthquake in China: A 10-year follow-up study. J Affect Disord 2020; 266:201-206. [PMID: 32056877 DOI: 10.1016/j.jad.2020.01.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Maternal psychopathology can be an important factor associated with psychological adjustment of children. However, there is limited research on long-term impacts of maternal posttraumatic stress disorder (PTSD) on children's mental health. This study examined how PTSD trajectories of women exposed to the 2008 Wenchuan earthquake in China predicted their children's mental health symptoms 10 years after the earthquake. METHODS 410 dyads of mothers and their adolescent children who exposed to the Wenchuan earthquake were investigated at 12 and 18 months post-earthquake. While the mothers completed measures of earthquake exposure and PTSD symptoms, the children completed measures of earthquake exposure, PTSD, depression and anxiety symptoms. In the 10-year follow up, 257 out of the 410 children completed measures of PTSD, depression and anxiety symptoms. Data were analyzed using linear regression. RESULTS Four trajectories of maternal PTSD symptoms were identified: (a) chronic (9.5%); (b) resilient (66.3%); (c) delayed (7.6%); and (d) recovery (16.6%); More importantly, the findings demonstrated that children whose mothers experienced chronic PTSD reported higher level of PTSD and anxiety symptoms 10 years after the earthquake. LIMITATIONS Only two waves of maternal PTSD were collected, self-reported tools other than clinical reviews were used to collect data, and a significant proportion of participants did not respond at the 10-year follow-up. CONCLUSIONS This study identified maternal PTSD trajectories following the Wenchuan earthquake. Chronic PTSD symptoms in mothers were associated with increased risk of children's PTSD and anxiety 10 years after the earthquake.
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Affiliation(s)
- Xiao-Yan Chen
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Shipai Road, Guangzhou 510631, Guangdong, China
| | - Jieling Chen
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Xuliang Shi
- College of Education, Hebei University, Hebei, China
| | - Min Jiang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Shipai Road, Guangzhou 510631, Guangdong, China
| | - Yuanyuan Li
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Shipai Road, Guangzhou 510631, Guangdong, China
| | - Ya Zhou
- Department of Psychology, Lund University, 221 00 Lund, Sweden
| | - Maosheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Yuan Lai
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Shipai Road, Guangzhou 510631, Guangdong, China
| | - Tong Wang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Shipai Road, Guangzhou 510631, Guangdong, China
| | - Fang Fan
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Shipai Road, Guangzhou 510631, Guangdong, China.
| | - Xianchen Liu
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Shipai Road, Guangzhou 510631, Guangdong, China
| | - Cecilia Lai Wan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study. Eur Child Adolesc Psychiatry 2020; 29:227-238. [PMID: 31302773 DOI: 10.1007/s00787-019-01370-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/05/2019] [Indexed: 12/22/2022]
Abstract
Despite the occurrence of several earthquakes, only a few studies were conducted in Italy on the psychological impact in children and adolescents, with data mostly collected within one year after the disaster. This cross-sectional study aimed at exploring the prevalence of both post-traumatic stress disorder (PTSD) and emotional/behavioral difficulties, as well as at identifying their main predictors, among youths 2 years after the earthquake that hit Northern Italy in 2012. 682 children and adolescents (9-14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The prevalence of a likely PTSD in the earthquake zone was 1.9% (4.4% near the epicenter) and the total PTSD score in the affected area was significantly higher than in the control zone. 14.9% of youths living in the earthquake zone had a borderline/abnormal SDQ total difficulties score and 87.5% of youth with a likely PTSD also had a SDQ total score in the borderline/abnormal range. Regression analysis showed that the number of lifetime traumatic events (e.g., death of a relative) was the best predictor of children/adolescents psychological difficulties 2 years after the earthquake, followed by severity of exposure (personal injuries and losses) and parental psychopathology. Despite some limitations, this study highlights that youths may exhibit PTSD symptoms years after disasters, often in comorbidity with behavioral/emotional difficulties, stressing the need for long-term surveillance and interventions in exposed populations.
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Epidemiological Characteristics and Risk Factors of Posttraumatic Stress Disorder in Chinese Children After Exposure to an Injury. Disaster Med Public Health Prep 2019; 14:486-493. [PMID: 31610821 DOI: 10.1017/dmp.2019.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to describe the risk factors of injured children's posttraumatic stress disorder (PTSD) in China and provide the scientific data for PTSD prevention and control in children. METHODS Electronic databases, including Medline, Science Direct, Google Scholar, and CNKI (China National Knowledge Infrastructure), were searched for articles published on or before October 30, 2018, searching for the words, "PTSD," "child"/"children," "injury"/"injuries," and "China"/"Chinese." Forty-seven articles met the inclusion criteria and were meta-analyzed using random-effect models. RESULTS The total sample size in our meta-analysis was 65 298, and there were 13 402 children diagnosed with PTSD. The prevalence of PTSD after suffering from injury was 20.52% (95% CI = 17%-23%). PTSD occurrence was higher in girls than boys (24.61% vs 19.36%, P < 0.001). The PTSD rate for students was 51.82%, 37.12%, and 14.02% in senior, junior high school children, and primary school student, respectively. PTSD prevalence was 58.93% in rural children and higher than the urban children (57.36%). The prevalence of PTSD in ethnic minority children was significantly higher than that of Han Chinese children (35.38% vs 13.50%). CONCLUSION PTSD in injured children is significantly higher in girls, senior high school children, in rural areas, and in ethnic minority children. PTSD prevention and control should be focused on these 4 subgroups.
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Du N, Zhou P, SiTu MJ, Zhu CZ, Huang Y. Post-traumatic stress disorder and depression symptoms of adolescents survived from a seriously-hit area in China: A 3-year follow-up study. Psychiatry Res 2019; 273:288-295. [PMID: 30677716 DOI: 10.1016/j.psychres.2019.01.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/06/2019] [Accepted: 01/15/2019] [Indexed: 02/05/2023]
Abstract
The objective of this study is to analyze the prevalence of probable PTSD and depression after earthquake and to find the risk factors. Adolescents having experienced an earthquake were recruited (n = 330) and assessed within 1 month of the trauma. Follow-up surveys were conducted 12 months, 24 months and 36 months later, respectively. Symptoms were assessed by the Children's Revised Impact of Event Scale and the Depression Self-Rating Scale for Children. Results indicate that the prevalence of probable PTSD in different stages was 42.2%, 20.1%, 30.3% and 11.2%. The corresponding rate of depression was 32.3%, 20.7%, 31.0% and 30.3%. The sub-symptoms of PTSD, intrusion and arousal, tended to decrease at the 1st year, followed by a rebound at the 2nd year, then dropping again at the 3rd year. The avoidance showed a consistent diminishing. The PTSD symptoms were significantly associated with gender and the degree of earthquake exposure. However, the gender, family relationship and despair played crucial roles in the development of depressive symptoms. Despite of the tendency of timing abatement, the prevalence of probable PTSD and depression might show rebound at the second year, which remind us a vital threshold for psychological intervention.
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Affiliation(s)
- Na Du
- Department of Psychiatry, the fourth people's hospital of ChengDu, ChengDu city, SiChuan 610000, China.
| | - Peng Zhou
- Department of Emergency, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ming-Jing SiTu
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Cui-Zhen Zhu
- Department of Clinical Psychology, the second people's hospital, Wannan Medical College, WuHu city, AnHui 241000, China
| | - Yi Huang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
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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; 33:558-564. [PMID: 30295206 DOI: 10.1017/s1049023x18000869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
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.
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Lai BS, Osborne MC, Lee N, Self-Brown S, Esnard AM, Kelley ML. Trauma-informed schools: Child disaster exposure, community violence and somatic symptoms. J Affect Disord 2018; 238:586-592. [PMID: 29945077 PMCID: PMC7482407 DOI: 10.1016/j.jad.2018.05.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/03/2018] [Accepted: 05/28/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Given the increasing prevalence of natural disasters, trauma-informed school settings should include efficient methods for assessing child health and mental health in post-disaster environments. To develop such methods, factors that contribute to children's vulnerability and key signs of distress reactions after disasters need to be understood. To address these issues, we evaluated pre-disaster community violence exposure as a vulnerability factor for children's post-disaster reactions and somatic symptoms as a key post-disaster outcome. METHODS We evaluated 426 children exposed to Hurricane Katrina at two timepoints (3-7 months and 13-17 months post-disaster). Structural equation models evaluated community violence exposure, hurricane exposure, and posttraumatic stress and somatic symptoms. RESULTS Community violence exposure was associated with increased levels of posttraumatic stress symptoms among disaster-impacted youth, and did not moderate the relationship between disaster exposure and posttraumatic stress symptoms. Posttraumatic stress symptoms were associated with somatic symptoms in the short-term recovery period (3-7 months), but not associated with somatic symptoms during the longer-term recovery period (13-17 months). LIMITATIONS This study did not include school-level factors, and somatic symptoms were based on parent reports. The study did not include parent functioning information or distinguish between whether somatic symptoms were medical or functional in nature. CONCLUSIONS Post-disaster school-based screeners may need to incorporate questions related to children's past exposure to community violence and their somatic symptoms to provide trauma-informed care for children.
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Affiliation(s)
- Betty S. Lai
- Department of Counseling, Developmental, and Educational Psychology, Boston College, United States,Corresponding author. (B.S. Lai)
| | | | - NaeHyung Lee
- School of Public Health, Georgia State University, United States
| | | | - Ann-Margaret Esnard
- Andrew Young School of Policy Studies, Georgia State University, United States
| | - Mary Lou Kelley
- Department of Psychology, Louisiana State University, United States
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The prevalence of posttraumatic stress in adolescents eight years after the Wenchuan earthquake. Psychiatry Res 2018; 262:262-269. [PMID: 29475105 DOI: 10.1016/j.psychres.2018.02.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/12/2018] [Accepted: 02/02/2018] [Indexed: 02/05/2023]
Abstract
In 2008, an 8.0 Richter scale earthquake devastated Wenchuan in China, which resulted in heavy casualties, and had wide-reaching psychological effects on survivors. To examine its impact on the survivors, this study aims to investigate the prevalence of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in adolescents eight years after the earthquake. The cross-section survey was conducted in two different earthquake-affected areas, and data were collected from 4118 respondents. Instruments included the questionnaire on demographic information, the questionnaire on seismic exposure, PTSD Checklist-Civilian Version (PCL-C) questionnaire, Posttraumatic Growth Inventory (PTGI), Perceived Social Support Scale (PSSS) and Simple Coping Style Questionnaire (SCSQ). During the survey, there were 1998 valid questionnaires from the generally affected area and 2120 questionnaires from the severely affected area. The rate of PTSD is 1.9% in the generally affected area and 2.7% in the severely affected disaster area; there is no significant difference between the two differently affected areas. Occurrences of PTSD and PTG are significantly positively correlated in the generally affected area, nevertheless, there is a significant negative correlation between PTSD and PTG in most systems of the severely affected area. The results of this study help to expand our knowledge regarding posttraumatic stress in adolescents 8 years after the Wenchuan earthquake, and it provides suggestions for specific long-term health interventions in such populations. To prevent earthquake-related psychological issues among adolescent survivors, social support, psychological aid, and improvement of the living environment are necessary to buffer negative posttraumatic stress.
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