Children, adolescents and trauma

Experiences of the Ukrainian adolescents during the Russia-Ukraine 2022 War

Purpose

The study aims to explore the current experiences of Ukrainian adolescents affected by the Russia-Ukraine war. The study focused on the changes in adolescents’ lives caused by the war, adolescents’ emotional reactions to the disruptions caused by the war, coping strategies employed by adolescents in dealing with disruptions and the role of information technology in supporting new realities and coping strategies of adolescents.

Design/methodology/approach

This study relied on semi-structured interviews conducted on Zoom with 27 Ukrainian adolescents ages 10-18. Participants were recruited using the snowball sample and came from various regions of Ukraine. The interview notes and partial transcripts were analyzed using thematic analysis to identify the common and unique patterns in participant responses.

Findings

The interview data revealed the signs of traumatic experiences and various stages and methods of coping with them. Participants’ resilience was supported by external factors, including families, communities, continuous schooling, ability to talk to friends, information technology, as well as internal skills, including social competence, problem-solving, critical consciousness, autonomy and a sense of purpose. Participants shared specific recommendations for improving information platforms and online content, e.g. making them more accessible and affordable for Ukrainian users, improving content curation and personalization, creating and promoting Ukrainian content and others.

Research limitations/implications

Research relied on convenience sample of participants who had access to information communication technology (ICT), were aware and had an ability to participate. Field work is needed to reach out to participants without access to ICT.

Practical implications

This study contains broad recommendations for improving information technologies for the use of Ukrainian adolescents.

Social implications

This research offers three timely account of the first-hand experiences of Ukrainian adolescents affected by the Russia-Ukraine war and can inform future work aimed at improving life conditions for teen population.

Originality/value

This study relied on first-hand reports of Ukrainian adolescents’ experiences, feelings and coping strategies during the first three months of Russia-Ukraine war. The study applied war trauma and resilience frameworks to interpret the findings and translate some of the findings into practical recommendations for the information science community.

Prevalence of posttraumatic stress disorder among adolescents in school and its impact on their well-being: a cross-sectional study

INTRODUCTION

anyone can develop posttraumatic stress disorder (PTSD) following a traumatic event; this disorder can develop comorbid PTSD disorders such as anxiety and depression, which could seriously interfere with the daily life of the adolescent who was to be the subject of our study by evaluating the prevalence of PTSD in public schools and also evaluating the impact of this disorder.

METHODS

the survey was carried out during the period from March to June 2017. Participants were selected for a cross-sectional survey. Standardized questionnaires (life events checklist, CPTS-RI, STAIY and CDI) were used. The independent variables were investigated using binary logistic regression analyzes which were performed to investigate factors associated with PTSD.

RESULTS

the number of students was 982 adolescents with an age of 12 to 17 years (14.98 ± 1.49) and the participation rate was 88.69% (n = 871). A high prevalence of PTSD was found with 19.3% (n = 168). The factors independently associated with PTSD included being a girl (adjusted odds ratio (AOR) =2.113, 95% C.I =1.015-4.399, p=0.046), having a middle school level (AOR =5.765, 95% C.I =2.262-14.692, p<0.0001), sleep interrupted (AOR =0.142, 95% C.I =0.027-0.745, p=0.021), guilt (AOR =27.378, 95% C.I =6.835-109.663, p<0.0001), difficulties of memory (AOR =0.157, 95% C.I = 0.071-0.346, p<0.0001), and difficulties of concentration (AOR =0.041, 95% C.I = 0.004-0.392, p=0.006). Among adolescents in school with PTSD, anxiety had 79.1% (n = 133) and depression had 51.1% (n = 86).

CONCLUSION

the prevalence of PTSD and comorbid anxiety and depression was high among educated students. Factors associated with PTSD included being in college, being a girl, and having guilt. It is necessary to adapt suitable treatments immediately after a traumatic event or during the disease.

Adolescent risk substance use behavior, posttraumatic stress, depression, and resilience: Innovative considerations for disaster recovery

Natural and technological disasters cause long-term psychological trauma and increase substance use in adults. It is unclear whether these problems also occur in children and whether trauma influences long-term psychological outcomes due to developmental stages at the time of trauma. One community of interest is located in southeastern Louisiana, where, as children, many locals were exposed to Hurricane Katrina in 2005 and the Deepwater Horizon Oil Spill in 2010. We hypothesized individuals exposed to these disasters in early childhood would exhibit higher rates of anxiety, depression, and alcohol use as adolescents than the general population. To test this, we developed a questionnaire with a focus on severity of disaster exposure, indicators of psychological resilience, and current levels of anxiety, depression, and alcohol use. This survey was administered to over 1000 adolescents in local high schools throughout southeastern Louisiana. Structural equation modeling was performed to test correlations and moderation effects. We found disaster exposure was positively associated with trauma-like symptoms and substance use and psychological resilience was negatively related to these outcomes. These findings demonstrate childhood disaster exposure has the potential to cause chronic psychological distress and predispose individuals to substance use later in life. They also suggest resilience may be protective for disaster survivors. Future studies should expand these concepts to other age groups and types of disasters. Whether resilience-focused psychotherapy may be beneficial in these populations is also a relevant topic for exploration.

Association between earthquake experience and depression 37 years after the Tangshan earthquake: a cross-sectional study

OBJECTIVE

To investigate the association between the Tangshan earthquake and depression after 37 years.

DESIGN AND SETTING

A cross-sectional study conducted in Tangshan from 2013 to 2014.

PARTICIPANTS

The sample included 5024 participants born before 28 July 1976 the date of the Tangshan earthquake, with available data on their earthquake experiences and depression 37 years post-earthquake.

OUTCOMES AND VARIABLES

The outcome was depression measured using the Center for Epidemiological Study and Depression Scale. The independent variable was earthquake experience, which was classified into three groups: no earthquake experience, earthquake experience without bereavement and earthquake experience with bereavement. Multivariable logistic regression analysis was used to evaluate the association between earthquake experience and depression after adjusting for gender, age at the time of the earthquake, smoking status, drinking status, education, income, residence in Tangshan 1 to 2 years post-earthquake, hypertension, diabetes and dyslipidaemia.

RESULTS

Of the 5024 participants, 641 experienced the Tangshan earthquake, and 98 experienced bereavement due to the earthquake. 37 years after the earthquake, survivors who had lost relatives during the earthquake were nearly three times (OR 2.82, 95% CI 1.24 to 6.39) as likely to have depression as those who had not experienced the earthquake, while those who had not lost relatives were 1.69 times as likely (OR 1.69, 95% CI 0.93 to 3.08). Stratified analyses showed that earthquake was significantly associated with depression in women with (OR 3.51, 95% CI 1.21 to 10.16) or without bereavement (OR 3.07, 95% CI 1.44 to 6.56) but not in men; this association was also significant in individuals over 18 years old at the time of the earthquake with (OR 13.16, 95% CI 3.08 to 56.3) or without bereavement (OR 3.39, 95% CI 1.31 to 8.87) but not in individuals less than 18 years old.

CONCLUSIONS

37 years after the Tangshan earthquake, earthquake experience was associated with depression among bereaved survivors, women and individuals over 18 years old at the time of the earthquake.

Psychosocial Difficulties in Adolescents nine Months after a Railway Accident

A railway accident which occurred in Lac-Megantic in Quebec, Canada, caused disruption for an entire community. This study examines the psychosocial difficulties in a group of exposed adolescents aged between 11 to 17, nine months after the tragedy. The analyses were conducted on a sample of 515 adolescents, attending high school, and living near the impact area. Post-traumatic stress disorder (PTSD), mental health problems (depression, anxiety), and problem use of alcohol or drugs prevalence were estimated. Multiple logistic regression was used to identify risk factors for PTSD clinical threshold. Almost half (43.4%) of adolescents reported being severely exposed to the railway accident and one third (31.3%) have reported a PTSD. Serious injuries, depression and anxiety (p < .05) were associated with greater risks for adolescents with a PTSD. However, sex, victimization, and emerging problems or problem use of alcohol or drugs are not associated with the PTSD. The results of the study highlight the relationship between a traumatic event such as the railway accident and the presence of PTSD nine months after, as well as risk factors for PTSD in adolescents. Paying close attention to mental health problems in adolescents when a traumatic event occurs and provide adequate aid is essential.

Trajectories of post-traumatic stress disorder symptoms among youth exposed to both natural and technological disasters

BACKGROUND

Theorists and researchers have demonstrated multiple trajectories of symptoms following disasters (Ecology and Society, 13, 2008, 9), highlighting the importance of obtaining more knowledge about exposed youth who demonstrate resilience as well as those who suffer chronic difficulties. This paper examines trajectories of post-traumatic stress disorder (PTSD) symptoms following exposure to hurricanes and the Deepwater Horizon Oil Spill to increase understanding of resilience and chronic reactions to both natural and technological disasters.

METHODS

A multiwave longitudinal design was used to follow N = 4,619 youth who were evaluated for PTSD symptoms, hurricane exposure, and oil spill exposure/stress at four time points over a period of 4 years. Trajectories were identified with cluster analyses and multilevel modeling.

RESULTS

Individual trajectories were statistically identified consistent with theory. The largest group exhibited stable-low symptoms (52%), a second group showed steep declines following initial symptoms (21%), a third group exhibited increasing symptoms (18%), and a fourth group showed stable-high symptoms (9%). Both hurricane exposure and oil spill stress predicted trajectories and overall levels of PTSD symptoms.

CONCLUSIONS

Results identified an effect of oil spill stress and hurricane exposure on symptom levels and trajectories of exposed youth. Results provide prospective data to support theories of multiple symptom trajectories following disasters and reinforce the importance of research that utilizes a developmental perspective to consider the long-term effects of disasters in youth. Findings highlight the importance of identifying symptoms and predictors of resilience as well as factors that contribute to resilience.

Displaced Children: The Psychological Implications

Millions of people across the world have been displaced or live in exile and/or as refugees largely as a consequence of wars, acts of terrorism, and catastrophic natural disasters. There are serious psychological consequences as a result of these extremely difficult life circumstances. Adults often can express their needs and have them be heard, whereas children are unable to do so. The children may be provided food, shelter, and clothing and have their medical needs attended to, but their emotional and psychological needs go unrecognized and unmet, with dire and monumental long-term consequences.

Professionally Led Peer Support Group Process After the School Shooting in Finland

Background

Traumatic grief is a risk factor for psychological and physiological impairment. In a school shooting incident in Finland, several people lost their lives, and a large number of bereaved family members were at risk for traumatic grief. Psychosocial support for these bereaved was therefore essential, and this article describes a program that was developed for that purpose.

Method

Professionally led peer support group process was provided for the relatives of the deceased in the school shooting in Kauhajoki, Finland, 2008. The 2-year-long process consisted of five weekend gatherings with psychoeducative and group-work elements. The content of the process was based on the existing knowledge of and recommendations for enhancing recovery after a traumatic loss.

Results

On the average, 50 relatives of the deceased in the school shooting participated in the process. The process was based on the principles of (a) timing of the group work and interventions according to stages of bereavement, (b) psychoeducation, awareness rising, and recognizing the signs of posttraumatic symptoms, (c) attachment theory-based elements in parents' and siblings' grief and group work, and (d) encouraging cohesion and strength of families' natural networks and support systems.

Conclusion

Professionally led peer support group process is a trauma-theory-based intervention, which reaches a large number of the bereaved with similar loss. Via group work, psychoeducation, and shared rituals, the bereaved have an opportunity to share and express emotions and experiences, as well as increase their skills in psychological recovery after a violent death of a family member.

Exposure to violence, social cognitive processing, and sleep problems in urban adolescents

Exposure to violence is associated with elevated levels of sleep problems in adolescence, which contributes to poor mental and physical health and impaired academic performance. However, reasons underlying the associations between exposure to violence and sleep difficulty have not been examined. This study tested a social cognitive processing path model linking experiences of witnessing and directly experiencing community violence and sleep problems. Participants were 362 early adolescents (M age = 12.45 years, SD = 0.59; range 11-14 years; 48.9% male; 51% Latino/a; 34% black) from urban communities enrolled in a middle-school-based intervention study on the east coast of the United States that was designed to reduce the negative effects of exposure to violence. All youth in the current study reported witnessing or directly experiencing community violence. Adolescents completed four school-based assessments over an 18-month period, reporting on their exposure to community violence, sleep problems, intrusive thoughts about and social constraints in talking about violence, and life events. A path model that included both victimization and witnessing violence revealed that wave 1 witnessing violence, but not victimization, was associated with elevated social constraints in talking about violence at wave 2, which was associated with elevated intrusive thoughts at wave 3, which was associated with poor sleep quality at wave 4. Prior levels of all constructs were controlled in the analysis, in addition to life events, single parent household status, children's age and sex, intervention condition, and school. Youth exposed to violence may benefit from help in processing their experiences, thus reducing social constraints in talking about their experiences and associated intrusive thoughts. This is turn may improve sleep outcomes.

Framework of the outreach after a school shooting and the students perceptions of the provided support

BACKGROUND

A large number of bereaved family members, surviving students, and their relatives as well as school staff and the wider community were in need of psychosocial support as a result of a school shooting in Kauhajoki, Finland, 2008. A multilevel outreach project provided psychosocial care to the trauma-affected families, students, schools staff, and wider community for 2 years and 4 months.

OBJECTIVE

This article is twofold. First, it presents the theoretical rationale behind the psychosocial support and describes the multimodal elements of the services. Second, it analyzes the trauma-exposed students' help-seeking behavior and perceptions of the usefulness of the support they were offered in different phases of recovery.

METHOD

Information of students' help-seeking and perceptions of support is based on a follow-up data from 4 months (T1, N=236), 16 months (T2, N=180), and 28 months (T3, N=137) after the shootings. Mean age of students was 24.9 (SD=10.2; 95% women). Their perceptions of the offered psychosocial support were collected with structured and open questions constructed for the study.

RESULTS

The results confirmed the importance of enhancing the natural networks after a major trauma and offering additional professional support for those in greatest need. The students' perceptions of the provided care confirmed that the model of the acute and long-term outreach can be used after major tragedies in diverse situations and in other countries as well.

The invisible soldiers: understanding how the life experiences of girl child soldiers impacts upon their health and rehabilitation needs

There are estimated 120,000 girl child soldiers worldwide. Recruitment makes girls vulnerable to the violence of war, torture, psychological trauma and sexual abuse with huge impact on their physical, mental and reproductive health. Despite this, girl soldiers often remain an invisible and marginalised group frequently neglected from disarmament, demobilisation and reintegration programmes. This is not just a local issue: with former child soldiers seeking asylum as refugees there is an increasing need for health workers in the destination countries to understand their health needs in order to inform appropriate holistic service provision. This review provides an overview of how the duties and life experiences of girl soldiers, including gender-specific abuses, impacts upon their health and concludes with a summary of recommendations as to how their rehabilitation needs can be addressed.

Mass trauma: disasters, terrorism, and war

Disasters, war, and terrorism expose millions of children globally to mass trauma with increasing frequency and severity. The clinical impact of such exposure is influenced by a child's social ecology, which is understood in a risk and resilience framework. Research findings informed by developmental systems theory and the related core principles of contemporary developmental psychopathology are reviewed. Their application to the recent recommendations for interventions based on evolving public health models of community resilience are discussed along with practical clinical tools for individual response.

Psychosocial support for trauma-affected students after school shootings in Finland

In Finland, as many as 20 people have lost their lives in two school shootings within one year. This article describes trauma-theoretical rationale, planning, and implementation of acute and long-term psychosocial aftercare that was organized in Kauhajoki where one of the school shootings happened. The aftercare was embedded in the school community's everyday life to enhance easy access. The aftercare proceeded in 6 phases, involving the immediate support phase at the first 24 hr, the acute phase for the first 2 weeks, followed by a 5-month period of empowerment, normalization, and creating "a safe place." The habituation phase coincided with the completion of the renovation of the damaged school building and students returning to the scene. The first anniversary was marked by shared rituals and remembrance, and the follow-up phase lasted until the end of the aftercare in 2 years. The aftercare contained, for example, psychoeducation, screening, and services at community, group, and individual levels.

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

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

Impact of exposure to conflict, tsunami and mental disorders on school absenteeism: findings from a national sample of Sri Lankan children aged 12-17 years

BACKGROUND

Armed conflicts and natural disasters are common. Millions of people, including children are killed, injured, disabled and displaced as a result. The effects of conflict and natural disaster on mental health, especially of children are well established but effects on education have received less attention. This study investigated associations between conflict and/or tsunami exposure in Sri Lanka and their associations with absenteeism in a national sample of school children.

METHODS

A cross-sectional survey was conducted in 2006-7 among 1,505 randomly selected school children aged 12-17 years attending government schools in 17 districts. The hypotheses were that absenteeism would be more common in children previously affected by conflict or the 2004 tsunami and that at least part of this effect would be accounted for by mental disorders. Survey information included socio-demographic, conflict and tsunami exposure, mental health status (Strengths and Difficulties Questionnaire) and information on absenteeism (defined as 20% or greater non-attendance over one year).

RESULTS

The total sample of consisted of 1,505 students aged 12-17 years with a mean age of 13.7 years. 120 children reported at least one conflict exposure and 65 reported at least one tsunami exposure while only 15 reported exposure to both conflict and tsunami. Prevalence of emotional disorder caseness was 2.7%, conduct disorder caseness 5.8%, hyperactivity disorder caseness 0.6%, and 8.5% were identified as having any psychiatric disorder. Absenteeism was present in 26.8%. Overall, previous exposure to tsunami (OR 2.29 95% CI 1.36-3.84) was significantly associated with absenteeism whereas exposure to conflict was not (OR 1.32 95% CI 0.88-1.97), although some specific conflict-related exposures were significant risk factors. Mental disorder was strongly associated with absenteeism but did not account for its association with tsunami or conflict exposure.

CONCLUSIONS

Exposure to traumatic events may have a detrimental effect on subsequent school attendance. This may give rise to perpetuating socioeconomic inequality and needs further research to inform policy and intervention.

Post-Traumatic Stress Disorders and mental health care (lessons learned from the Hanshin-Awaji Earthquake, Kobe, 1995)

The Hanshin-Awaji Earthquake of 1995 and has moved through the various phases into the recovery stage. After the earthquake we conducted two surveys involving approximately 8000 families with pre-school aged children and 466 families with disabled children. Symptoms related to PTSD were found more frequently in the small children whose houses had been severely damaged one year after the earthquake. Although the symptoms decreased, they were still present more frequently in the children and their mothers with severely damaged homes in 1998. Our results show children with intellectual or emotional disabilities displayed many behavioral problems. The physically disabled children required medical resources and specialized support in a structured environment. Both groups voiced the need to set up specialized facilities for people with disabilities. Following the Central Java Earthquake in 2006, we have engaged in "children house" activities in the disaster stricken area in collaboration with Gadjah Mada University. Through this activity, we have been able to share what works in helping children with disabilities and their families. From our experience we have found exchanging of information among the people in the disaster stricken areas helps to reduce the psychological damage of the children and aids in their recovery process.

The relationship between organized violence, family violence and mental health: findings from a community-based survey in Muhanga, Southern Rwanda

BACKGROUND

The relationship between organized violence and family violence, and their cumulative effect on mental health in post-conflict regions remains poorly understood.

OBJECTIVE

The aim of the present study was to establish prevalence rates and predictors of family violence in post-conflict Rwanda. And to examine whether higher levels of war-related violence and its socio-economic consequences would result in higher levels of violence within families and whether this would be related to an increase of psychological distress in descendants.

METHOD

One hundred and eighty-eight parent-child pairs from four sectors of the district Muhanga, Southern Province of Rwanda, were randomly selected for participation in the study. Trained local psychologists administered structured diagnostic interviews. A posttraumatic stress disorder (PTSD) diagnosis was established using the PTSD Symptom Scale Interview (PSS-I) and child maltreatment was assessed by means of the Childhood Trauma Questionnaire (CTQ). Additionally, the Hopkins Symptom Checklist (HSCL-25) assessed symptoms of depression and anxiety in descendants.

RESULTS

Prevalence rates of child abuse and neglect among descendants were below 10%. Ordinal regression analyses revealed that the level of child maltreatment in descendants was predicted by female sex, poverty, loss of the mother, exposure to war and genocide as well as parents' level of PTSD and reported child maltreatment. Poor physical health, exposure to war and genocide, parental PTSD symptoms, and reported childhood trauma were significantly associated with depressive and anxious symptoms, while only exposure to war and genocide and poor physical health predicted the level of PTSD.

CONCLUSION

The results indicate that cumulative stress such as exposure to organized violence and family violence in Rwandan descendants poses a risk factor for the development of depressive and anxious symptoms. Besides the support for families to cope with stress, awareness-raising initiatives challenging the current discourse of discipline toward children in schools or at home need to be fostered.

Growing up in the shadow of Chornobyl: adolescents' risk perceptions and mental health

PURPOSE

Despite long-term research on risk perceptions of adults after ecological disasters, little is known about the legacy for the generation exposed to toxic elements as infants. This study examined Chornobyl-related risk perceptions and their relationship to mental health in adolescents raised in Kyiv in the aftermath of the accident.

METHODS

Risk perceptions, 12-month DSM-IV major depression (MDD)/generalized anxiety disorder (GAD), and current symptomatology were examined in 265 evacuee adolescents, 261 classmate controls, and 327 population-based controls 19 years after the accident. Competing risk factors, including maternal risk perceptions and MDD/GAD, were taken into account.

RESULTS

Significantly more evacuees (48.7%) than controls (33.4-40.0%) reported at least one negative perception of Chornobyl; 18.1% of evacuees versus 10.0-12.8% of controls reported 2-4. In contrast, 75.7% of evacuee mothers versus 34.8-37.6% of controls endorsed 2-4 negative perceptions. In the unadjusted analyses, adolescents' perceptions were associated with both MDD/GAD and symptomatology. After adjusting for competing risk factors, their perceptions were associated with symptomatology only (p < 0.01). Among the competing risk factors, gender, self-esteem, life events, and peer support were significantly associated with MDD/GAD. These measures, along with quality of parental communication, father belligerence when drunk, and maternal MDD/GAD, were significantly associated with symptoms.

CONCLUSIONS

More evacuee teens reported negative risk perceptions than controls, but these perceptions were only modestly associated with mental health. Instead, the strongest risk factors comported with epidemiologic studies conducted in other parts of the world. Research is needed to determine whether children raised in the aftermath of other ecological disasters demonstrate similar resilience.

A controlled follow-up study of adolescents exposed to a school shooting--psychological consequences after four months

BACKGROUND

In November 2007, a student shot eight people and himself at Jokela High School, Finland. This study aims to evaluate the long-term effects of exposure to a school shooting among adolescents.

METHOD

Associations between psychological outcomes and background factors were analysed and compared with "comparison students" four months after the incident. A questionnaire including Impact of Event Scale (IES) and General Health Questionnaire (GHQ-36) was used.

RESULTS

Half of the females and a third of the males suffered from posttraumatic distress. High level of posttraumatic distress (IES≥35), predicting PTSD, was observed in 27% of the females and 7% of the males. The odds ratio was 6.4 (95% confidence interval 3.5-10.5) for having high levels of posttraumatic distress. Severe or extreme exposure and female gender were found to increase the risk. Forty-two percent of the females and 16% of the males had psychiatric disturbance (GHQ≥9). Severe or extreme exposure, older age and female gender increased the risk. Perceived support from family and friends was found to be protective.

CONCLUSIONS

The observed risk and protective factors were similar to earlier studies. Follow-up will be essential in identifying factors predicting persisting trauma-related symptoms in adolescence.

Exposure to potentially traumatic life events in children with special needs

A series of studies of potentially-traumatic life-events (PTLE) in children and youth with special needs (CSN) was conducted after parents of 102 CSN from interdisciplinary pediatric clinics listed PTLE at significantly higher rates on the Pediatric Emotional Distress Scale (PEDS) compared to parents 58 students with no diagnoses. Subsequent studies replicated this disparity in 213 5-15 year-olds sampled through school-distributed parent PTLE checklists instead of PEDS. Results from school samples suggested significantly more PTLE in CSN, t (211) = -3.39, p < .001. In both studies some of PTLE reported significantly more in CSN were potentially related to the special needs of the child (e.g., hospitalizations, school problems) but others were not (e.g., traumatic events such as vehicular accidents and disasters). Children exposed to more PTLE were rated as having significantly more behavior problems across measures. Suggested cost-effective screening for PTLE may enable clinicians to enhance differential diagnosis, medical management, and psychosocial interventions for CSN by taking into account PTLE and symptoms related to recent disruptive events.

What do Youth Report as a Traumatic Event? Toward a Developmentally Informed Classification of Traumatic Stressors

The aim of this study was to explore youth reports of traumatic events by 1) identifying the types of events that children and adolescents report as traumatic in their lives, 2) investigating the association between self reported traumatic events and self and parent reported emotional problems and 3) by examining developmental differences in the types and severity of the events reported as traumatic. Information regarding traumas and symptoms was collected from a sample of youth aged 6-17 using The Child PTSD Checklist. A coding system was developed for classifying the events reported. Findings suggest that youth reported a wide variety of experiences as traumatic that could be reliably coded and classified, and that youth reporting traumatic events and symptoms consistent with PTSD evidence higher levels of emotional, and behavioral problems (via parent and child report) than youth not reporting traumatic events. Youth aged 13-17 tended to report traumas that were rated by independent coders as more severe than youth aged 6-12. While the types of events reported did not differ in PTSD symptoms and other emotional, and behavioral problems there were differences in objective ratings of physical severity and psychological intensity. Implications of the findings are discussed in terms of the creation of developmentally informed classification of traumatic stressors.

The psychosocial consequences for children of mass violence, terrorism and disasters

Children and families are now in the front line of war, conflict and terrorism as a consequence of the paradigm shift in the nature of warfare and the growth of terror as a weapon. They are as vulnerable as are adults to the traumatizing effects of violence and mass violence. Furthermore, employing children as soldiers is not new, but it is continuing and young people are also perpetrators of other forms of violence. This paper summarizes a selection of the literature showing the direct and indirect psychosocial impacts on minors of their exposure to single incident (event) and recurrent or repetitive (process) violence. Additionally, children's psychosocial and physical development may be affected by their engagement with violence as victims or perpetrators. Several studies point to positive learning from certain experiences in particular communities while many others show the potential for lasting negative effects that may result in children being more vulnerable as adults. The spectrum of response is very wide. This paper focuses on resilience but also provides access to several frameworks for planning, delivering and assuring the quality of community and family-orientated and culture-sensitive responses to people's psychosocial needs in the aftermath of disasters of all kinds including those in which children and young people have been involved in mass violence.

School performance and social-emotional behavior of primary school children before and after a disaster

OBJECTIVES

The purpose of this work was to evaluate the cognitive and social-emotional consequences in a general population of primary school children affected by the firework disaster in Enschede, The Netherlands, on May 13, 2000. The explosions caused tremendous damage in the surrounding neighborhood. Twenty-two people immediately died and >1000 were injured.

METHODS

This retrospective study assessed school performance and social-emotional behavior before and up to 3 years after the disaster. Objectively measured school test results in spelling and arithmetic/mathematics and multi-informant social-emotional behavioral assessments were compared between exposed and nonexposed primary school children. Multivariate logistic-regression was used to assess the relationship between exposure and cognitive and social emotional functioning.

RESULTS

On school performances, the children exposed to the disaster performed over a period of 3 years after the disaster as good as or better than classmates, controls, and a national reference population. Shortly after the disaster, exposed children even seemed to have better school test results than nonexposed children. Two to 3 years after the disaster, a significant effect of disaster exposure was found on social-emotional behavior. Problematic behavior was reported by teachers, parents, and the school doctor.

CONCLUSIONS

This study demonstrates a limited influence of disaster exposure on school performance in primary school children. This study also shows that teachers and youth health care practitioners especially should be aware of children starting school several years after a disaster. Although very young at the time of a disaster (1-4 years of age), they may experience disaster-related problems.

Uncertainty, Posttraumatic Stress, and Health Behavior in Young Adult Childhood Cancer Survivors

BACKGROUND

Young adult survivors of childhood cancer are at risk for medical late effects, some of which can be managed through health promotion behaviors. However, chronic uncertainty about the future can lead to the development of posttraumatic stress symptoms (PTSS) that can interfere with health promotion behaviors.

OBJECTIVES

To test a mediating model for the relationships among uncertainty, PTSS, and health promotion behaviors in young adult survivors of childhood cancer.

METHODS

The design was cross-sectional correlational. A convenience sample was used, and the data were collected using a mailed survey. Study measures included the Mishel Uncertainty in Illness Scale-Community Form, the Posttraumatic Stress Disorder Index, and the Health Promoting Lifestyle Profile II.

RESULTS

Forty-six (51.1%) of the eligible survivors responded to the invitation to participate in the study. The analysis was based on data from 45 survivors. The results show that the relationship between PTSS and health promotion behaviors was mediated by uncertainty.

DISCUSSION

Uncertainty is a suitable target for theory-based nursing interventions used to boost health promotion behaviors in young adult survivors of childhood cancer.

The effect of a severe disaster on the mental health of adolescents: a controlled study

BACKGROUND

Disasters greatly affect the mental health of children and adolescents, but quantification of such effects is difficult. Using prospective predisaster and postdisaster data for affected and control populations, we aimed to assess the effects of a severe disaster on the mental health and substance use of adolescents.

METHODS

In January, 2001, a fire in a café in Volendam, Netherlands, wounded 250 adolescents and killed 14. In the 15 months before the disaster, all grade 2 students (aged 12-15 years) from a school in Volendam (of whom 31 were in the café during the fire), and from two other schools, had been selected as controls for a study. 124 Volendam students and 830 from the other two schools had provided data for substance use, and completed the youth self-report (YSR) questionnaire about behavioural and emotional problems. 5 months after the disaster, we obtained follow-up data from 91 (response rate 73.4%) Volendam adolescents and 643 (77.5%) controls from the other two schools. The primary outcome measures were changes in score in YSR categories of total problems, alcohol misuse, smoking, and substance use. We compared changes in scores between groups using logistic regression.

FINDINGS

Volendam adolescents had larger increases in clinical scores than controls for total problems (odds ratio 1.82, 95% CI 1.01-3.29, p=0.045) and excessive use of alcohol (4.57, 2.73-7.64, p<0.0001), but not for smoking or use of marijuana, MDMA (ecstasy), and sedatives. Increases in YSR scores were largest for being anxious or depressed (2.85, 1.23-6.61), incoherent thinking (2.16, 1.09-4.30), and aggressive behaviour (3.30, 1.30-8.36). Intention-to-treat analyses showed significantly larger for increases in rates of excessive drinking and YSR symptom subscales in Volendam adolescents than controls. Effects were mostly similar in victims and their classmates.

INTERPRETATION

Mental health interventions after disasters should address anxiety, depression, thought problems, aggression, and alcohol abuse of directly affected adolescents and their peer group.

Children and war

Children bear disproportionate consequences of armed conflict. The 21st century continues to see patterns of children enmeshed in international violence between opposing combatant forces, as victims of terrorist warfare, and, perhaps most tragically of all, as victims of civil wars. Innocent children so often are the victims of high-energy wounding from military ordinance. They sustain high-energy tissue damage and massive burns - injuries that are not commonly seen in civilian populations. Children have also been deliberately targeted victims in genocidal civil wars in Africa in the past decade, and hundreds of thousands have been killed and maimed in the context of close-quarter, hand-to-hand assaults of great ferocity. Paediatricians serve as uniformed military surgeons and as civilian doctors in both international and civil wars, and have a significant strategic role to play as advocates for the rights and welfare of children in the context of the evolving 'Laws of War'. One chronic legacy of contemporary warfare is blast injury to children from landmines. Such blasts leave children without feet or lower limbs, with genital injuries, blindness and deafness. This pattern of injury has become one of the post-civil war syndromes encountered by all intensivists and surgeons serving in four of the world's continents. The continued advocacy for the international ban on the manufacture, commerce and military use of antipersonnel landmines is a part of all paediatricians' obligation to promote the ethos of the Laws of War. Post-traumatic stress disorder remains an undertreated legacy of children who have been trapped in the shot and shell of battle as well as those displaced as refugees. An urgent, unfocused and unmet challenge has been the increase in, and plight of, child soldiers themselves. A new class of combatant comprises these children, who also become enmeshed in the triad of anarchic civil war, light-weight weaponry and drug or alcohol addiction. The International Criminal Court has outlawed as a War Crime, the conscription of children under 15 years of age. Nevertheless, there remain more than 300000 child soldiers active and enmeshed in psychopathic violence as part of both civil and international warfare. The typical profile of a child soldier is of a boy between the ages of 8 and 18 years, bonded into a group of armed peers, almost always an orphan, drug or alcohol addicted, amoral, merciless, illiterate and dangerous. Paediatricians have much to do to protect such war-enmeshed children, irrespective of the accident of their place of birth. Only by such vigorous and maintained advocacy can the world's children be better protected from the scourge of future wars.

The aftermath of violence: children, disaster, and posttraumatic stress disorder

Terrorist attacks, situations of armed conflict, and all forms of catastrophe tax our abilities to cope, understand, and respond. Because of their developmental status, children are even more emotionally vulnerable to the devastating effects of a disaster. When tragedy strikes a family, community, or the nation, helping children cope and regain a sense of safety is critical. A child with posttraumatic stress disorder (PTSD) develops symptoms such as intense fear, disorganized and agitated behavior, emotional numbness, anxiety, or depression after being directly exposed to or witnessing an extreme traumatic situation involving threatened death or serious injury. Victims of repeated abuse or children who live in violent neighborhoods or war zones, or who have witnessed extensive media coverage of violent events, may experience PTSD.

Emergency mental health management in bioterrorism events

The United States has not suffered significant psychosocial or medical consequences from the use of biological weapons within its territories. This has contributed to a "natural" state of denial at the community level. This denial could amplify the sense of crisis, anxiety, fear, chaos, and disorder that would accompany such a bioterrorist event. A key part of primary prevention involves counteracting this possibility before an incident occurs. Doing so will require realistic information regarding the bioterrorism threat followed by the development of a planned response and regular practice of that response. Unlike in natural disasters or other situations resulting in mass casualties, emergency department physicians or nurses and primary care physicians (working in concert with epidemiologic agencies), rather than police, firemen, or ambulance personnel, will be most likely to first identify the unfolding disaster associated with a biological attack. Like community leaders, this group of medical responders must be aware of its own susceptibility to mental health sequelae and performance decrement as the increasing demands of disaster response outpace the availability of necessary resources. A bioterrorist attack will necessitate treatment of casualties who experience neuropsychiatric symptoms and syndromes. Although symptoms may result from exposure to infection with specific biological agents, similar symptoms may result from the mere perception of exposure or arousal precipitated by fear of infection, disease, suffering, and death. Conservative use of psychotropic medications may reduce symptoms in exposed and uninfected individuals, as may cognitive-behavioral interventions. Clear, consistent, accessible, reliable, and redundant information (received from trusted sources) will diminish public uncertainty about the cause of symptoms that might otherwise prompt persons to seek unnecessary treatment. Training and preparation for contingencies experienced in an attack have the potential to enhance delivery of care. Initiating supportive social, psychotherapeutic, and psychopharmacologic treatments judiciously for symptoms and syndromes known to accompany the traumatic stress response can aid the efficient treatment of some patients and reduce long-term morbidity in affected individuals. Preventive strategies and planning must take into account the idea that specific groups within the population are at higher risk for psychiatric morbidity. First responders comprise one group at psychologic risk in this situation, and healthcare providers comprise another. These and other high-risk groups will benefit from the same supportive interventions developed for the community as a whole.