Psychological responses after a major, fatal earthquake: the effect of peritraumatic dissociation and posttraumatic stress symptoms on anxiety and depression

The development of the fear of earthquake scale: validity and reliability study in Türkiye after the 2023 earthquake

BACKGROUND

In 2023, Türkiye experienced a significant earthquake disaster that profoundly impacted 11 provinces. The enduring consequences of these earthquakes on daily life triggered widespread fears and anxieties in society, leading to scholarly investigations in this field.

OBJECTIVE

The primary objective of this study was to create and evaluate the psychometric properties of the Fear of Earthquake Scale (FES), a modified adaptation of the Fear of COVID-19 Scale (FCV-19 S), tailored to measure earthquake-related experiences in Türkiye.

METHODS

A total of 315 Turkish adult participants (106 men, 209 women), with a mean age of 37.71 years, completed the FES, along with the Brief Psychological Resilience Scale (BPRS). Psychometric analyses included confirmatory factor analysis as well as the evaluation of alternative factor structures, internal consistency, convergent validity, and criterion validity with respect to resilience.

RESULTS

The findings indicate that the Turkish version of the Fear of Earthquake Scale has strong psychometric properties in terms of validity and reliability. After assessing various factor structures, it was observed that the two-factor model which represents the emotional and somatic response to fear, exhibited the best-fit values The Cronbach's alpha coefficients were calculated as 0.89 for the overall FES, 0.84 for the emotional subscale and 0.86 for the somatic subscale, indicating high internal consistency. Additionally, the negative correlation between resilience and the FES supports the criterion validity of the scale, and multi-group confirmatory factor analyses proved that measurement invariance held across genders and whether they experienced an earthquake or not for all groups. Furthermore, the results of the study revealed that women and individuals with prior earthquake experience reported higher levels of fear of earthquakes.

CONCLUSIONS

The FES emerged as a reliable and valid tool for assessing earthquake-related fears among the Turkish population.

The Switch to Online Learning during the COVID-19 Pandemic: The Interplay between Personality and Mental Health on University Students

The switching from traditional to online learning during the COVID-19 pandemic was challenging for students, determining an increase in physical and mental health problems. The current paper applied a two-step cluster analysis in a large sample of n = 1028 university students (Mage = 21.10 years, SD = 2.45 years; range: 18-30 years; 78.4% females). Participants responded to an online survey exploring neuroticism, trait/state anxiety, general self-efficacy, academic motivation, fear of COVID-19, the impact of the COVID-19 pandemic on physical and mental health, and the help requests. Results showed two significant clusters of students having a Maladaptive Academic Profile (n = 456; 44.4%) or an Adaptive Academic Profile (n = 572; 55.6%). Significant differences were found between the two clusters, where students belonging to the Maladaptive Academic Profile reported higher levels of neuroticism, higher dispositional and situational anxiety, and fear of COVID-19, and lower self-efficacy and academic motivation than students of the Adaptive Academic Profile cluster. In addition, more physical or mental health problems and help requests, mainly to partners during the COVID-19 pandemic, were found in the Maladaptive Academic Profile cluster compared to the Adaptive Academic Profile. Finally, the practical implications of the study's results in implementing university counseling services as protective measures to contrast psychological distress in the long-term COVID-19 pandemic are discussed.

The Relationship between Lifetime Exposure to Potentially Traumatic Events, Peritraumatic Dissociation, and PTSD in a Sample of Sexually Assaulted Women in Sao Paulo, Brazil

Sexually assaulted women represent a particularly high-risk group for developing post-traumatic stress disorder (PTSD). Potentially traumatic events (PTEs) and peritraumatic dissociation (PD) are known risk factors for PTSD. However, little is known about how previous trauma affects PD and how this relationship affects PTSD. We aimed to investigate whether PD acts as a mediator between PTEs and PTSD severity in a sample of recently sexually assaulted women in Sao Paulo, Brazil. Seventy-four sexually assaulted women aged 18-44 completed questionnaires and structured interviews on PTSD, PD, and PTEs. We examined direct and indirect effects of variables using causal mediation analysis. Lifetime exposure to PTEs was a risk factor for PD, but PD was not a risk factor for PTSD symptom severity. Also, PD was not a mediator between PTEs and PTSD severity. We provided recommendations on how to further explore the relationship between lifetime traumatic exposure, PTSD, and peritraumatic dissociation.

The war next-door-A pilot study on Romanian adolescents' psychological reactions to potentially traumatic experiences generated by the Russian invasion of Ukraine

Introduction

Romania shares the longest UE border with Ukraine, and since the Russian invasion of Ukraine began, many have been involved in helping the refugees. Consequently, children and adolescents might be directly and indirectly exposed to war-related trauma. In the present exploratory research, we investigated Romanian adolescents' potential risk and protective factors related to the psychological outcomes of war exposure. Our cross-sectional study was conducted shortly after February 24th (i.e., the first invasion day).

Methods

The sample included 90 Romanian adolescents aged 11 to 15 (M = 12.90, SD = 1.17), residents in Iași, Romania (i.e., 205,7 km from the Ukrainian border). Participants completed self-reported measures of peritraumatic dissociative experiences, knowledge about the conflict in Ukraine, personal, school, and family implications in volunteering/helping behavior, discussions about the conflict, threat perception (self and perceived parental threat), anxiety, social media engagement, resilience, and moral elevation.

Results

The main findings suggested that participants involved in helping behaviors toward Ukrainian refugees present higher peritraumatic dissociative experiences, anxiety symptoms, and higher moral elevation than boys and participants not involved in these behaviors. Moreover, anxiety symptoms were positively associated with threat perception, peritraumatic dissociation, and social media engagement and negatively related to resilience.

Discussions

Finally, we discuss the implications of our findings concerning their practical utility in managing peritraumatic exposure to war by using interventions designed to increase adolescents' resilience during difficult times.

Socio-demographic and trauma-related predictors of depression within eight weeks of motor vehicle collision in the AURORA study

BACKGROUND

This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.

METHODS

We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.

RESULTS

Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.

CONCLUSIONS

These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.

Validity, Reliability and Internal Consistency of Persian Versions of the Childhood Trauma Questionnaire, the Traumatic Exposure Severity Scale and the Peritraumatic Dissociative Experiences Questionnaire

The Childhood Trauma Questionnaire (CTQ), the Traumatic Exposure Severity Scale (TESS) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) are questionnaires widely used in studies of trauma and dissociation. This study aimed to examine the validity of the Persian versions of these questionnaires among a total of 230 individuals from the cities of Kermanshah and Sarpol-e Zahab that had experienced 2017 Iran earthquake. Results from a confirmatory factor analysis did not support the original five-factor solution for the TESS. Two principal component analyses resulted in a four-component solution for a revised version of the scale. PDEQ scores, TESS scores, and its sub-scales, were found to significantly correlate with a PTSD measure with their effect sizes ranging from medium to large according to Cohen's guidelines. Furthermore, significant correlations between two sub-scales of the CTQ and a dissociation measure were found with medium effect sizes. Consequently, reliability and validity measures obtained from the sample of this study were supportive of the use of the Persian versions of the TESS, the PDEQ, and the CTQ among Persian-speaking populations. Further research on psychological responses to earthquakes and other natural disasters can provide the opportunity for cross-cultural comparisons in terms of specific resilience factors and vulnerabilities following mass trauma.

Challenges and Problems Facing 2017 Kermanshah Earthquake Survivors: A Qualitative Study

It is widely accepted that earthquake poses many challenges to human life. Therefore, the main objective of this study was to explore challenges and problems facing the 2017 Kermanshah earthquake survivors. The present qualitative study was conducted using conventional qualitative content analysis in Kermanshah Province, Iran, in 2018. The data were collected through semi-structured interviews with 28 earthquake-stricken individuals, aged over 18 years, selected through purposive sampling method. The Graneheim and Lundman method was also used to analyze the data, and then Lincoln and Guba criteria were employed to provide robustness and transferability of the research. The results of data analysis were classified into 4 main categories and 11 sub-categories. Accordingly, the main categories were: (1) health problems and issues, (2) economic problems and issues, (3) improper management of human and non-human resources, and (4) incomplete social services. According to the results, earthquake victims face many challenges. Therefore, fundamental steps can be taken to reduce survivors' problems by considering all aspects of their health, improving equal distribution of social assistance and services provided, and using local social capital in a better way.

A scoping review of post-disaster social support investigations conducted after disasters that struck the Australia and Oceania continent

This scoping review provides a summary of research findings on social support dynamics in the wake of disasters that occurred on the continent of Australia and Oceania between 1983 and 2013. Forty-one studies, quantitative and qualitative, were summarised, investigating different facets of post-disaster supportive interactions. All inquiries assessed disasters resulting from natural hazards, with the majority of them conducted following events in Australia and New Zealand. The review revealed similar patterns of post-disaster social support dynamics that routinely unfold after disastrous incidents all over the world. Consistent with the disaster mental health literature, the documentation of social support mobilisation and social support deterioration processes was common. Salutary direct effects of supportive behaviours on post-disaster psychological distress were also highly evident. Most studies, however, posed research questions or hypotheses that lacked empirical or theoretical grounding. In conclusion, the review offers several recommendations on how to advance research on post-disaster social support.

Dissociation and disasters: A systematic review

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

A systematic review of the psychological impacts of the Canterbury earthquakes on mental health

OBJECTIVE

This systematic review aims to identify and evaluate all studies that measured psychological distress or mental disorder following the Canterbury earthquakes to establish the psychological consequences of the earthquakes on those exposed. A secondary aim is to outline and emphasise key methodological factors in disaster research.

METHOD

Eligible studies were identified following a comprehensive literature search. A quality assessment was undertaken for all included studies. This was followed by methodological and descriptive review.

RESULTS

Thirty-one papers measuring psychological distress or mental disorder following the Canterbury earthquakes were identified. These papers reported outcomes from 20 separate studies of which seven were rated high-quality, eight were rated medium and five were rated low-quality. Key methodological findings and outcomes are discussed for each study.

CONCLUSION

The Canterbury earthquakes were associated with widespread but not universal adverse effects on mental health. Disaster research quality is assisted by representative samples, repeated measures, and the use of appropriate controls to allow accurate assessments of psychological consequences to be made. Implications for public health: The presence of widespread adverse effects as a result of the earthquakes suggests broad-ranging community initiatives are essential to mitigate the negative consequences of disasters.

Risk factors of post-traumatic stress among survivors of the 2017 Iran earthquake: The importance of peritraumatic dissociation

The aim of this study was to explore the roles of pre-earthquake characteristics (age, gender, years of education, history of childhood and recent trauma and trait dissociation), during-the-earthquake state (peritraumatic dissociation) and post-earthquake difficulties (severity of exposure to earthquake) in post-traumatic stress among survivors of the 2017 Iran earthquake. A total number of 127 individuals in Kermanshah and 103 individuals in Sarpol-e Zahab completed and returned a 105-item questionnaire. Among these, 32 (25.2%) participants in the Kermanshah sample and 80 (77.7%) participants in the Sarpol-e Zahab sample scored equal to, or more than, the cut-off score of 33 on the Impact of Event Scale - Revised and, thus, were considered as having high likelihood of having PTSD. A three-model hierarchical linear regression analysis showed that pre-earthquake characteristics, during-the-earthquake state and post-earthquake difficulties each explained a unique variance of 11.3%, 34.4% and 14.7%, respectively, and together explained a total variance of 60.4% in post-traumatic stress. Earthquake victims who report higher degrees of peritraumatic dissociation during and immediately after the earthquake are more vulnerable to develop PTSD and should be prioritized in terms of receiving psychological interventions.

Spatio-temporal variation of mood and anxiety symptom treatments in Christchurch in the context of the 2010/11 Canterbury earthquake sequence

This article explores the spatio-temporal variation of mood and anxiety treatments in the context of a severe earthquake sequence. The aim was to examine a possible earthquake exposure effect, identify populations at risk and areas with particularly large mood and anxiety treatment rate increases or decreases in the affected Christchurch urban area. A significantly stronger increase of mood and anxiety treatments among residents in Christchurch compared to others in New Zealand have been found, as well as children and elderly identified as especially vulnerable. Spatio-temporal cluster analysis and Bayesian spatio-temporal modelling revealed little changes in mood and anxiety treatment patterns for most parts of the city, whereas areas in the less affected north and northwest showed the strongest increases in risk. This effect may be linked to inner-city mobility activity as a consequence of the earthquakes, but also different levels of community cohesion after the disaster, which merit further research.

Predisposing and Precipitating Factors for Dissociation During Labor in a Cohort Study of Posttraumatic Stress Disorder and Childbearing Outcomes

INTRODUCTION

Peritraumatic dissociation is an important predictor of posttraumatic stress disorder (PTSD), depression, and impaired bonding following childbirth. The purpose of this study was to follow up on an earlier finding that peritraumatic dissociation in labor was associated with adverse postpartum outcomes by identifying predictors of dissociation in labor.

METHODS

This analysis used data from a prospective cohort study of primiparous women from southeast Michigan. There were 564 women included in the analysis; the primary outcome measure was the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) score measuring dissociation during labor.

RESULTS

The prevalence of dissociation in labor for this sample was 7.4%. Important predictors of dissociation in labor included both predisposing (eg, childhood maltreatment trauma, preexisting psychopathology) and precipitating (eg, perception of care, negative appraisal of labor) factors. Overall, these predictors explained 14.7% of variance in PDEQ score. In 3 separate, simple linear regression models, the PDEQ score explained 20% of variance in postpartum PTSD, 13% of variance in postpartum depression, and 9% of variance in impaired bonding.

DISCUSSION

Women with maltreatment history and PTSD are at risk to be retraumatized or overwhelmed by birth and to dissociate. Although it would be optimal to assess for dissociative coping prenatally, assessing with the PDEQ following birth could contribute to evaluation of risk for postpartum psychopathology.

Regional differences in the psychological recovery of Christchurch residents following the 2010/2011 earthquakes: a longitudinal study

We examined changes in psychological distress experienced by residents of Christchurch following two catastrophic earthquakes in late 2010 and early 2011, using data from the New Zealand Attitudes and Values Study (NZAVS), a national probability panel study of New Zealand adults. Analyses focused on the 267 participants (172 women, 95 men) who were living in central Christchurch in 2009 (i.e., before the Christchurch earthquakes), and who also provided complete responses to our yearly panel questionnaire conducted in late 2010 (largely between the two major earthquakes), late 2011, and late 2012. Levels of psychological distress were similar across the different regions of central Christchurch immediately following the September 2010 earthquake, and remained comparable across regions in 2011. By late 2012, however, average levels of psychological distress in the regions had diverged as a function of the amount of property damage experienced within each given region. Specifically, participants in the least damaged region (i.e., the Fendalton-Waimairi and Riccarton-Wigram wards) experienced greater drops in psychological distress than did those in the moderately damaged region (i.e., across the Spreydon-Heathcote and Hagley-Ferrymead wards). However, the level of psychological distress reported by participants in the most damaged region (i.e., across Shirley-Papanui and Burwood-Pegasus) were not significantly different to those in the least damaged region of central Christchurch. These findings suggest that different patterns of psychological recovery emerged across the different regions of Christchurch, with the moderately damaged region faring the worst, but only after the initial shock of the destruction had passed.