Factor structure of the Children’s Revised Impact of Event Scale among children and adolescents who survived the 2008 Sichuan earthquake in China

Psychometric Validation of the Indonesian Version of Children's Revised Impact of Event Scale 13

A psychometric evaluation of the Children's Revised Impact of Event Scale 13 (CRIES-13), which measures the posttraumatic stress disorder (PTSD) symptoms in children and adolescents caused by the coronavirus disease 2019 (COVID-19) pandemic, was conducted. We aimed to cross-culturally adapt and test the psychometric qualities of the CRIES-13 that was applied to Indonesian adolescents exposed to COVID-19 risk across gender groups. A cross-sectional study was conducted at a junior high school in Yogyakarta, Indonesia, in May 2022; 346 Indonesian adolescents aged 12 to 18 years completed the Indonesian version of the CRIES-13. The factorial validity results supported the scale's three-factor structure (intrusion, avoidance, and arousal), which satisfied all parameter index requirements and exhibited a favorable level of internal consistency reliability. Excellent results were obtained across genders for the four-level measurement of invariance (i.e., configural, metric, scalar, and full invariance), and they met the recommended criteria. Our Cronbach's alphas and composite reliability ratings were high (>0.7), indicating a strong correlation and reliability of the items for measuring each construct. We strongly support the use of the Indonesian CRIES-13, which was demonstrated to be valid and reliable for an adolescent population.

Increased symptoms of post-traumatic stress in school students soon after the start of the COVID-19 outbreak in China

BACKGROUND

The outbreak of Coronavirus Disease 2019(COVID-19) caused psychological stress in Chinese adults population. But we are unaware of whether the pandemic causes psychological stress on children.

METHODS

We used the Children's Impact of Event Scale questionnaire (CRIES-13) to investigate the degree of Post-traumatic Stress (PTSD) symptoms caused by the pandemic in students selected from schools in Sichuan, Jiangsu, Henan, Yunnan, and Chongqing provinces of China.

RESULTS

A total of 7769 students(3692 male and 4077 female), aged 8-18 years, were enrolled in the study, comprising 1214 in primary schools, 2799 in junior high schools and 3756 in senior high schools. A total of 1639 students (21.1%) had severe psychological stress reactions. A large proportion of senior high school students (23.3%) experienced severe psychological stress, and they had the highest median total CRIES-13 score. Female students were more likely to experience severe psychological stress and had higher median CRIES-13 total scores than males.

CONCLUSION

COVID-19 has placed psychological stresses on primary and secondary school students in China. These stresses are more likely to reach severe levels among female students and senior high school students.

The Children's Revised Impact of Event Scale: Dimensionality and Measurement Invariance in a Sample of Children and Adolescents Exposed to Wildfires

Natural disasters are potentially traumatic events due to their disruptive nature and high impact on social and physical environments, particularly for children and adolescents. The present study aimed to examine the psychometric properties of the Children's Revised Impact of Event Scale (CRIES-13) in a sample of Portuguese children and adolescents exposed to a specific type of natural disaster (i.e., wildfire). The sample was recruited at six school units of the Central region of Portugal following wildfires in the summer of 2017 and included children and adolescents without a clinical diagnosis of a psychopathological condition associated with exposure to the traumatic event (i.e., nonclinical sample, n = 486) and those with a clinical diagnosis of a trauma- and/or stress-related disorder (i.e., posttraumatic stress disorder [PTSD], adjustment disorder, separation anxiety disorder, or grief; clinical sample, n = 54). Confirmatory factor analyses indicated that a two-factor model (i.e., Intrusion/Arousal and Avoidance) provided a better fit than a three-factor model (i.e., Intrusion, Arousal, and Avoidance) and was found to be invariant across gender and age groups. The CRIES-13 showed good reliability for all subscales, with Cronbach's αs > .79. Higher CRIES-13 scores were associated with poorer health and well-being and more internalizing and externalizing problems. The clinical sample presented with significantly higher CRIES-13 scores than the nonclinical sample, η_p ² = .13. These results contribute to the cross-cultural validation of the CRIES-13 and support its use as a reliable and valid measure for assessing posttraumatic symptoms in children and adolescents.

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

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

Epidemiological Characteristics and Risk Factors of Posttraumatic Stress Disorder in Chinese Children After Exposure to an Injury

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.

Influence of earthquake exposure and left-behind status on severity of post-traumatic stress disorder and depression in Chinese adolescents

In the Longmenshan seismic fault zone in the Sichuan province of China, many children and adolescents have been exposed to the 2008 Wenchuan earthquake and/or the 2013 Lushan earthquake, and many are left alone for extended periods by parents who migrate to larger cities for work. We wished to examine how these two kinds of trauma-earthquake exposure and left-behind status-influence severity of post-traumatic stress disorder (PTSD) and depressive reactions. A cross-sectional survey of 2447 adolescents aged 13-18 at 11 schools in three cities in the Longmenshan fault zone was conducted in 2016. Potential relationships of scores on the Children's Revised Impact of Event Scale (CRIES-13) and the Depression Self-Rating Scale (KADS-6) with severity of PTSD and depression symptoms were explored using ANOVA and multiple hierarchical linear regression. Prevalence of post-traumatic stress and depression symptoms were higher among left-behind children than among those not left behind, and both types of symptoms were more severe in children exposed to both earthquakes than in children exposed only to the Lushan earthquake. Our results suggest that earthquake exposure is a strong risk factor for PTSD, whereas being left behind is a strong risk factor for depression.

Children's Reactions to Flood Disaster in Kashmir

BACKGROUND

The flood disaster of 9^th-10^th September 2014 wreaked havoc in the Jammu and Kashmir region of India. Incessant rains and deluge claimed 283 lives and damaged 2.53 lakh houses. This article presents the findings of the psychosocial care team from the National Institute of Mental Health and Neuro Sciences, Bengaluru, India, during the early phase of disaster.

MATERIALS AND METHODS

The team assessed posttraumatic stress symptoms of 64 child survivors from six villages of two districts struck by floods using Children's Revised Impact of Event Scale (CRIES)-8 and qualitative narrations.

RESULTS

Children showed high levels of intrusion and avoidance in the aftermath of floods. Both boys and girls showed moderate to severe level of psychological impact on the domains of CRIES-8. The narrations by the children centred on the theme of "water" and "enjoyment in seeing lots of water;" followed by "fearing of the parent's life," later on "fear of their own life," and subsequently to avoidance to go near the river and nightmares like "floating in the water."

CONCLUSION

Disasters immensely impact children because of their particular stage of psychological and social development. This highlights the need for psychosocial interventions to minimize the impact of disasters on children at the earliest using simple psychosocial care techniques by employing available community-based manpower.

Assessment Tools for the Mental Health of School-Aged Children and Adolescents Exposed to Disaster: A Systematic Review (1988-2015)

Objectives

In this study, we aimed to conduct a systematic review of studies investigating psychosocial factors affecting children exposed to disasters.

Methods

In total, 140 studies were retrieved. The studies were published from 1988 to 2015. A systematic review was performed using the PRISMA guidelines. MEDLINE, EMBASE, Cochrane Central, Web of Science, PsycINFO, PubMed, and Google Scholar were searched. Each database was searched using the following terms: 'Child,' 'Adolescent,' 'Youth,' 'Disaster,' 'Posttraumatic,' 'Psychosocial,' 'Assessment,' 'Evaluation,' and 'Screening.' The identified studies were subjected to data extraction and appraisal.

Results

The database search identified 713 articles. Based on the titles and abstracts, the full texts of 118 articles were obtained. The findings of this review can be used as a basis for the design of a psychosocial evaluation tool for disaster preparedness.

Conclusion

Given the paramount importance of post-disaster evaluation and the weaknesses of current disaster evaluation tools, the need to develop valid and reliable tools and psychometric evaluations cannot be overstated. Our findings provide current evidence supporting various assessments in children, who are very vulnerable psychologically following disasters.

Understanding the Impact of Natural Disasters on Psychological Outcomes in Youth from Mainland China: a Meta-Analysis of Risk and Protective Factors for Post-Traumatic Stress Disorder Symptoms

Post-traumatic Stress Disorder (PTSD) is a mental illness that causes significant distress and impairment. Studies generally indicate lower rates of PTSD post-disaster in Chinese child populations. Irrespective of population examined, findings suggest that trauma alone cannot account for the development of PTSD (Ma et al. 2011). It is important to understand what other variables may contribute to the onset of PTSD. This was the first meta-analysis conducted to investigate risk and protective factors for PTSD (as well as mediating/moderating variables) in children directly impacted by natural disasters in China. Understanding these factors can help guide disaster readiness efforts, as well as post-disaster interventions (Yule et al. 2000). Also, this study is extremely relevant given recent earthquakes in China that have devastated many.

Psychosocial problems of children whose parents visit the emergency department due to intimate partner violence, substance abuse or a suicide attempt

BACKGROUND

High levels of maltreatment are found in children who are identified because their parents visit the emergency department due to partner violence, substance abuse or suicide attempt. However, it is unknown if these children experience psychosocial problems. This study aims to assess their levels of post-traumatic stress, anxiety, depression, behavioural problems and health-related quality of life.

METHODS

A cross-sectional study was conducted in six hospitals. All consecutive families of which a parent visited the emergency department due to partner violence, substance abuse or suicide attempt between 1 July 2012 and 1 March 2014 with children aged 1.5-17 years were approached for participation. Parents and children aged 8 years and older filled out questionnaires measuring post-traumatic stress [13-item version of Children's Revised Impact of Event Scale (CRIES-13)], anxiety, depression (Revised Child Anxiety and Depression Scale), behavioural problems [Child Behavior Checklist (CBCL) and Youth Self-Report (YSR)] and health-related quality of life (PedsQL). Scores of participants were compared with reference data obtained in children in similar age ranges from representative Dutch community samples (CRIES-13, Revised Child Anxiety and Depression Scale, PedsQL and CBCL) and to a normed cutoff score (CRIES-13).

RESULTS

Of 195 eligible families, 89 (46%) participated in the study. Participating children did not score different from community children, both on child-reported and parent-reported instruments. Standardized mean differences of total sum scores were 0 (CRIES-13 and CBCL 1.5-5), 0.1 (YSR), 0.2 (CBCL 6-18) and -0.3 (PedsQL) and not statistically different from community children. Thirty-five percent of the participating children scored above the cutoff score on the CRIES-13, indicating post-traumatic stress disorder, but this difference was not statistically significant from community children (mean difference 8%; 95% CI -4-22%).

CONCLUSIONS

We found no differences in psychosocial problems between children whose parents visited the emergency department due to partner violence, substance abuse or suicide attempt and children from community samples. Because 35% of the children scored in the range of post-traumatic stress disorder, we advise healthcare providers to pay attention to post-traumatic stress symptoms.

Measurement Issues: Measurement of posttraumatic stress disorder in children and young people - lessons from research and practice

BACKGROUND

Many young people are exposed to traumatic events and a significant minority of these individuals will go on to experience posttraumatic stress disorder (PTSD). Valid and reliable measurement tools for assessing PTSD are essential and can aid screening, clinical diagnosis, treatment planning and outcome monitoring.

METHODS

This article outlines the range of instruments available for these aspects of measurement, including assessment of PTSD in very young children, with a focus on those scales with good clinical utility and sound psychometric properties.

FINDINGS

This is a particularly challenging time for clinicians working with children and young people with PTSD: all instruments will need to be revised and updated in order to better reflect the recent revisions to the diagnostic criteria for PTSD with the publication of the DSM-5 and no doubt the anticipated ICD-11. Despite this, measurement tools can still play a vital role in assessing PTSD in children and young people.

Prevalence of traumatic events and risk for psychological symptoms among community and at-risk children and adolescents from Bangladesh

BACKGROUND

Children from developing countries are more vulnerable to traumatic experiences and more likely to suffer a range of psychological problems than children from developed countries.

METHOD

The current paper describes a survey of 1360 children and adolescents from Bangladesh who were selected either from the general community or through a range of social service organizations. Children completed a checklist of traumatic events and questionnaires to assess symptoms of PTSD, anxiety and depression.

RESULTS

Children from both samples reported high levels of exposure to traumatic events, both via direct experience and indirectly. Direct experiences with intentional, man-made events were more frequently reported by children from support services while trauma from natural disasters was more common among community children. Psychological symptoms were significantly higher within children from social support services. The strongest predictors of psychological symptoms were age, gender, sample source and exposure to man-made direct traumas.

CONCLUSION

The results point to the common occurrence of traumatic events and their emotional consequences among children and adolescents from Bangladesh and indicate the need to develop effective and accessible mental health services for Bangladeshi children and adolescents.

Psychometric Properties of the Child's Reaction to Traumatic Events Scale-Revised in English and Lugandan

Brief and age-appropriate measures of trauma-related symptoms are useful for identifying children in need of clinical services. The current study examines the psychometric properties of the 23-item Child's Reaction to Traumatic Events Scale-Revised (CRTES-R). The CRTES-R includes subscales assessing hyperarousal, avoidance and intrusion. To date, no studies have examined the psychometric properties of this revised measure or cross-cultural differences in its factor structure. Two samples of (a) children (ages 6-21) who had experienced a hurricane in the USA or Grenada (N = 135), and (b) Ugandan children (ages 8-17) who had experienced a variety of traumatic events (N = 339) completed the CRTES-R in English or Lugandan. Confirmatory factor analysis supported an empirically adjusted model with three modified latent factors in both the English (χ²/df = 1.34, CFI = .90, RMSEA = .05) and Lugandan samples (χ²/df = 1.45, CFI = .93, RMSEA = .04). Although the analysis supported separate hyperarousal, avoidance and intrusion subscales, the items that loaded on each factor differed from the original CRTES-R subscales. The English version of the CRTES-R showed good concurrent validity with the Kauai Recovery Index measure of trauma symptoms. Those using the CRTES-R to assess children's experiences of the different symptom types should consider using the empirically-derived subscales described in this paper; however, those who wish to capture a broad spectrum of PTSD symptoms should consider using all the original CRTES-R items and calculating a total score.

Posttraumatic Coping and Distress

The current body of knowledge related to trauma and posttraumatic stress disorder (PTSD) is primarily based on research conducted in Western nations. Thus, Western clinicians and researchers may know little about whether people from non-Western societies have similar reactions or symptom manifestations to specific traumatic events. Traditional Chinese health beliefs with their roots in Taoism, Confucianism, and Buddhism influence illness perception and affect coping behaviors of Chinese exposed to traumatic events. This article discusses compatible and incompatible aspects of the traditional Chinese health beliefs with Western beliefs about PTSD and examines how culture-based motivations may possibly impact emotional responses to traumatic events between American and Chinese cultures. This article also reviews the literature on the prevalence and applications of Western diagnostic criteria and measures of PTSD in contemporary Chinese populations and proposes suggestions for developing a culturally sensitive framework for clinical management of Chinese trauma survivors.

Psychometric properties of the Children's Revised Impact of Events Scale (CRIES) with Bangladeshi children and adolescents

Identification of possible cases suffering post-traumatic stress disorder (PTSD) is important, especially in developing countries where traumatic events are typically prevalent. The Children's Revised Impact of Events Scale is a reliable and valid measure that has two brief versions (13 items and 8 items) to assess reactions to traumatic events among young people. The current study evaluated the psychometric properties of both versions of the CRIES in a sample of 1,342 children and adolescents aged 9-17 years (M = 12.3 years, SD = 2.12) recruited from six districts of Bangladesh. A sub-group of 120 children from four schools was re-tested on the measures within 3.5 weeks. Confirmatory factor analysis supported factor structures similar to those found in other studies for both versions of the CRIES. Multiple group confirmatory factor analysis showed gender and age-group differences within the sample, supporting established age and gender differences in prevalence of PTSD symptoms. Analyses also indicated moderate to excellent internal consistency and test-retest reliability and clear discriminant and convergent validity. These data support use of both the CRIES-13 and CRIES-8 to provide quick and psychometrically sound assessment of symptoms of PTSD among children and adolescents from Bangla-speaking communities.

Characteristics of the Children's Revised Impact of Event Scale in a clinically referred Dutch sample

Early identification of posttraumatic stress disorder (PTSD) in children is important to offer them appropriate and timely treatment. The Children's Revised Impact of Event Scale (CRIES) is a brief self-report measure designed to screen children for PTSD. Research regarding the diagnostic validity of the CRIES is still insufficient, has been restricted to specific populations, and sample sizes have often been small. This study evaluated the reliability and validity of the 8-item (CRIES-8) and 13-item (CRIES-13) versions of the CRIES in a large clinically referred sample. The measure was completed by 395 Dutch children (7-18 years) who had experienced a wide variety of traumatic events. PTSD was assessed using the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent version. A cutoff score of 17 on the CRIES-8 and 30 on the CRIES-13 emerged as the best balance between sensitivity and specificity, and correctly classified 78%-81% of all children. The CRIES-13 outperformed the CRIES-8, in that the overall efficiency of the CRIES-13 was slightly superior (.81 and .78, respectively). The CRIES appears to be a reliable and valid measure, which gives clinicians a brief and user-friendly instrument to identify children who may have PTSD and offer them appropriate and timely treatment.

Posttraumatic reactions to an earthquake: multidimensional scaling profile analysis of adolescent survivors

The current study examined the prototypical profiles of posttraumatic stress reactions among a sample of 282 adolescent survivors of the 2008 Wenchuan earthquake in China. Based on a dimensional perspective, the results of profile analysis via multidimensional scaling (PAMS) model revealed a two-dimensional solution corresponding to four profiles: intrusion, avoidance/arousal, partial avoidance, and hyperarousal. These profiles of posttraumatic stress symptoms equally manifested across gender. In addition, the Intrusion Profile was found to be associated with more elevated psychological distress symptoms. Results are discussed with respect to the typical posttraumatic stress symptoms following the earthquake.

Children and war: the work of the Children and War Foundation

The Children and War Foundation was established after the authors' experiences following the civil war in former Yugoslavia in the mid-1990s. Many organizations tried to mitigate the effects of the war on children but few interventions were based on evidence and fewer were properly evaluated. The Foundation was established in Norway with the aim of promoting better evidence-based interventions to help children after wars and natural disasters.The Foundation has developed a number of empirically grounded manuals that aim to help children learn strategies that will lessen the stress reactions that they have developed. The manuals are designed to be delivered by personnel who are not necessarily very experienced in child mental health. They are aimed at groups of children using a public health approach to reach large numbers in a short space of time. The strategies are not intended as individual therapy.The Teaching Recovery Techniques manual has been used following a number of earthquakes and other natural disasters and data from a number of these will be discussed. A Writing for Recovery manual is aimed at helping adolescents and is based on the seminal work of James Pennebaker. It is currently being evaluated in three separate studies. A group-based manual to help children bereaved by war or disaster has recently been developed.

Structure of the Children's Revised Impact of Event Scale (CRIES) with children and adolescents exposed to debris flood

AIM

PTSD symptoms were pervasive among children and adolescents after experiencing or exposure to traumatic events. Screening and diagnosis of PTSD symptoms is crucial in trauma-related research and practice. The 13-item Children's Revised Impact of Event Scale (CRIES) has been demonstrated to be a valid and reliable tool to achieve this goal. This study was designed to examine the psychometric properties of the 13-item CRIES in a sample of Chinese debris flood victims.

METHODS

A total of 268 participants (145 girls, 123 boys) aged 8-18 years were recruited from an integral part of a service oriented project, supported by the Institute of Psychology, Chinese Academy of Sciences following the debris flood. The participants were given the 13-item CRIES 3 months after the debris flood.

RESULTS

The results of confirmatory factor analysis indicated that a two-factor structure (intrusion+arousal vs avoidance) emerged as the model best fit in total sample, boys and girls subsamples, respectively. The scale was also demonstrated to have good internal consistency (Cronbach's alpha = 0.83).

CONCLUSION

The study confirmed the good psychometric properties of the CRIES and its' applicability to Chinese children and adolescents. Moreover, these findings imply that the CRIES factor structure is stable across age, gender, and different types of trauma.

Prevalence of PTSD and depression among junior middle school students in a rural town far from the epicenter of the Wenchuan earthquake in China

CONTEXT

On May 12(th) 2008, a devastating earthquake measuring 8.0 on the Richter scale, struck Wenchuan county and surrounding areas in China. The prevalence of mental illness among children and adolescents in a rural town far from the earthquake epicenter is unknown.

OBJECTIVE

To assess the prevalence of posttraumatic stress disorder (PTSD) and depression among junior middle school students in a rural town Ningqiang county, 327 km from the earthquake epicenter.

DESIGN, SETTING, AND PARTICIPANTS

A population-based mental health survey was conducted in March, 2009.

MAIN OUTCOME MEASURE

Survey Self-designed General Condition Survey Scale, Children's Revised Impact of Event Scale (CRIES-13), and the Depression Self-rating Scale for Children (DSRSC) were used to sample 1,841 junior middle school students in Ningqiang county, ten months after the Wenchuan earthquake.

RESULTS

The prevalence rate of a high-risk for PTSD was 28.4%, with 32.7% among females, 23.8% among males (female vs. male, p<0.001), 38.6% in the severe exposure group and 24.3% in the mild exposure group (severe vs. mild exposure, p<0.001). For depressive symptoms, the overall prevalence was 19.5%, with 24.0% among females, 14.7% among males, 24.5% in the severe exposure group and 17.5% in the mild exposure group (female vs. male, p<0.001; severe vs. mild exposure, p<0.001, respectively). In multivariate analysis, factors such as "having felt despair", or "danger" and "having own house destroyed or damaged" were significantly associated with PTSD symptoms. Female gender and delayed evacuation in females, and earthquake related experiences in males were significantly associated with depression.

CONCLUSION

Traumatic events experienced during the earthquake were significantly associated with symptoms of PTSD and depression in children and adolescents, ten months after the Wenchuan earthquake. These data highlight a need for mental health services for children and adolescents in rural areas, far from earthquake epicenters.