Post-Traumatic Stress Disorder in Turkish Child and Adolescent Survivors Three Years after the Marmara Earthquake

School-based psychosocial and educational interventions for children and adolescents after the 1999 Marmara earthquakes in Turkey: A review on lessons learned

The massive earthquakes experienced in August and November 1999 affected thousands of people in the Marmara region, the most densely populated and industrialized part of Turkey. The humanitarian and economic cost was so enormous, and these earthquakes have changed the Turkish disaster management system and the Turkish people's approach to disasters. Marmara earthquakes are also considered as a milestone in the provision of psychosocial services for disaster victims. This paper aims to review the psychosocial interventions targeting children, adolescents, and their families after the 1999 earthquakes in Turkey. The progression from initial responses to more organized psychosocial interventions is outlined. Conducting the interventions at schools has ensured that thousands of children, teachers, and parents are reached in the most efficient and effective way possible. The significance of the school context in designing psychosocial interventions is highlighted and implications of the lessons learned for traumatic experiences of children and parents are also explored. It is evaluated that these inferences obtained from the Marmara earthquake in Turkey can be used in disasters around the world.

The psychological impact of the Turkey-Syria earthquake on children: addressing the need for ongoing mental health support and global humanitarian response

This letter aims to explore the potential impact of the Turkey-Syria earthquake on the psychological well-being of the affected children and adolescents. It emphasises the crucial importance of prompt identification and management of emerging mental health disorders in this vulnerable population. The letter draws on existing research evidence to highlight the need for suitable mental health interventions to mitigate the anticipated suffering of many children and adolescents affected by the earthquake. A comprehensive overview of the mediating factors which may play a role in the extent of the impact of an earthquake on the mental health of children is discussed. A range of appropriate strategies and interventions are recommended and the call for continued global support is renewed. We have concluded that major earthquakes can potentially contribute to the development of mental health disorders among children and adolescents. However, by providing timely and effective support, it is possible to prevent long-term psychological consequences and facilitate early recovery. We propose the urgent implementation of effective mental health interventions in the aftermath of the Turkey-Syria earthquake to foster the recovery and resilience of the affected young population.

The relationship between posttraumatic stress disorder, posttraumatic growth, and rumination in adolescents after earthquake: A systematic review

PURPOSE

This systematic review aims to examine, from an interdisciplinary perspective, the relationship between posttraumatic stress disorder (PTSD), posttraumatic growth (PTG), and rumination in adolescents after an earthquake. The aim of the review is to provide high-quality, evidence-based recommendations that contribute to the roles of psychiatric nurses and the development of psychosocial support systems.

DESIGN AND METHODS

This study has been conducted in line with the Centres for Reviews and Dissemination (CRD) guideline which guides preparation for transparent reporting of meta-analysis and systematic reviews.

FINDINGS

Despite the limited evidence, it was concluded that it is important to identify the psychological processes that lead to PTG and reduce the incidence of PTSD in earthquake-affected adolescents.

PRACTICAL IMPLICATIONS

This evidence shows how important it is to raise the awareness of healthcare providers in different disciplines, including psychiatric nurses, around the need for psychosocial support interventions following a natural disaster.

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.

Rumination mediates the relationships of fear and guilt to posttraumatic stress disorder and posttraumatic growth among adolescents after the Ya'an earthquake

Background: Although previous research has demonstrated that fear and guilt have an effect on posttraumatic stress disorder (PTSD), it is still unclear how these two emotions affect posttraumatic growth (PTG). Moreover, few studies have examined the mechanisms by which fear and guilt affect PTSD and PTG. Guided by Lee et al.'s theory of PTSD generation mechanisms and Calhoun and Tedeschi's PTG theory, the current study proposes that intrusive rumination (IR) and deliberate rumination (DR) may play a mediating role in the effects of guilt and fear on PTSD and PTG. Objective: This study aimed to simultaneously examine the mediating roles of IR and DR in the relationship between fear, guilt, PTSD, and PTG. Method: This study employed a two-wave longitudinal design. A total of 408 adolescent survivors were assessed using self-report questionnaires after the Ya'an earthquake in China. Measures were obtained for trauma exposure, subjective fear, survivor guilt, IR, and DR at three and a half years after the Ya'an earthquake (Time 1), while PTSD and PTG were assessed at time point four and a half years after the Ya'an earthquake (Time 2). Results: The results showed that both fear and guilt had a direct and positive effect on PTSD and PTG. Fear and guilt were positive predictors of PTSD and negative predictors of PTG through the mediating variable of IR. DR mediated the relationship between guilt and PTG but not PTSD, and also mediated the relationship between IR and PTG. Conclusions: Study findings indicate that fear, guilt, and intrusive rumination may contribute to PTSD symptoms in adolescent trauma survivors. Results also suggest that adolescent survivors can grow emotionally and psychologically following traumatic events, and that directed rumination may contribute to such growth. Interventions that reduce fear, guilt, and intrusive rumination while increasing directed rumination may assist adolescent trauma survivors in recovery and growth.

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.

The effects of spatially varying earthquake impacts on mood and anxiety symptom treatments among long-term Christchurch residents following the 2010/11 Canterbury earthquakes, New Zealand

This study investigates the effects of disruptions to different community environments, community resilience and cumulated felt earthquake intensities on yearly mood and anxiety symptom treatments from the New Zealand Ministry of Health's administrative databases between September 2009 and August 2012. The sample includes 172,284 long-term residents from different Christchurch communities. Living in a better physical environment was associated with lower mood and anxiety treatment rates after the beginning of the Canterbury earthquake sequence whereas an inverse effect could be found for social community environment and community resilience. These results may be confounded by pre-existing patterns, as well as intensified treatment-seeking behaviour and intervention programmes in severely affected areas. Nevertheless, the findings indicate that adverse mental health outcomes can be found in communities with worse physical but stronger social environments or community resilience post-disaster. Also, they do not necessarily follow felt intensities since cumulative earthquake intensity did not show a significant effect.

The relationship between rumination, posttraumatic stress disorder, and posttraumatic growth among Chinese adolescents after earthquake: A longitudinal study

BACKGROUND

Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) can coexist in individuals following traumatic experiences, and cognitive pathways to PTSD and PTG can be different. Nevertheless, to date, no study using the longitudinal-design has examine the cognitive process of PTSD and PTG, nor has the specific causal relation between cognitive factors and PTSD/PTG been clarified in the aftermath of disaster. Therefore, the aim of this study was to extend previous study from a longitudinal perspective, and further examine the possible cognitive mechanism of PTSD and PTG in a long-time frame after earthquake.

METHODS

310 middle school students in Lushan County were assessed using the Event-Related Rumination Inventory, the Post-Traumatic Growth Inventory and the Child PTSD Symptom Scale at 6 months (T1), 12 months (T2) and 18 months (T3) after the Ya'an earthquake.

RESULTS

Intrusive rumination at T2 partly mediated the relationship of intrusive rumination at T1 to PTSD but not PTG at T3. Deliberate rumination at T2 did not mediate the relationship of intrusive rumination at T1 and PTG/PTSD at T3 but completely mediated the relation of intrusive rumination at T2 and PTSD/PTG at T3.

LIMITATIONS

All variables were measured by self-report scales.

CONCLUSIONS

Intrusive rumination at T1 had an effect on PTSD but not PTG at T3 through intrusive rumination at T2, and it could affect PTSD and PTG at T3 through deliberate rumination at T2. These results suggest that PTSD and PTG are influenced by different mechanisms and that intrusive rumination leads to PTSD, whereas deliberate rumination elicits PTG in a long time after trauma.

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.

The role of rumination in posttraumatic stress disorder and posttraumatic growth among adolescents after the wenchuan earthquake

Three hundred and seventy-six middle school students in Wenchuan County were assessed three and one-half years after the Wenchuan earthquake to examine the effects of rumination on posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG). The results revealed that recent intrusive ruminations partly mediated the relationship between intrusive rumination soon after the earthquake with PTSD but not with PTG. Recent deliberate rumination partly mediated the relationship between intrusive rumination soon after the earthquake and PTG but not PTSD. Moreover, recent deliberate rumination also partly mediated the relationship between recent intrusive rumination with PTG but not with PTSD. Overall, intrusive rumination soon after the earthquake had an effect on PTSD but not on PTG through recent intrusive rumination and affected PTG but not PTSD through deliberate recent rumination. Furthermore, intrusive rumination soon after the earthquake affected PTG but not PTSD by recent deliberate rumination following recent intrusive rumination. More importantly, the present study also found that PTSD exhibited no relation to PTG. These results suggest that PTSD and PTG are influenced by different mechanisms, which further indicates that PTSD and PTG represent two separate dimensions of experience after adversity.

Disasters and Depressive Symptoms in Children: A Review

BACKGROUND

Disasters are destructive, potentially traumatic events that affect millions of youth each year.

OBJECTIVE

The purpose of this paper was to review the literature on depressive symptoms among youth after disasters. Specifically, we examined the prevalence of depression, risk factors associated with depressive symptoms, and theories utilized in this research area.

METHODS

We searched MEDLINE, PsycInfo, and PubMed electronic databases for English language articles published up to May 1, 2013. Reference lists from included studies were reviewed to capture additional studies. Only quantitative, peer reviewed studies, conducted with youth under the age of 18 years, that examined postdisaster depressive symptoms were included. Seventy-two studies met inclusion criteria. Prevalence of depressive symptoms, disaster type, correlates of depressive symptoms, and theories of depressive symptoms were reviewed.

RESULTS

Only 27 studies (38%) reported on prevalence rates among youth in their sample. Prevalence rates of depression among youth postdisaster ranged from 2% to 69%. Potential risk factors were identified (e.g., female gender, exposure stressors, posttraumatic stress symptoms). Theories were examined in less than one-third of studies (k = 21).

CONCLUSIONS

Given the variability in prevalence rates, difficulty identifying a single profile of youth at risk for developing depressive symptoms, and lack of a unifying theory emerging from the studies, recommendations for future research are discussed. Use of established batteries of assessments could enable comparisons across studies. Merging existing theories from children's postdisaster and depression literatures could aid in the identification of risk factors and causal pathways.

Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: a systematic review of epidemiological studies across 1987-2011

AIMS

The goal of this paper was to systematically review evidence on (1) the potential magnitude of the psychopathological impacts of community-wide disasters on child and adolescent survivors, and (2) the long-term course or trajectory of disaster-induced psychopathology among children and adolescents.

METHODS

The PubMed/MEDLINE and PsycINFO databases were searched from their respective inception through December 2011. All of the resulting epidemiological studies of child and adolescent survivors following community-wide disasters were examined.

RESULTS

Sixty cross-sectional studies and 25 longitudinal or long-term follow-up studies were identified. The estimated rates of posttraumatic stress disorder (PTSD) and depression among child and adolescent survivors varied greatly across the included studies, ranging from 1.0 to 95 % and 1.6 to 81 %, respectively, while the reported rates of diagnosable PTSD according to the DSM-IV criteria and diagnosable depression ranged from 1.0 to 60 % and 1.6 to 33 %, respectively. The long-term courses of psychopathology among youthful survivors were summarized. Methodological issues with those studies were discussed.

CONCLUSIONS

The empirical findings summarized in this review highlight the importance of psychosocial intervention at early postdisaster stages for child and adolescent survivors. The methodological flaws revealed by this review indicate the need for continued attempts to better understand the epidemiology and trajectory of psychopathological problems among youthful survivors.

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

OBJECTIVE

Our aims were to investigate the prevalence of PTSD, depression, anxiety-related disorders, and dissociative symptomotology, and to assess the risk factors for development of psychopathology among children and adolescents after the 2011 Van earthquake in Turkey.

METHODS

The screening was conducted among 738 participants at 6months post-earthquake using the CPTSD-Reaction Index, State and Trait Anxiety Inventory for Children, Screen for Child Anxiety Related Emotional Disorders, Child Depression Inventory, Childhood Anxiety Sensitivity Index, Metacognitions Questionnaire for Children, and Adolescent Dissociative Experiences Scale.

RESULTS

Less than half (40.69% of) of the participants reported severe levels of PTSD symptoms, 53.04% were at greater risk for developing an anxiety-related disorder, 37.70% met the criteria for clinical depression, and 36.73% revealed pathological levels of dissociative symptomotology. State-trait anxiety, and anxiety sensitivity were significant antecedents of psychopathology.

CONCLUSION

We concluded that anxiety sensitivity is a significant risk factor in various types of psychopathology, but metacognitions seem to have a limited utility in accounting for poor psychological outcomes in young survivors of earthquake.

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.

Validation of the Chinese version of the Children's Revised Impact of Event Scale (CRIES) among Chinese adolescents in the aftermath of the Sichuan Earthquake in 2008

OBJECTIVE

This study examined the psychometric properties of the 13-item Chinese version of the revised Impact of Event Scale for Children (CRIES) among 3160 high school students in Chengdu, China, 1 month after the Sichuan Earthquake in 2008.

METHODS

Participants self-administered a structured questionnaire in classroom settings. Posttraumatic stress symptoms (using the Chinese version of the CRIES) and other psychological variables, including depression, anxiety, thoughts of physical threat, and earthquake-related experiences, were measured. Confirmatory factor analysis and Spearman correlation analyses were conducted to confirm the factor structure and examine the validity of the CRIES.

RESULTS

As in previous Western studies, confirmatory factor analysis results indicated that the 3-factor structure of the CRIES (intrusion, avoidance, and hyperarousal) provided a significantly better fit than the single-factor model and the 2-factor model. The CRIES showed good reliability (Cronbach αs for the full scale and subscales ranged from .74 to .85). The CRIES total score was positively correlated with depression, anxiety, automatic thought of physical threat, earthquake-related worries, and postearthquake suicidal ideation.

CONCLUSIONS

The CRIES has shown to be reliable and valid in assessing Chinese adolescents' symptoms of potential posttraumatic stress disorder. Our findings also support the 3-factor measurement model of posttraumatic stress symptoms, which is comparable with their Western studies. Further validation studies on other forms of traumatic experience among Chinese adolescents are warranted.

Victims' time discounting 2.5 years after the Wenchuan earthquake: an ERP study

BACKGROUND

Time discounting refers to the fact that the subjective value of a reward decreases as the delay until its occurrence increases. The present study investigated how time discounting has been affected in survivors of the magnitude-8.0 Wenchuan earthquake that occurred in China in 2008.

METHODOLOGY

Nineteen earthquake survivors and 22 controls, all school teachers, participated in the study. Event-related brain potentials (ERPs) for time discounting tasks involving gains and losses were acquired in both the victims and controls.

FINDINGS

The behavioral data replicated our previous findings that delayed gains were discounted more steeply after a disaster. ERP results revealed that the P200 and P300 amplitudes were increased in earthquake survivors. There was a significant group (earthquake vs. non-earthquake) × task (gain vs. loss) interaction for the N300 amplitude, with a marginally significantly reduced N300 for gain tasks in the experimental group, which may suggest a deficiency in inhibitory control for gains among victims.

CONCLUSIONS

The results suggest that post-disaster decisions might involve more emotional (System 1) and less rational thinking (System 2) in terms of a dual-process model of decision making. The implications for post-disaster intervention and management are also discussed.

Reducing the Risk of Posttraumatic Stress Disorder in Children Following Natural Disasters

A significant number of children suffer long-term psychological disturbance following exposure to a natural disaster. Evidence suggests that a dose-response relationship exists, so that children and adolescents who experience the most intense or extensive exposure to the risk factors for posttraumatic stress disorder (PTSD) are likely to develop the most serious and persistent symptoms. Risk factors include gender, age, personality, extent of exposure to the natural disaster, amount of damage to property and infrastructure, witnessing the death or injury of others or perceiving a threat to one's own life. Knowing these factors enables various strategies to be put in place to decrease the risk of psychological disturbance following traumatic events. Reestablishing a sense of safety, security and normality is important in the aftermath of a natural disaster, and promoting social connectedness, positive family functioning and effective coping mechanisms can make children more resilient in the face of catastrophic events. This paper examines the risk and protective factors associated with the development of PTSD, and considers how schools can use this knowledge to contribute to the recovery effort and reduce the prevalence of PTSD among pupils in the wake of a natural disaster.

Adolescents' posttraumatic stress reactions and behavior problems following Marmara earthquake

BACKGROUND

Although most children and adolescents exhibit some kindof postdisaster reactions, their symptoms vary depending on the age, gender, parental social support, disaster and postdisaster contextual factors.

OBJECTIVE

This study examined adolescents' postdisaster experiences, posttraumatic stress disorder (PTSD) symptoms, and behavior problems 13 months after the 1999 Marmara earthquake in Turkey.

DESIGN

Participants included 695 adolescents aged 12-17 years, who resided in three districts of Izmit at varying distances from the epicenter (e.g., high (HI), medium (MI), and low impact (LI) areas). Measures included demographics, earthquake exposure experiences, ChildPTSD Reaction Index, and Behavior Problems Index.

RESULTS

Findings revealed that 76% of the adolescents reported moderate to very severe levels of PTSD symptoms (82% HI, 70% MI, and 70% LI) after the devastating earthquake. As expected, the HI group reported more symptoms than did members of MI and LI groups. Overall, 39% of the variance in adolescents' PTSD symptoms was accounted for by the degree of exposure and gender. Analyses also indicated an increase in the frequency of adolescents' behavior problems following the earthquake.

CONCLUSIONS

The findings of this study have clinical implications for designing and implementing effective, developmentally appropriate, and culturally sensitive intervention programs for the victims of major disasters.

The prevalence of long-term post-traumatic stress symptoms among adolescents after the tsunami in Aceh

The aim of this study was to identify long-term post-traumatic stress disorder (PTSD) symptoms in Aceh 4.5 years after the tsunami and to examine whether certain factors affected the severity of PTSD symptoms among adolescents. The PTSD symptoms of 482 adolescents aged 11 to 19 years were assessed according to the Child Post-Traumatic Stress Reaction Index (CPTSD-RI). The severity of the disaster was identified by the Traumatic Exposure Severity Scale (TESS). Of the adolescents who completed the questionnaire, 54 (11.2%), 124 (25.7%), 196 (40.7%), 103 (21.4%) and 5 (1%), respectively, reported none, mild, moderate, severe and very severe symptoms on CPTSD-RI. Gender, loss of parents, somatic response and support level were significantly associated with the total score on CPTSD-RI (P < 0.05). The TESS-Occurrence Scale and CPTSD-RI were significantly correlated (r= 0.33, P < 0.05). The TESS-Distress Scale was significantly correlated with CPTSD-RI (r= 0.48, P < 0.05). The study indicated that the symptoms of PTSD, ranging from very severe to moderate, could persist for a long time after the tsunami and be affected by gender, loss of parents, somatic response, support level and severity of the disaster.

Female victimization and intimate partner violence after the May 12, 2008, Sichuan earthquake

This study investigates the impact of the earthquake that occurred on May 12, 2008 in Sichuan, China on stressed families already experiencing domestic violence. We hypothesized that cumulative postdisaster stress would increase marital aggression and that the well-being of victims would deteriorate following the quake. A total of 186 women were recruited for this study. Results show that all types of family violence, including psychological aggression and physical violence between partners, increased after the earthquake. We provided preliminary evidence that psychological aggression was significantly associated with the detrimental effects on victims' mental and physical functioning. The findings support the need for violence assessment among victims of earthquakes, and we recommend that violence prevention be considered as part of the intervention during such natural disasters.