Traumatic experiences and mental health consequences among child survivors of the 2008 Sichuan earthquake: a community-based follow-up study

Improving earthquake prediction accuracy in Los Angeles with machine learning

This research breaks new ground in earthquake prediction for Los Angeles, California, by leveraging advanced machine learning and neural network models. We meticulously constructed a comprehensive feature matrix to maximize predictive accuracy. By synthesizing existing research and integrating novel predictive features, we developed a robust subset capable of estimating the maximum potential earthquake magnitude. Our standout achievement is the creation of a feature set that, when applied with the Random Forest machine learning model, achieves a high accuracy in predicting the maximum earthquake category within the next 30 days. Among sixteen evaluated machine learning algorithms, Random Forest proved to be the most effective. Our findings underscore the transformative potential of machine learning and neural networks in enhancing earthquake prediction accuracy, offering significant advancements in seismic risk management and preparedness for Los Angeles.

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.

Heart rate variability in 2014 predicted delayed onset of internalizing problems in 2015 among children affected by the 2011 Great East Japan Earthquake

Experience of natural disaster was related to an increased risk of long-term child internalizing problems. Initial traumatic experiences are hypothesized to work as disaster-related stresses and sensitize neural circuitry, leading to heightened reactivity to subsequent stressful experiences, which in turn results in delayed onset of internalizing problems. However, empirical evidence is lacking. Thus, we aimed to examine the association between heart rate variability (HRV) and internalizing problems among children exposed to the disaster. The Great East Japan Earthquake Follow-up for Children (GEJE-FC) study followed children aged 4-6 years old and their siblings and parents from three affected prefectures (Miyagi, Fukushima, and Iwate) and one unaffected prefecture (Mie) in Japan over four periods: from August 2012 to June 2013 (= T1), August 2013 to April 2014 (= T2), July 2014 to December 2014 (= T3), and August 2015 to December 2015 (= T4) (n = 155). HRV was assessed at T2 and T3 as a biomarker of autonomic nervous system activity. Child internalizing problems were assessed by caregivers at T3 and T4, using the Child Behavior Checklist. HRV measurements at T2 were not associated with child internalizing problems at T3. However, HRV in low frequency domains at T3 showed an inverse association with child internalizing problems at T4 (B = -1.72, 95% CI = -3.12 to -0.31). The findings indicated that later exacerbation of internalizing problems could be predicted by dysfunction of autonomic nervous system measured by HRV.

Medication use in populations exposed to the 2010 Eyjafjallajökull eruption: an interrupted time series analysis

OBJECTIVES

To assess the trends in medication use indicative of physical and psychological morbidity following the 2010 volcanic eruption in Eyjafjallajökull immediately after and during a 3-year period following the eruption.

DESIGN

Population-based register study.

SETTING

Eyjafjallajökull eruption in Iceland, 2007-2013.

PARTICIPANTS

All residents in Iceland who received at least one medication dispensing were identified. Residents of exposed areas were classified into exposure groups (individual-level data) and residents in other parts of Iceland were included as a non-exposed group (aggregated data).

INTERVENTION/EXPOSURE

Eyjafjallajökull erupted on 14 April 2010 and continued for 39 days, producing heavy ash fall in South Iceland.

MAIN OUTCOME MEASURES

Using interrupted time series analysis, we examined annual and quarterly changes in medicine use, measured as number of dispensed defined daily dose (DDD) per 1000 individuals. We calculated the level shift (immediate change) and change in slope from pre-eruption to post-eruption (long-term change) in medication dispensing.

RESULTS

Among exposed residents, there was a 6% decrease (95% CI -7% to -4%) in the annual number of dispensed DDDs 1-year post-eruption in the overall medication class, including analgesics (-5%, 95% CI -6% to -3%), hypnotics and sedatives (-9%, 95% CI -11% to -7%) and respiratory medications (-7%, 95% CI -9% to -5%; -8%, 95% CI -11% to -4%). Simultaneously, there was a 9% decrease (95% CI -14% to -4%) in the overall medication class among non-exposed residents. Moreover, among exposed residents, we observed change in slope of -4% (95% CI -7% to -1%) in the overall medication class, including for analgesics (-6%, 95% CI -8% to -3%) and other respiratory drugs (-10%, 95% CI -16% to -4%).

CONCLUSION

Our findings indicate that the eruption did not lead to increases in medication dispensing among residents of exposed areas, rather decreases for some medicine classes. The results should be interpreted with caution since the content of each eruption differs.

Post-traumatic Stress and Depressive Symptoms Among Adolescents After the 2015 Earthquake in Nepal: A Longitudinal Study

Few longitudinal studies have focused on mental health problems among adolescents after earthquakes. We investigated changes in post-traumatic stress symptoms (PTSS) and depressive symptoms from 18 to 31 months after the 2015 earthquake in Nepal and explored potential risk factors associated with the change in psychiatric symptoms. This study comprised of 515 adolescents, aged 11-17 years from two earthquake-affected areas, one severely affected than the other. The psychiatric symptoms were assessed using the standardized Child Post-traumatic Stress Disorder Scale and the Depression Self-Rating Scale. No significant change was observed in the prevalence of PTSS and depressive symptoms from 18 to 31 months after the earthquake. Living in severely affected area and exposure to trauma after the earthquake were associated with adolescents who developed chronic or delayed PTSS and depressive symptoms. The study findings highlight the need for disaster preparedness and early interventions that strengthen support at various levels.

Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy

Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9-15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.

25-year follow-up of treated and not-treated adolescents after the Spitak earthquake: course and predictors of PTSD and depression

BACKGROUND

There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors.

METHODS

At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate-severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D).

RESULTS

(1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1-22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses.

CONCLUSION

Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.

Changes Over Time in Post-traumatic Stress Disorder Among Children Who Survived the 2008 Wenchuan Earthquake and Predictive Variables

Background: This study examines changes over time in post-traumatic stress disorder (PTSD) among children who survived the 2008 Wenchuan earthquake and the relevant predictive variables. Methods: A total of 203 children and adolescents were investigated 24 months after the earthquake, and 151 children and adolescents completed the 1-year follow-up study. Participants completed the Children's Revised Impact of Event Scale (CRIES-13), the Center for Epidemiologic Studies Depression Scale (CES-D) and the Connor-Davidson Resilience Scale (CD-RISC). Hierarchical linear regression analysis was used to evaluate the predictors of changes in PTSD severity. Results: Eighty percent of the children still had some PTSD symptoms 2 years after the Wenchuan earthquake, and 66.25% of the children had symptoms that lasted 3 years. In the model predicting PTSD symptom severity, the loss of family members and child burial explained a significant 21.9% of the variance, and depression explained a significant 16.7% of the variance. In the model predicting changes in PTSD severity, the change scores for resilience and depression explained a significant 18.7% of the variance, and cognitive behavioral therapy (CBT) explained a significant 33.6% of the variance. Conclusions: PTSD symptoms in children and adolescents can persist for many years after trauma. In addition to using psychological interventions to improve PTSD symptoms, improvements in depression and resilience should also be considered.

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.

Multidimensional Scale of Perceived Social Support in Indonesian adolescent disaster survivors: A psychometric evaluation

BACKGROUND

Social support plays an important role in adolescents' mental health and well-being, and even more so for disaster survivors. To measure the level of social support, one needs an appropriate tool to produce valid and reliable results; therefore, we aimed to measure the invariance across gender groups, and analyze the construct validity and reliability of the Indonesian version of the Multidimensional Scale of Perceived Social Support (MSPSS), a social support measurement tool which was theoretically constructed and has been well validated in many countries with various cultures and backgrounds.

METHODS

A school-based assessment was conducted in junior and senior high schools in a post-disaster setting in Yogyakarta Province, Indonesia. We analyzed 299 adolescent survivors of a volcanic eruption, aged 12~18 years who completed a 12-item Indonesian version of the MSPSS.

RESULTS

The factorial validity confirmed the three-factor structure of the scale (Family, Friends, and Significant Others) which met all of the criteria of parameter indices and provided evidence of high internal consistency reliability. The three-level measurement of invariance, which consisted of configural, metric, and scalar invariance, also performed very well across gender groups with our data and corresponded to the recommended parameters. Our composite reliability values were all fine (>0.7) and indicated that the items in the same construct were strongly correlated and reliable.

CONCLUSIONS

The Indonesian version of the MSPSS was shown to be a valid, reliable, theoretically constructed, and applicable instrument for adolescent disaster survivors.

Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study

Despite the occurrence of several earthquakes, only a few studies were conducted in Italy on the psychological impact in children and adolescents, with data mostly collected within one year after the disaster. This cross-sectional study aimed at exploring the prevalence of both post-traumatic stress disorder (PTSD) and emotional/behavioral difficulties, as well as at identifying their main predictors, among youths 2 years after the earthquake that hit Northern Italy in 2012. 682 children and adolescents (9-14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The prevalence of a likely PTSD in the earthquake zone was 1.9% (4.4% near the epicenter) and the total PTSD score in the affected area was significantly higher than in the control zone. 14.9% of youths living in the earthquake zone had a borderline/abnormal SDQ total difficulties score and 87.5% of youth with a likely PTSD also had a SDQ total score in the borderline/abnormal range. Regression analysis showed that the number of lifetime traumatic events (e.g., death of a relative) was the best predictor of children/adolescents psychological difficulties 2 years after the earthquake, followed by severity of exposure (personal injuries and losses) and parental psychopathology. Despite some limitations, this study highlights that youths may exhibit PTSD symptoms years after disasters, often in comorbidity with behavioral/emotional difficulties, stressing the need for long-term surveillance and interventions in exposed populations.

School-based psychoeducation and storytelling: Associations with long-term mental health in adolescent survivors of the Wenchuan earthquake

AIMS

We explored the factors promoting long-term mental health among adolescent survivors of the 2008 Wenchuan earthquake in China. We examined the associations of their long-term mental health with disaster-related storytelling and school-based psychoeducation, and of school-based psychoeducation with disaster-related storytelling.

METHODS

A secondary school-based cross-sectional survey was conducted 6 years after the disaster. Participants with traumatic experiences such as injury, loss, witnessing someone's death/injury and home destruction (N = 1028, mean age 15, standard deviation 1.38, male 51%) were eligible. Mental health/disaster education (MHE/DE) was defined as taking one or more lessons in MHE and/or DE at school since the earthquake. Experiences of storytelling about the disaster involved expressing distressing memories and feelings regarding the earthquake since the disaster happened, according to four groups: never expressed distressing memories and feelings, expressed them through writing/drawing, expressed them through talking to lay supporters and expressed them through talking to health professionals. Analysis of covariance was used to compare mean scores on five selected subscales of the Symptom Checklist-90 (SCL-90), the Athens Insomnia Scale (AIS) and the Psychotic-Like Experiences (PLEs) scale among the four storytelling groups. Linear regression analysis was used to identify the relationships between MHE/DE and current mental health as measured by the SCL-90, AIS and PLEs. The relationship between education and storytelling was probed by χ2 test.

RESULTS

The talked-to-lay-supporters group showed better mental health on the SCL-90 (p ⩽ 0.001), AIS (p < 0.001) and PLEs (p = 0.004), while the consulted-health-professionals group showed worse mental health on the three dimensions of the SCL-90: depression (p = 0.05), anxiety (p = 0.02) and fear (p = 0.04), and on PLEs (p = 0.02) compared with the never-expressed group. MHE and DE were inversely associated with SCL-90, AIS and PLE scores. Participants who received these forms of education talked about their disaster experiences to lay supporters more than those who did not.

CONCLUSIONS

MHE and DE at school may promote adolescents' mental health after a disaster. Experience of storytelling about the disaster to lay supporters may be helpful for long-term psychological recovery, and may be a potential mediating factor for school-based education and better mental health. Because of the cross-sectional nature of this study, causality cannot be inferred; therefore, further prospective intervention studies are needed to elucidate the effect of these factors on adolescent survivors' mental health.

Psychological Characteristics of Children at Two Years after the Great East Japan Earthquake: Analyses of Telephone Consultation Records

The 2011 Great East Japan Earthquake was the largest and most catastrophic earthquake and tsunami in Japanese history. The aim of the present study was to evaluate the burden and psychological characteristics of children at 2 years after this catastrophe to allow a better understanding of the situation and the provision of appropriate support. We investigated a cross-sectional study carried out in 2013 by sending a questionnaire to schools located in Miyagi Prefecture to be answered by parents or guardians. The questionnaire included the Strengths and Difficulties Questionnaire (SDQ) to estimate the psychological adaptation of children. Telephone consultations were provided for children with SDQ scores > 16 whose parents or guardians had given consent. From the target population of 12,742, a total of 4,074 responses were received (response rate: 32%), among which, 720 had an SDQ score > 16 and received a telephone consultation. At the time of the telephone consultation, 301 (42%) of the 720 children and parents or guardians showed some type of psychological reaction and were thus classified as "Insufficient recovery". Among these, 230 had not received social support at any point in time, suggesting the need for long-term psychological support. Those who resided in a coastal area tended to show a higher rate of psychological reactions than those in an inland area (27.1% vs. 12.9%, respectively). In conclusion, catastrophic disasters have a long-lasting psychological impact on children, and thus, long-term psychological support may be needed.

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.

Risk Factors of Post-traumatic Stress and Depressive Disorders in Longmenshan Adolescents After the 2013 Lushan Earthquake

This study examined the severity of post-traumatic stress and depressive disorders in Longmenshan adolescents after the 2013 Lushan earthquake, as well as relationships among earthquake-related exposure, post-earthquake negative factors, previous exposure to the 2008 Wenchuan earthquake, and level of earthquake impact (city). A cross-sectional survey was conducted among adolescents in Lushan (n = 1416), Baoxing (n = 1102) and Tianquan (n = 1265) at 3 years after the Lushan earthquake. Respondents were evaluated using the Earthquake Experience Scale, the Adolescent Self-rating Life Events Checklist (ASLEC), the Children's Revised Impact of Event Scale (CRIES-13), and the Depression Self-Rating Scale (KADS-6). High levels of post-traumatic stress and depression symptoms were found among adolescents in the most heavily affected cities, and these symptoms were more severe in respondents exposed to the 2008 earthquake. PTSD correlated most strongly with earthquake exposure, whereas depression correlated most strongly with psychosocial stressors following the event.

Posttraumatic stress disorder in Longmenshan adolescents at three years after the 2013 Lushan earthquake

OBJECTIVE

This study aimed to estimate the prevalence and risk factors of probable posttraumatic stress disorder (PTSD) among adolescent survivors of the 2013 Lushan earthquake.

METHODS

A cross-sectional survey was conducted in the Longmenshan thrust fault area at three years after the 2013 earthquake in Lushan, China. Most respondents (60.8%) had also been exposed to the 2008 Wenchuan earthquake. Probable PTSD was identified based on the Children's Revised Impact of Event Scale (CRIES-13), the Adolescent Self-Rating Life Events Checklist and Earthquake Experience Scale. Logistic regression was used to identify risk factors of probable PTSD.

RESULTS

Probable PTSD prevalence was 14.1% among all respondents (n = 3851), 15.9% among those who had been exposed to the 2008 and 2013 earthquakes (n = 2342) and 11.3% among those who had experienced only the 2013 earthquake (n = 1509). Earthquake-related factors most strongly associated with probable PTSD were feeling scared of dying and exposure to the Wenchuan earthquake. The negative life event most strongly associated with probable PTSD was academic stress.

CONCLUSION

Among survivors of the 2013 Lushan earthquake, risk of probable PTSD was significantly higher if the person had also been exposed to the Wenchuan earthquake. Researchers and health care workers should pay more attention to adolescent earthquake survivors, especially those who experienced both the Wenchuan and Lushan earthquakes. Providing psychological care and preventing negative events may be effective measures for reducing PTSD after an earthquake.

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.

Long-term health of children following the Eyjafjallajökull volcanic eruption: a prospective cohort study

Background: More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children's health beyond the first year are sparse. Objective: To examine the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms. Method: In a population-based prospective cohort study, data was collected on the adult population (N = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group (N = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results: In 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07-2.03; high exposed OR 1.52; 95% CI 1.03-2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67-3.45; high exposed OR 2.77; 95% CI 1.81-4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13-2.32) and depressed mood (OR 1.55; 95% CI 1.07-2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Conclusions: Adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster.

Prevalence of probable posttraumatic stress disorder and determination of its relationship with everyday functioning in children and adolescents by using generalized estimating equations

INTRODUCTION

We investigated the prevalence rates for probable PTSD and used generalized estimating equations to identify risk factors for probable PTSD in children and adolescents exposed to the Lushan earthquake.

METHODS

A total of 1623 participants completed 3 assessments, including the Children's Revised Impact of Event Scale, at 2 weeks, 3, and 6 months after experiencing the Lushan earthquake. Additionally, demographic variables and variables related to everyday functioning were evaluated at 2 weeks after the earthquake via a self-constructed questionnaire.

RESULTS

The percentages of children and adolescents who changed from having no PTSD to probable PTSD and probable PTSD to no PTSD at each time point were approximately 8% and 20% of the sample, respectively. The percentage of participants without PTSD increased from 41.1% at the 2-week to 3-month time point to 54.3% at the 3-month to 6-month time point, and the percentage with persistent probable PTSD decreased from 29.6% to 16.4% at the 2 time points, respectively. Female gender, a sedentary lifestyle, and actively helping others were significant risk factors for probable PTSD, whereas initiating communications with others, actively playing with classmates and friends, and the ability to concentrate on academic studies after resuming class were factors that helped protect against probable PTSD.

DISCUSSION

Resistance to PTSD and persistent PTSD symptoms were both common occurrences in child and adolescent survivors. Specific variables related to everyday functioning may be risk factors for probable PTSD. These findings have implications for agencies that provide mental health services after an earthquake.

Long-term psychological consequences among adolescent survivors of the Wenchuan earthquake in China: A cross-sectional survey six years after the disaster

BACKGROUND

Most epidemiological studies on adolescent survivors' mental health have been conducted within 2 years after the disaster. Longer-term psychological consequences remain unclear. This study explored psychological symptoms in secondary school students who were living in Sichuan province 6 years after the Wenchuan earthquake.

METHODS

A secondary data analysis was performed on data from a final survey of survivors conducted 6 years after the Wenchuan earthquake as part of the five-year mental health and psychosocial support project. A total of 2641 participants were divided into three groups, according to the level of traumatic experience exposure during the earthquake (0, 1, and 2 or more). ANCOVA was used to compare the mean scores of the Symptom Checklist-90 (SCL-90) among the three groups, adjusting for covariates such as age, gender, ethnicity, having a sibling, parents' divorce, and socio-economic status. Logistic regression analysis was used to identify relationships between the traumatic experiences and suicidality after the disaster.

RESULTS

Having two or more kinds of traumatic experiences was associated with higher psychological symptom scores on the SCL-90 (Cohen's d=0.23-0.33) and suicidal ideation (OR 1.98, 95% CIs:1.35-2.89) and attempts (OR 3.32, 95% CIs:1.65-6.68), as compared with having no traumatic experience.

LIMITATIONS

Causality cannot be inferred from this cross-sectional survey, and results may not generalize to other populations due to convenience sampling.

CONCLUSIONS

Severely traumatized adolescent survivors of the earthquake may suffer from psychological symptoms even 6 years after the disaster. Long-term psychological support will be needed for these individuals.

Poly-victimisation and health risk behaviours, symptoms of mental health problems and suicidal thoughts and plans among adolescents in Vietnam

BACKGROUND

Limited evidence is available about poly-victimisation (exposure to multiple forms of victimisation) and mental health among adolescents in low and lower-middle-income countries. The aim of this study was to examine the associations between lifetime exposure to poly-victimisation, health risk behaviours, symptoms of common mental health problems and suicidal ideas in the previous year among high school students in Vietnam.

METHODS

Participants were high school students in rural and urban districts of Hanoi, Vietnam. The data source was an anonymously-completed structured self-report survey. Lifetime exposure to poly-victimisation was assessed using the juvenile victimisation questionnaire revised 2 (JVQ R-2); mental health symptoms by the depression, anxiety and stress scale-21 (DASS-21); involvement in health risk behaviours and previous year suicidal thoughts and plans by questions adapted from the 2013 youth risk behaviour survey. Data were collected between October, 2013 and January, 2014 and were analysed using generalised structural equation modelling.

RESULTS

In total 1616/1745 (92.6 %) eligible students provided complete data. Prior year suicidal thoughts were reported by 21.4 % (95 % CI 18.5-24.5 %) of the female respondents and 7.9 % (95 % CI 6.2-9.8 %) of the male respondents. Prior year suicidal plans were reported by 7.8 % (95 % CI 5.9-9.8 %) of the girls and 4.0 % (95 % CI 2.7-5.3 %) of the boys. Poly-victimisation was associated with increased likelihood of involvement in health risk behaviours and symptoms of common mental health problems among both sexes, which increased adolescents' risk of having suicidal ideas in the previous year. Compared to non-victims or victims of fewer forms, poly-victims were also more likely to report suicidal thoughts and plans among both girls and boys (p < 0.05).

CONCLUSIONS

Overall, the results revealed that poly-victimisation was associated with increased involvement in health risk behaviours, poorer mental health and increased risks of suicidal ideas among Vietnamese adolescents. Suicidal ideas were prevalent among the students. Interventions to assist victims of violence and prevention of violence, especially poly-victimisation, among adolescents in Vietnam is therefore important.

Does social capital reduce child behavior problems? Results from the Great East Japan Earthquake follow-up for Children Study

PURPOSE

We sought to investigate the association between social capital and child behavior problems in Iwate prefecture, Japan, in the aftermath of the 2011 Great East Japan Earthquake.

METHODS

Children and their caregivers were recruited from four nursery schools in coastal areas affected by the tsunami, as well as one in an unaffected inland area (N = 94). We assessed the following via caregiver questionnaire: perceptions of social capital in the community, child behavior problems (Child Behavior Checklist, Strength and Difficulty Questionnaire), post-traumatic stress disorder (PTSD) symptoms, child's exposure to trauma (e.g. loss of family members), and caregiver's mental health (Impact of Event Scale-R for PTSD symptoms; K6 for general mental health). We collected details on trauma exposure by interviewing child participants. Structural equation modeling was used to assess whether the association between social capital and child behavior problems was mediated by caregiver's mental health status.

RESULTS

Children of caregivers who perceived higher community social capital (trust and mutual aid) showed fewer PTSD symptoms. Furthermore, caregiver's mental health mediated the association between social trust and child PTSD symptoms. Social capital had no direct impact on child behavior problems.

CONCLUSIONS

Community social capital was indirectly associated (via caregiver mental health status) with child behavior problems following exposure to disaster. Community development to boost social capital among caregivers may help to prevent child behavior problems.

Behavior Problems and Post-traumatic Stress Symptoms in Children Beginning School: A Comparison of Pre- and Post-Earthquake Groups

INTRODUCTION

Literature reviews caution that estimating the effects of disasters on the behavior of children following a disaster is difficult without baseline information and few studies report the effects of earthquakes on young children. In addition the relationship between age at the time of disaster and consequential behavior problems have not been reported for young children who experience disaster-related stress during a developmentally sensitive period.

METHODS

Behavior problems and symptoms of post-traumatic stress (PTS) were reported for two groups of children from nearby neighborhoods during their first term at school, using the Behavior Problem Index by teacher report, following approved informed consent procedures. Data on one group, "Pre-EQ" (N=297), was collected four years before the beginning of the earthquakes on children born 2001-2002. Data on the second group, "Post-EQ" (N=212), was collected approximately three to four years after the beginning of the earthquakes on children born 2007-2009 and living in heavily damaged neighborhoods. The Post-EQ group had significantly more children from high socioeconomic neighborhoods but no other significant differences on main demographic characteristics.

RESULTS

The mean behavior problem score was significantly higher in the Post-EQ group (Mean =6.11) as compared to the Pre-EQ group (Mean = 3.78). PTS symptoms were also significantly higher in the Post-EQ group (Mean =2.91) as compared to the Pre-EQ group (Mean=1.98) and more children had high PTS scores (20.9% v. 8.8%, OR= 2.73, 95%CI =1.57, 4.76). Model testing identified that a younger age at the time of exposure was the only significant predictor of high numbers of PTS symptoms in the Post-EQ group. Discussion: Rates of teacher-reported behavior problems in young children more than doubled following the Christchurch earthquakes. Younger children may be more vulnerable to the effects of earthquakes that occur during a developmentally sensitive period. Additional research is needed to consider the effects of age and duration of disaster effects to better understand the effects of disasters on children, their families and communities.

The incidence of post-traumatic stress disorder among survivors after earthquakes:a systematic review and meta-analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a common psychological disorder caused by unusual threats or catastrophic events. Little is known about the combined incidence of PTSD after earthquakes. This study aimed at evaluating the combined incidence of PTSD among survivors after earthquakes using systematic review and meta-analysis.

METHODS

The electronic databases of PubMed, Embase, Web of Science and PsycARTICLES were searched for relevant articles in this study. Loney criteria were used to assess the quality of eligible articles. The combined incidence of PTSD was estimated by using the Freeman-Tukey double arcsine transformation method. Subgroup analyses were conducted using the following variables: the time of PTSD assessment, gender, educational level, marital status, damage to one's house, bereavement, injury of body and witnessing death.

RESULTS

Forty-six eligible articles containing 76,101 earthquake survivors met the inclusion criteria, of which 17,706 were diagnosed as having PTSD. Using a random effects model, the combined incidence of PTSD after earthquakes was 23.66 %. Moreover, the combined incidence of PTSD among survivors who were diagnosed at not more than 9 months after earthquake was 28.76 %, while for survivors who were diagnosed at over nine months after earthquake the combined incidence was 19.48 %. A high degree of heterogeneity (I(2) = 99.5 %, p<0.001) was observed in the results, with incidence ranging from 1.20 to 82.64 %. The subgroup analyses showed that the incidence of PTSD after earthquake varied significantly across studies in relation to the time of PTSD assessment, gender, educational level, damage to one's house, bereavement, injury of body and witnessing death. However, stratified analyses could not entirely explain the heterogeneity in the results.

CONCLUSIONS

Given the high heterogeneity observed in this study, future studies should aim at exploring more possible risk factors for PTSD after earthquakes, especially genetic factors. In spite of that, the results of this study suggest that nearly 1 in 4 earthquake survivors are diagnosed as having PTSD. Therefore, the local government should plan effective psychological interventions for earthquake survivors.

Probable Post-Traumatic Stress Disorder and Its Predictors in Disaster-Bereaved Survivors: A Longitudinal Study After the Sichuan Earthquake

This study examined the trajectory of probable PTSD prevalence and severity, and analyzed the predictors for PTSD severity in bereaved survivors at 6 months and 18 months after the 2008 Sichuan earthquake. This was a longitudinal study with 226 bereaved survivors sampled at 6 months and 18 months post-earthquake. The instrument used in the study was the revised version of the Impact of Event Scale. The results showed that the prevalence of probable PTSD in bereaved survivors decreased significantly from 38.9% at 6 months to 16.8% at 18 months post-earthquake. Loss of a child, being directly exposed to the death of family members and property loss during the earthquake, and mental health services utilization after the earthquake were significant predictors for PTSD severity at both assessments. These findings can contribute to post-disaster psychological rescue work. The bereaved survivors at high risk for more severe PTSD should be particularly targeted.

Depressive Symptoms and Associated Psychosocial Factors among Adolescent Survivors 30 Months after 2008 Wenchuan Earthquake: A Follow-Up Study

Purpose: This study longitudinally investigated the changes of depressive symptoms among adolescent survivors over 2 years and a half after the 2008 Wenchuan earthquake in China, as well as the predictive effects of demographic characteristics, earthquake exposure, negative life events, social support, and dispositional resilience on the risk of depressive symptoms at two time points after the earthquake.

Methods: Participants were 1573 adolescent survivors (720 males and 853 females, mean age at initial survey = 15.00 ± 1.26 years), whose depressive symptoms were assessed at 6 months (T_6m) and 30 months (T_30m) post-earthquake. Data on demographics, earthquake exposure, and dispositional resilience were collected at T_6m. Negative life events and social support were measured at T_6m and 24 months (T_24m) post-earthquake.

Results: The prevalence rates of probable depression, 27.5 at T_6m and 27.2% at T_30m, maintained relatively stable over time. Female gender was related with higher risk of depressive symptoms at both T_6m and T_30m, while being only child could only predict higher risk of depressive symptoms at T_30m. Negative life events and social support at T_6m, as well as earthquake exposure, were concurrently associated with increased risk of depressive symptoms at T_6m, but not associated with the risk of depressive symptoms at T_30m, while negative life events and social support at T_24m could predict depressive symptoms at T_30m, all of which suggested that these variables may have strong but short-term effect on adolescents’ depressive symptoms post-earthquake. Besides, dispositional resilience was evidenced as a relatively stable negative predictor for depressive symptoms.

Conclusions: These findings could inform mental health professionals regarding how to screen adolescent survivors at high risk for depression, so as to provide them with timely and appropriate mental health services based on the identified risk and protective factors for depressive symptoms.

Psychological consequences and quality of life among medical rescuers who responded to the 2010 Yushu earthquake: A neglected problem

A comprehensive study was conducted 8 months after the 2010 Yushu earthquake to assess the prevalence of posttraumatic stress disorder (PTSD) among medical rescuers and the rescuers' quality of life. Additionally, the study examines differences between local and supporting forces, as well as the relationship between PTSD and lower quality of life (QoL), and the risk factors for both. A total of 338 rescuers (including 123 local rescuers and 215 supporting ones) were randomly selected from Yushu County (the epicenter) and Xining City using multistage systematic sampling. Two standardized instruments, the PTSD Checklist-Civilian Version (PCL-C) and the Chinese version of the WHOQOL-BREF, were used to evaluate the prevalence of PTSD and obtain the rescuers' QoL. Being between 40 and 50 years old, a nurse, Tibetan, having been in serious danger or having received mental health training before this earthquake were significantly and independently associated with PTSD symptoms. Compared with supporting rescuers, local rescuers were more likely to develop PTSD and to report a lower QoL. Additional mental health services and training should be available to at-risk medical rescuers and groups to ensure they are adequately prepared for relief efforts and to maintain their mental health after assistance in disaster relief.

Posttraumatic stress disorder and somatic symptoms among child and adolescent survivors following the Lushan earthquake in China: A six-month longitudinal study

OBJECTIVE

To explore somatic conditions in a sample of 2299 child and adolescent survivors of an earthquake and their relationship to posttraumatic stress disorder (PTSD) symptoms.

METHODS

The Children's Revised Impact of Event Scale, the Patient Health Questionnaire (PHQ)-13 scale, a short version of PHQ-15 scale that omits two items involving sexual pain/problems and menstrual problems, and a project-developed questionnaire were administered to participants three and six months after the earthquake.

RESULTS

Among child and adolescent survivors, the prevalence rates of probable PTSD were 37.4 and 24.2% three and six months, respectively, after the earthquake. The most common somatic symptoms were trouble sleeping (58.4 and 48.4%), feeling tired or having low energy (52.0 and 46.1%), and stomach pain (45.8 and 45.4%) after three and six months, respectively. Several specific somatic symptoms evaluated three months after the earthquake including trouble sleeping, headache, and shortness of breath were predictors of the overall PTSD symptoms evaluated six months after the earthquake. Additionally, the symptom of hyperarousal evaluated after three months could predict the overall somatic symptoms evaluated after six months.

CONCLUSIONS

PTSD and somatic symptoms were common after the earthquake, and a longitudinal association between PTSD and somatic symptoms was detected among child and adolescent survivors. These findings have implications in China and possibly elsewhere.

Health-related quality of life for medical rescuers one month after Ludian earthquake

BACKGROUND

An earthquake struck Ludian in Yunnan province of China on August 3, 2014, resulting in 3143 injuries, 617 deaths, and 112 missing persons. Our study aimed at estimating the quality of life and associated determinants among medical rescuers after Ludian earthquake.

METHODS

A cross-sectional survey was performed among personnel from three hospitals that assumed rescue tasks in Ludian earthquake. Descriptive statistics, t-tests, ANOVA and stepwise linear regression analysis were used for data analysis.

RESULTS

The mean scores on the physical component summary (PCS) and mental component summary (MCS) were 49.86 (SD = 6.01) and 35.85(SD = 6.90), respectively. Lower PCS in the aftermath of an earthquake was associated with non-military medical rescuers, elderly age, and being trapped/in danger while lower MSC in the aftermath of an earthquake was associated with non-military medical rescuers, young age, being female, being trapped/in danger and low education degree.

CONCLUSIONS

In conclusion, our study demonstrates that medical rescuers are at risk for a lower HRQoL after exposure to Ludian earthquake. The results of this study help expand our knowledge of health-related quality of life among medical rescuers after the Ludian earthquake.

Mental health impact of the 2010 Haiti earthquake on the Miami Haitian population: A random-sample survey

This study examined the mental health consequences of the January 2010 Haiti earthquake on Haitians living in Miami-Dade County, Florida, 2-3 years following the event. A random-sample household survey was conducted from October 2011 through December 2012 in Miami-Dade County, Florida. Haitian participants (N = 421) were assessed for their earthquake exposure and its impact on family, friends, and household finances; and for symptoms of posttraumatic stress disorder (PTSD), anxiety, and major depression; using standardized screening measures and thresholds. Exposure was considered as "direct" if the interviewee was in Haiti during the earthquake. Exposure was classified as "indirect" if the interviewee was not in Haiti during the earthquake but (1) family members or close friends were victims of the earthquake, and/or (2) family members were hosted in the respondent's household, and/or (3) assets or jobs were lost because of the earthquake. Interviewees who did not qualify for either direct or indirect exposure were designated as "lower" exposure. Eight percent of respondents qualified for direct exposure, and 63% qualified for indirect exposure. Among those with direct exposure, 19% exceeded threshold for PTSD, 36% for anxiety, and 45% for depression. Corresponding percentages were 9%, 22% and 24% for respondents with indirect exposure, and 6%, 14%, and 10% for those with lower exposure. A majority of Miami Haitians were directly or indirectly exposed to the earthquake. Mental health distress among them remains considerable two to three years post-earthquake.

Clinically significant behavior problems among young children 2 years after the Great East Japan Earthquake

Background

On March 11, 2011, a massive undersea earthquake and tsunami struck East Japan. Few studies have investigated the impact of exposure to a natural disaster on preschool children. We investigated the association of trauma experiences during the Great East Japan Earthquake on clinically significant behavior problems among preschool children 2 years after the earthquake.

Method

Participants were children who were exposed to the 2011 disaster at preschool age (affected area, n = 178; unaffected area, n = 82). Data were collected from September 2012 to June 2013 (around 2 years after the earthquake), thus participants were aged 5 to 8 years when assessed. Severe trauma exposures related to the earthquake (e.g., loss of family members) were assessed by interview, and trauma events in the physical environment related to the earthquake (e.g. housing damage), and other trauma exposure before the earthquake, were assessed by questionnaire. Behavior problems were assessed by caregivers using the Child Behavior Checklist (CBCL), which encompasses internalizing, externalizing, and total problems. Children who exceeded clinical cut-off of the CBCL were defined as having clinically significant behavior problems.

Results

Rates of internalizing, externalizing, and total problems in the affected area were 27.7%, 21.2%, and 25.9%, respectively. The rate ratio suggests that children who lost distant relatives or friends were 2.36 times more likely to have internalizing behavior problems (47.6% vs. 20.2%, 95% CI: 1.10–5.07). Other trauma experiences before the earthquake also showed significant positive association with internalizing, externalizing, and total behavior problems, which were not observed in the unaffected area.

Conclusions

One in four children still had behavior problems even 2 years after the Great East Japan Earthquake. Children who had other trauma experiences before the earthquake were more likely to have behavior problems. These data will be useful for developing future interventions in child mental health after a natural disaster.

Prevalence of psychiatric symptoms in children and adolescents one year after the 2009 L'Aquila earthquake

BACKGROUND

In 2009, an earthquake devastated the Abruzzo region in Italy. Despite the occurrence of several disasters in this country, no study on mental health of Italian children has ever been conducted in complex emergencies. Objective of the study was to assess the prevalence of psychiatric symptoms among children in the affected area 12 to 17 months after the event.

METHODS

A community sample of 1839 3-14 years children was identified from the general population assigned to 37 paediatricians of the National Health System, including children living in the earthquake epicentre, the surrounding earthquake zone, and the adjacent non-affected areas. Psychiatric symptoms were assessed with the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR), completed by 452 children aged 11-14 years. The association between symptoms and sociodemographic, health, family, and earthquake-related factors was examined.

RESULTS

The prevalence of CBCL-defined cases was 14.9% in the epicentre, 13.0% in the remainder earthquake zone, 13.9% in the unaffected area (p = .876). No differences among areas were found when comparing the YSR results. Prevalence of CBCL-defined post-traumatic stress (PTS) cases was 8.4% in the epicentre, 4.0% in the remainder earthquake zone, 2.2% in the unaffected area (p = .002). PTS and anxiety were significantly more frequent in the epicentre than in other areas only in the 6-10 year-old children group (respectively p = .009 and p = .014). In multivariate logistic analyses, factors associated with PTS were living in the epicentre (OR = 3.6) and child or maternal history of mental health care prior to the earthquake (respectively OR = 7.1 and OR = 4.5).

CONCLUSIONS

Children living in the epicentre, particularly those 6-10 years old, had the highest prevalence of CBCL-defined cases, and of PTS and anxiety symptoms one year after the earthquake. No signs of increased psychopathology were detected in younger (3-5 years) or older children (11-14 years). Family and health related factors showed stronger association with psychiatric outcomes than earthquake-related factors. The identification of populations at higher risk of developing psychiatric symptoms has implications for public health interventions in complex emergencies.

A Comparative Study on Physical Vulnerability of Urban Area against Natural Hazards: Importance of Health Promoting Approach in Civil Engineering

BACKGROUND

Estimation of urban vulnerability to earthquakes can be consid-ered as an Ill-structured problem in urban in both unplanned and planned areas. Multi-criteria evaluation (MCE) provides a way to integrate different spatial data layers in a geographic information system to create composite maps representing risk. We utilized MCE in a raster Geographic Information System (GIS) to evaluate risk in vulnerable tissues of Tabriz, Iran zone.

METHODS

In this MCE physical risk factors and sub-factors were included and were weighted by experts. Afterward data entered to GIS and then the layers of the criteria were exported. The obtained results were entered to IDRISI and fuzzified. Ultimately the final map of physical vulnerability was outputted by overlaying order.

RESULTS

Vulnerable tissues are highly consistent to non-official areas. However, the planned area which is called Valiasr is in low risky condition and this condition is desirable in crisis times. Here, we observe the preference of physical pre-planning operations.

CONCLUSION

The links between urban planning and health are many and varied. Environmental, social and economic conditions in cities can have both positive and negative influences on human health and centre. Urban planning and related professions play an important role in shaping those conditions.

Care of children in a natural disaster: lessons learned from the Great East Japan earthquake and tsunami

The Great East Japan earthquake was one of the most devastating natural disasters ever to hit Japan. We present features of the disaster and the radioactive accident in Fukushima. About 19,000 are dead or remain missing mainly due to the tsunami, but children accounted for only 6.5% of the deaths. The Japanese Society of Pediatric Surgeons set up the Committee of Aid for Disaster, and collaborated with the Japanese Society of Emergency Pediatrics to share information and provide pediatric medical care in the disaster area. Based on the lessons learned from the experiences, the role of pediatric surgeons and physicians in natural disasters is discussed.