Adjustment among area youth after the Boston Marathon bombing and subsequent manhunt

Media Exposure to Armed Conflict: Dispositional Optimism and Self-Mastery Moderate Distress and Post-Traumatic Symptoms among Adolescents

BACKGROUND

Rapid technological developments enable the immediate transmission of armed conflict events through a variety of media channels, inducing mass anxiety, fear, and helplessness. Youth are particularly vulnerable and face new challenges as a result of this exposure. The effects of media exposure to such events on psychological distress and post-traumatic symptoms were examined.

METHODS

A total of 161 participants aged 13-18 years completed a questionnaire battery that included measures of media exposure to armed conflict events, previous direct exposure to armed conflict events, psychological distress, post-traumatic symptoms, dispositional optimism, and self-mastery. A structural equation model (SEM) approach was employed for data analysis.

RESULTS

The extent of media exposure to armed conflict was directly associated with psychological distress and post-traumatic symptoms. Dispositional optimism moderated the association between media exposure and psychological distress, while self-mastery moderated the association between media exposure and post-traumatic symptoms. The effects of the Internet factor of media exposure, which included social media, were particularly disturbing as neither of the resilience factors moderated negative outcomes.

CONCLUSIONS

The findings suggest that clinical interventions to enhance dispositional optimism and self-mastery as well as other potential resilience factors can protect adolescents from the severe effects of media exposure to violent armed conflict events. Developmental and public health implications related to vulnerabilities and resilience during adolescence are discussed.

Children's psychosocial state after the 2018 Lombok earthquake

Background

The current earthquake disaster in Lombok, Indonesia, in July 2018 has caused 564 deaths, and 445.343 were evacuated to refugee camps, including children. Disasters have the potential in resulting short-and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. Nurses play a significant role when a disaster occurs. One of the nurses' roles is to give a traumatic healing intervention to the victims.

Objective

This study sought to assess children's psychosocial state after the 2018 Lombok earthquake.

Methods

A total of 189 children from five regencies in Lombok were selected to participate in the study using accidental sampling. Data were collected using the Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics and cross-tabulation were used for data analysis.

Results

The participants consisted of 98 girls (51.9%) and 91 boys (48.1%), with the majority (n = 142 [75.1%]) being from school-aged children. The SDQ results showed that most of the children were at the abnormal stage for difficulties (n = 103 [54.5%]), and most of them were at a normal stage for strength (n = 97 [51.3%]). The cross-tabulation analysis revealed that gender might influence the SDQ score for the strength (p = 0.034), but not for difficulties (p = 0.482). However, age did not have a correlation with SDQ score, either for strength (p = 0.475) or difficulties (p = 0.836), respectively.

Conclusion

The study found that children in Lombok generally displayed positive behavior and emotional progress after the earthquake. However, some children remained in distress and thus required more observation from parents or other social welfare agencies. This research may help nurses decide on their nursing care for children who experience disasters.

Neural vulnerability and hurricane-related media are associated with post-traumatic stress in youth

The human toll of disasters extends beyond death, injury and loss. Post-traumatic stress (PTS) can be common among directly exposed individuals, and children are particularly vulnerable. Even children far removed from harm's way report PTS, and media-based exposure may partially account for this phenomenon. In this study, we examine this issue using data from nearly 400 9- to 11-year-old children collected before and after Hurricane Irma, evaluating whether pre-existing neural patterns moderate associations between hurricane experiences and later PTS. The 'dose' of both self-reported objective exposure and media exposure predicted PTS, the latter even among children far from the hurricane. Furthermore, neural responses in brain regions associated with anxiety and stress conferred particular vulnerability. For example, heightened amygdala reactivity to fearful stimuli moderated the association between self-reported media exposure and PTS. Collectively, these findings show that for some youth with measurable vulnerability, consuming extensive disaster-related media may offer an alternative pathway to disaster exposure that transcends geography and objective risk.

What's in a name? Comparing alternative conceptualizations of posttraumatic stress disorder among preadolescent children following the Boston Marathon bombing and manhunt

BACKGROUND AND OBJECTIVES

New diagnostic criteria for posttraumatic stress disorder (PTSD) were introduced by DSM-5 and ICD-11. It remains unclear how well these new definitions of PTSD capture the posttrauma responses of children, particularly when using parent report. This study compared different conceptual models of PTSD in children following the Boston Marathon bombing and manhunt.

DESIGN AND METHODS

Parents/caretakers (N = 254) reported on PTSD symptoms of their children (ages 4-11) following the Boston Marathon bombing and manhunt. Algorithms compared criteria from ICD-11, DSM-IV, and DSM-5 (specifically the "Preschool" criteria).

RESULTS

DSM-5 Preschool criteria identified twice as many children as ICD-11, and over four times as many as DSM-IV. DSM-5 Preschool criteria identified all cases detected by ICD-11 and DSM-IV. Across models, all identified cases had greater trauma exposure than non-identified children. DSM-5 Preschool and ICD-11 (but not DSM-IV) cases had greater clinical decline than non-identified children. The Avoidance cluster showed the most variability in identifying cases.

CONCLUSIONS

Newer models of PTSD are likely to identify more children than DSM-IV, mostly related to changes in the Avoidance criteria. The DSM-5 Preschool definition is the most inclusive model. ICD-11 may provide a balance between inclusivity and stringency in detecting childhood PTSD.

Integrating Advocacy for Marginalized Children and Families Into Evidence-Based Care During COVID-19: Clinical Vignettes

The novel coronavirus (COVID-19) has disproportionately impacted the health and socioeconomic outcomes for low-income populations, people of color, and immigrant children and families in the United States. As inequities in resources (i.e., food, internet, housing), health care, and education increased for marginalized families as a result of COVID-19, child-focused clinicians had to broaden their professional scope and implement new advocacy efforts. The current paper uses clinical vignettes taken from a New York State Office of Mental Health-licensed child and adolescent outpatient clinic in the Bronx, New York. The vignettes highlight the social inequities that impacted marginalized children and families during the pandemic, as well as the clinical team's response through the integration of evidence-base practice and advocacy. Implications for practice with vulnerable populations as the COVID-19 pandemic persists are discussed.

From Apathy to Vigilance: Young Adolescents' Reactions to the Unite the Right Rally in Charlottesville

The present study examined middle school students' responses to the 2017 Unite the Right rally in Charlottesville, Virginia. Using a consensual qualitative research approach, we analyzed interviews from 73 local, seventh-grade students (58% female; 55% students of color) to explore the range of students' emotional responses and cognitive engagement with the events. The resulting six profiles document heterogeneity in meaning-making and personal impacts across youth. Individual and social factors including race and ethnic identity varied across profiles. Many students of color expressed fear and vigilance toward racial violence while many White students expressed sadness and sympathy. We discuss the role of developmental factors in students' reactions as well as implications for supporting early adolescents in the wake of bias-motivated violence.

Patients Living With Breast Cancer During the Coronavirus Pandemic: The Role of Family Resilience, Coping Flexibility, and Locus of Control on Affective Responses

The coronavirus disease 2019 (COVID-19) pandemic has strongly affected oncology patients. Many screening and treatment programs have been postponed or canceled, and such patients also experience fear of increased risk of exposure to the virus. In many cases, locus of control, coping flexibility, and perception of a supportive environment, specifically family resilience, can allow for positive emotional outcomes for individuals managing complex health conditions like cancer. This study aims to determine if family resilience, coping flexibility, and locus of control can mitigate the negative affect caused by the pandemic and enhance positive affect in breast cancer patients. One hundred and fifty-four female patients with breast cancer completed the Walsh’s Family Resilience Questionnaire, the Perceived Ability to Cope With Trauma Scale, the Positive-Negative Affect Schedule, and the Mini Locus of Control Scale. Family resilience and internality of locus of control contribute significantly to positive affective responses. Family resilience is responsible for mitigating the negative affect perceived during the pandemic and is enhanced by external locus of control. Evidence suggests that clinical psychologists should develop and propose programs to support oncology patients’ family resilience, coping flexibility, and internal locus of control, allowing for decreased stress and improved adaptability for effectively managing cancer treatment during the pandemic.

Children's Exposure to Single Incidents of Terrorism: Perspectives Over 25 Years Since the Oklahoma City Bombing

PURPOSE OF REVIEW

This paper traces advances in our knowledge about children's exposure and reactions to terrorist events over the last 25 years, beginning with the 1995 Oklahoma City bombing, and offers observations about cross-cutting issues including implications for services.

RECENT FINDINGS

Direct and indirect interpersonal exposures have been examined in community samples and in samples of children selected because of their event experiences. Despite its present exclusion from the stressor criterion for a diagnosis of posttraumatic stress disorder, considerable research has documented an association between children's initial subjective reaction and outcomes. Few studies have examined the influence of community or distant effects on outcomes, but contact with media coverage has been well studied. This review confirms the central role of exposure in influencing children's reactions to terrorist incidents and supports recent efforts to distinguish specific experiences that constitute children's event exposures.

Role of adolescent exposure to rockets in the links between personality vulnerability and psychopathology

The aim of this study is to examine the role of repeated exposure to rocket attacks in the links between personality vulnerability (dependency and self-criticism) and internalizing/externalizing psychopathology. A main-effect vulnerability model (personality leads to psychopathology) was compared with a main-effect scarring model (psychopathology leads to personality vulnerability). Also, a stress-diathesis pattern (personality vulnerability is activated under stress) was compared to a dual-vulnerability pattern (either personality vulnerability or stress, but not both, lead to psychopathology). Israeli adolescents (N = 362) repeatedly exposed to rocket attacks were assessed annually over 3 years. In 2008 and 2010, personality and psychopathology were assessed. Cumulative exposure was measured as the sums of exposure across the three assessment waves. Theoretical models were tested via Autoregressive Cross-Lagged Structural Equation Modeling analyses. Baseline dependency and self-criticism were associated with an increase in anxiety, whereas baseline depression was associated with an increase in dependency. Under low, not high, levels of rocket exposure, self-criticism and depression were longitudinally associated. Violence commission was associated with an increase in dependency under high, not low, cumulative exposure. Results are consistent with both scarring and vulnerability models, and with both stress-diathesis and dual-vulnerability patterns of adolescent risk and resilience.

Long-Term Reactions to the Loss of a Close Friend in an Extreme Terror Incident

This article presents results from one of the first longitudinal studies exploring the effects of losing a close friend to traumatic death, focusing on complicated grief over time and how this is affected by avoidant behavior and rumination about the loss. The sample consists of 88 persons (76% women and 24% men, mean age = 21) who lost a close friend in the Utøya killings in Norway on July 22, 2011.Quantitative data were collected at three time-points; 18, 28, and 40 months postloss. Main findings are that bereaved friends are heavily impacted by the loss and their grief reactions are affected negatively by avoidant behavior and rumination. This indicates that close bereaved friends are a group to be aware of and that there is a need for better strategies for identifying individuals in need for follow-up.

A latent profile analysis of co-occurring youth posttraumatic stress and conduct problems following community trauma

Although most research with youth exposed to violent manmade disasters has focused on internalizing problems, recent work suggests conduct problems (CPs) may also manifest in exposed youth. However, the extent to which youth postevent CPs present independently, versus co-present in conjunction with PTSD symptoms, remains unclear. The present study examined PTS and CP symptom profiles among affected Boston-area youth following the 2013 Boston Marathon bombing. This study used latent profile analysis to identify distinct PTS and CP symptom profiles among Boston-area youth ages 4-19 years (N=344) affected by the Boston Marathon bombing events. PTS and CPs were measured using the UCLA-PTSD-RI and the SDQ parent reports, respectively. Analyses identified 3 distinct profiles: presentations characterized by (a) low PTS, low CPs, (b) moderate PTS, low CPs, and (c) high PTS, elevated CPs. The profile characterized by the highest PTS was the only profile with elevated CPs; hyperarousal and emotional numbing/avoidance symptoms showed the greatest distinguishing properties among profiles with and without elevated CP. Types of traumatic exposure experienced by youth were differentially associated with profiles. Specifically, direct (but not relational) exposure distinguished youth classified in the profile showing elevated CPs. Findings suggest interventions following violent manmade disasters may do well to incorporate CP modules when working with youth showing the greatest hyperarousal and emotional numbing, and/or who have directly witnessed the most violence.

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.

Media Effects in Youth Exposed to Terrorist Incidents: a Historical Perspective

PURPOSE OF REVIEW

This paper reviews the evidence on the relationship between contact with media coverage of terrorist incidents and psychological outcomes in children and adolescents while tracing the evolution in research methodology.

RECENT FINDINGS

Studies of recent events in the USA have moved from correlational cross-sectional studies examining primarily television coverage and posttraumatic stress reactions to longitudinal studies that address multiple media forms and a range of psychological outcomes including depression and anxiety. Studies of events in the USA-the 1995 Oklahoma City bombing, the September 11 attacks, and the 2013 Boston Marathon bombing-and elsewhere have used increasingly sophisticated research methods to document a relationship between contact with various media forms and adverse psychological outcomes in children with different event exposures. Although adverse outcomes are associated with reports of greater contact with terrorism coverage in cross-sectional studies, there is insufficient evidence at this time to assume a causal relationship. Additional research is needed to investigate a host of issues such as newer media forms, high-risk populations, and contextual factors.

Disqualified qualifiers: evaluating the utility of the revised DSM-5 definition of potentially traumatic events among area youth following the Boston marathon bombing

The DSM-5 includes a revised definition of the experiences that qualify as potentially traumatic events. This revised definition now offers a clearer and more exclusive definition of what qualifies as a traumatic exposure, but little is known about the revision's applicability to youth populations. The present study evaluated the predictive utility of the revised DSM definitional boundaries of traumatic exposure in a sample of youth exposed to the 2013 Boston Marathon bombing and related events METHODS: Caregivers (N = 460) completed surveys 2 to 6 months postbombing about youth experiences during the events and youth posttraumatic stress (PTS) symptoms RESULTS: Experiencing DSM-5 qualifying traumatic events (DSM-5 QTEs) significantly predicted child PTS symptoms (PTSS), whereas DSM-5 nonqualifying stressful experiences (DSM-5 non-QSEs) did not after accounting for DSM-5 QTEs. Importantly, child age moderated the relationship between DSM-5 QTEs and PTSS such that children 7 and older who experienced DSM-5 QTEs showed greater postbombing PTSS, whereas there was no such relationship in children ages 6 and below CONCLUSIONS: Data largely support the revised posttraumatic stress disorder (PTSD) definition of QTEs in older youth, and also highlight the need for further refinement of the QTE definition for children ages 6 and below.

Catastrophizing, rumination, and reappraisal prospectively predict adolescent PTSD symptom onset following a terrorist attack

BACKGROUND

Disruptions in emotion regulation are a transdiagnostic risk factor for psychopathology. However, scant research has examined whether emotion regulation strategies are related to the onset of posttraumatic stress disorder (PTSD) symptoms among youths exposed to trauma. We investigated whether pretrauma emotion regulation strategies prospectively predicted PTSD symptom onset after the 2013 Boston Marathon terrorist attack among adolescents and whether these associations were moderated by the degree of exposure to media coverage of the attack.

METHODS

A sample of 78 Boston-area adolescents (mean age = 16.72 years, 65% female) who previously participated in studies assessing emotion regulation and psychopathology were recruited following the terrorist attack. Within 4 weeks of the attack, we assessed self-reported PTSD symptoms and attack-related media exposure via an online survey. We examined the association of pretrauma emotion regulation strategies with PTSD symptom onset after adjustment for pretrauma internalizing symptoms and violence exposure.

RESULTS

Greater pretrauma engagement in rumination predicted onset of PTSD symptoms following the attack. Adolescents who engaged in catastrophizing also had greater PTSD symptoms postattack, but only when exposed to high levels of media coverage of the attacks; the same pattern was observed for adolescents who engaged in low levels of cognitive reappraisal.

CONCLUSIONS

Engagement in specific emotion regulation strategies prior to a traumatic event predicts the onset of PTSD symptoms among youths exposed to trauma, extending transdiagnostic models of emotion regulation to encompass trauma-related psychopathology in children and adolescents.

Children's Mental Health in the Context of Terrorist Attacks, Ongoing Threats, and Possibilities of Future Terrorism

Over the past two decades, the field has witnessed tremendous advances in our understanding of terrorism and its impacts on affected youth. It is now well established that a significant proportion of exposed youth show elevated PTSD symptoms in the months following a terrorist attack. In more recent years, research has expanded beyond confirming our understanding of the association between direct terrorism exposure and child PTSD symptoms by elucidating (a) links between terrorism exposure and non-PTSD clinical outcomes (e.g., externalizing problems, substance use), (b) individual differences associated with divergent patterns of risk and resilience, (c) the clinical correlates of media-based contact with terrorism, (d) clinical outcomes associated with exposure to recurrent terrorist attacks, and (e) exposure to extended contexts of uncertainty and the possibilities of future terrorism. Researchers studying the effects of terrorism and political violence on youth have increasingly examined a much broader range of regions in the world, affording needed opportunities to consider the generalizability of prior findings to youth living in different political contexts, in less developed regions of the world, and/or in regions with different rates of recurrent terrorism. In order to understand and, in turn, best meet the clinical needs of the majority of terrorism-affected youth across the globe, more targeted research on exposed youth is needed in developing regions of the world and regions enduring more recurrent terrorist attacks.

Exposure to Violence During Ferguson Protests: Mental Health Effects for Law Enforcement and Community Members

There is little information available on the mental health effects of exposure to shared community violence such as the August 2014 violence that occurred in Ferguson, Missouri. This study sought to examine the relationship between proximity to community violence and mental health in both community members and police officers. We recruited 565 adults (community, n = 304, and police, n = 261) exposed to the violence in Ferguson to complete measures of proximity to violence, posttraumatic stress, depression, and anger. Using structural equation modeling, we assessed aspects of proximity to violence-connectedness, direct exposure, fear from exposure, media exposure, reactions to media, and life interruption-as correlates of posttraumatic stress disorder (PTSD) symptoms, depression, and anger. The final model yielded (n = 432), χ(2) (d = 12) = 7.4, p = .830; comparative fit index = 1.0, root mean square error of approximation = 0 [0, .04]. All aspects of proximity except direct exposure were associated with mental health outcomes. There was no moderation as a function of community versus police. Race moderated the relationship between life interruptions and negative outcomes; interruption was related to distress for White, but not Black community members. Based on group comparisons, community members reported more symptoms of PTSD and depression than law enforcement (ηp (2) = .06 and .02, respectively). Black community members reported more PTSD and depression than White community members (ηp (2) = .05 and .02, respectively). Overall, distress was high, and mental health interventions are likely indicated for some individuals exposed to the Ferguson events.

Caregiver-reports of Internet Exposure and Posttraumatic Stress Among Boston-Area Youth Following the 2013 Marathon Bombing

Although practitioners and researchers have considered children's television-based terrorism exposure, Internet-based exposure has not been sufficiently examined. We examined the scope and correlates of children's Internet-based exposure following the Boston Marathon bombing among Boston-area youth (N=460; 4-19 years), and the potential moderating role of age. Further exploratory analyses examined patterns of caregiver attempts to regulate child Internet exposure. Caregivers reported on child Internet-based and direct exposure to traumatic bombing-related events, and youth posttraumatic stress (PTS). Online youth consumed on average over two daily hours of Internet coverage, and roughly one-third consumed over three daily hours of coverage. Internet exposure was particularly high among children over 12. Greater Internet-based exposure was associated with PTS, and 12-15 year olds were particularly vulnerable. Further exploratory analyses found that although most caregivers reported believing media exposure can cause children further trauma, a considerable proportion of caregivers made no attempt to restrict or regulate their child's Internet-based exposure. These findings help practitioners clarify forms of indirect exposure that can place youth at risk following terrorism. Future work is needed to examine the important roles caregivers play as media regulators and as promoters of child coping and media literacy following terrorism.

Investigating the Aftermath of Terror: Fundamental Outcomes, Methodological Choices, and Future Directions

Acts of terrorism are becoming increasingly common throughout the world. These events represent a significant public health concern given the associated health consequences. Although it is clear that terrorist attacks have mental and physical health sequelae, the exact nature and prevalence of these consequences are unclear. Epidemiological research can play an important role in better understanding the mental and physical impact of terrorist attacks. In this editorial, we highlight recent epidemiological research on these terrorism-related health outcomes. We also provide suggestions for how future studies can build on the existing literature and describe ways in which epidemiological methods can be harnessed to extend the current literature. Lastly, we offer recommendations on how to best prepare communities for the aftermath of terrorist attacks, highlighting secondary intervention and prevention strategies. Overall, multilevel strategies are needed to adequately cope with the growing rise of terrorist acts, and these strategies will have to be reassessed as the nature of terrorist attacks changes.

Conduct Problems Among Boston-Area Youth Following the 2013 Marathon Bombing: The Moderating Role of Prior Violent Crime Exposure

A large body of work documents the heavy mental health burden of youth exposure to disasters, but the majority of this research has focused on posttraumatic stress and internalizing symptoms. Less is known about associations between disaster exposure and children's conduct problems (CPs), or variables that may moderate such relationships. Given well-documented links between CPs and children's exposure to community violence, youth with greater prior community violence exposure through residence in high-crime areas may be particularly vulnerable to the impacts of disaster exposure on CPs. We surveyed Boston-area caregivers (N = 460) in the first 6 months following the 2013 Marathon bombing on their children's event-related exposures, as well as CPs. To estimate prior violent crime exposure, children's neighborhoods were assigned corresponding violent crime rates obtained from the Federal Bureau of Investigation's uniform crime reporting statistics. Almost 1 in 6 Boston-area children assessed in this convenience sample showed clinically elevated CPs in the aftermath of the Boston Marathon bombing and subsequent manhunt. Prior violent crime exposure significantly moderated the link between children's manhunt exposure (but not bombing exposure) and child CPs. Manhunt exposure was related to increased CPs among children living in areas with high and medium (but not low) levels of prior violent crime. Children living in neighborhoods characterized by violent crime may be at particularly increased risk for developing CPs after violent manmade disasters. As most postdisaster child intervention efforts focus on posttraumatic stress, efforts are needed to develop programs targeting child CPs, particularly for youth dwelling in violent neighborhoods.

Event-Related Household Discussions Following the Boston Marathon Bombing and Associated Posttraumatic Stress Among Area Youth

Despite research documenting the scope of disaster-related posttraumatic stress (PTS) in youth, less is known about how family processes immediately postdisaster might associate with child outcomes. The 2013 Boston Marathon bombing affords a unique opportunity to assess links between immediate family discussions about community trauma and child mental health outcomes. The present study examined associations between attack-related household discussions and child PTS among Boston-area youth ages 4 to 19 following the Marathon bombing (N = 460). Caregivers completed surveys 2 to 6 months postattack about immediate household discussions about the events, child exposure to potentially traumatic attack-related experiences, and child PTS. During the Marathon bombing and manhunt, there was considerable heterogeneity in household discussions across area families, and several discussion items were differentially predictive of variability in children's PTS. Specifically, after controlling for children's direct exposure to the potentially traumatic attack/manhunt events, children showed lower PTS when it was their caregivers who informed them about the attack and manhunt, and when their caregivers expressed confidence in their safety and discussed their own feelings about the manhunt with their child. Children showed higher PTS when their caregivers did not discuss the events in front of them, asked others to avoid discussing the events in front of them, and expressed concern at the time that their child might not be safe. Child age and traumatic attack/manhunt exposure moderated several links between household discussions and child PTS. Findings underscore the importance of family communication and caregiver modeling during times of community threat and uncertainty.

Trauma and Child Health: An Introduction to the Special Issue

Potentially traumatic events are common occurrences that can lead to significant psychological distress, and yet, there has been remarkably little attention to the associations between traumatic events and youth's physical health. The articles contained in this Special Issue of the Journal of Pediatric Psychology represent a significant step forward in the establishment of "Trauma and Child Health" as a major area of study within the field of pediatric psychology. In this introductory article, we briefly describe several contextual issues that may help to set the stage for the articles contained in this Special Issue. These contextual issues include the most common types of traumatic events that are studied, as well as the features of traumatic events that may affect physical and mental health outcomes, such as whether casualties or interpersonal violence is involved.

Coping and Social Support in Children Exposed to Mass Trauma

The goal of this paper was to critically evaluate the literature on children coping with mass trauma published between the years 2011 and 2014 and to emphasize interesting and important findings with the aim of proposing a new comprehensive model for better understanding the process of coping with these events in this unique developmental stage. Using a variety of databases, 26 research papers were selected. The papers were divided into two main categories, natural and manmade disasters. The findings suggest that several areas in this context still lack foundational knowledge and should be further investigated. Thus, it has been suggested that future research should emphasize the developmental stage of the children, the cultural context and atmosphere in which the investigated children grow up and live, and the type of event (acute vs. chronic; natural vs. manmade). A more comprehensive coping model which addresses these omissions and combines main theories is suggested for use in future research as well.

School- and Classroom-Based Supports for Children Following the 2013 Boston Marathon Attack and Manhunt

School staff provide key mental health services following mass crisis events and teachers, in particular, can provide important supports within their classrooms. This study examines Boston-area teachers' perception of classroom-wide psychiatric distress and the types of supports that schools and teachers provided following the 2013 Boston Marathon bombing and subsequent manhunt. Boston-area K-12 teachers (N = 147) in communities with varying levels of exposure to the bombing and manhunt completed an anonymous web-based survey 2-5 months after the attack. Teachers reported on students' exposure to the bombings and manhunt, classroom-wide psychiatric distress, and the types of supports they and their schools provided students. Teacher reports of student exposure to the bombings and manhunt were significantly associated with their perceptions of greater classroom-wide psychiatric distress. Almost half indicated that their school had no formal policy for responding to the crisis, half reported no training to address events, and even the most common classroom-based support strategy-reassuring students of their safety-was provided by only 76 % of teachers. Teacher perceptions of student exposure to the manhunt, but not the bombing, were significantly associated with greater provision of these supports. In the aftermath of the Boston Marathon bombings and manhunt, teachers and schools provided supports; however, the extent and types of supports varied considerably. Working with teachers to most effectively and consistently serve in this complex role has the potential to improve school-based crisis response plans, as well as student outcomes.

Caregiver distress, shared traumatic exposure, and child adjustment among area youth following the 2013 Boston Marathon bombing

BACKGROUND

Disasters are associated with myriad negative outcomes in youth, including posttraumatic stress disorder and related psychopathology. Prior work suggests links between caregiver distress and child mental health outcomes following community traumas, but the extent to which caregiver distress is directly linked to post-disaster child functioning, or whether such associations may simply be due to shared traumatic exposure, remains unclear.

METHODS

The current study examined relationships among caregiver distress, caregiver-child shared traumatic exposure, and child outcomes in Boston-area families (N=460) during the six months following the 2013 Boston Marathon bombing. Parents completed surveys about their and their child׳s potentially traumatic experiences during the bombing and subsequent manhunt. Post-attack caregiver distress and child psychological functioning were also assessed.

RESULTS

After accounting for caregiver-child shared traumatic exposure, significant associations were retained between caregiver distress and child functioning across several domains. Furthermore, after accounting for caregiver traumatic exposure, caregiver distress moderated relationships between child traumatic exposure and child posttraumatic stress and conduct problems, such that associations between child traumatic exposure and child posttraumatic stress and conduct problems were particularly strong among children of highly distressed caregivers.

LIMITATIONS

The cross-sectional design did not permit evaluations across time, and population-based methods were not applied.

CONCLUSIONS

Findings clarify links between caregiver distress and child psychopathology in the aftermath of disaster and can inform optimal allocation of clinical resources targeting disaster-affected youth and their families.

Adjustment among children with relatives who participated in the manhunt following the Boston Marathon attack

BACKGROUND

Following the Boston Marathon attack, the extraordinary interagency manhunt and shelter-in-place made for a truly unprecedented experience for area families. Although research on Boston youth has found robust associations between manhunt-related experiences and post-attack functioning, such work does little to identify the specific needs of a particularly vulnerable population--i.e., children with a relative who participated in the manhunt. Understanding the adjustment of these youth is critical for informing clinical efforts.

METHODS

Survey of Boston-area parents/caretakers (N = 460) reporting on their child's attack/manhunt-related experiences, as well as psychosocial functioning in the first six post-attack months; analyses compared youth with and without a relative in law enforcement or the armed services who participated in the manhunt.

RESULTS

The proportion of youth with likely PTSD was 5.7 times higher among youth with relatives in the manhunt than among youth without. After accounting for child demographics, blast exposure, and children's own exposure to manhunt events (e.g., hearing/seeing gunfire/explosions, having officers enter/search home), having a relative in the manhunt significantly predicted child PTSD symptoms, emotional symptoms, and hyperactivity/inattention. Fear during the manhunt that a loved one could be hurt mediated relationships between having a relative in the manhunt and clinical outcomes; living within the zone of greatest manhunt activity did not moderate observed relationships.

CONCLUSIONS

Children with relatives called upon to participate in the unprecedented interagency manhunt following the Boston Marathon attack carried a particularly heavy mental health burden. Continued research is needed to clarify the clinical needs of youth with relatives in high-risk occupations.