Childhood life events and psychological symptoms in adult survivors of the 2004 tsunami

Psychiatric Morbidity and Suicidal Ideation Among Early Survivors Following the 2023 Kahramanmaras Earthquake in Turkey

OBJECTIVE

The aim of this study was to investigate the effects of psychiatric morbidity along with sociodemographic and earthquake-related data on suicidal ideation among survivors of the 2023 Kahramanmaras earthquake in Turkey.

METHOD

The study included 270 volunteers who experienced the 2023 earthquake in Kahramanmaras, a province in middle east region of Turkey. These individuals were informed of the use of their personal data within the scope of the personal data protection law numbered 6698 and consent was obtained. The volunteers participated in the study online and were evaluated with a sociodemographic data form, Suicidal Ideation Scale and DSM-5 level one cross-sectional symptom scale.

RESULTS

Single individuals (p = .009) and those who stated that they had insufficient social support (p = .001), had been injured or had lost a relative during the earthquake (p = .02), felt discrimination-exclusion after the earthquake (p = .03), and those who could not attend the funeral or funeral ceremony of their deceased relative (p < .001) scored higher on the Suicidal Ideation Scale. The DSM-5 level one cross-sectional symptom scale scores indicated that the scores in the depression (p = .024), somatization (p = .001), personality (p < .001) and addiction (0.039) subscales were more related to suicidal ideation.

CONCLUSION

After a mass trauma, it is very important to investigate the risk factors that may be associated with suicidal ideation among survivors and to be aware of possible psychiatric symptoms. Preventive actions in the earthquake-affected regions can be made more effective by considering these factors.

Measuring changes in adult health and well-being during the COVID-19 pandemic and their relationship with adverse childhood experiences and current social assets: a cross-sectional survey

BACKGROUND

Adverse childhood experiences (ACEs) can impact mental and physical health, leaving people with less resilience to health challenges across the life-course. This study examines whether individuals' levels and changes in levels of mental health, physical health and sleep quality reported across the first year of the COVID-19 pandemic are associated with ACEs and moderated by social assets such as having trusted family and friends.

METHODS

A cross-sectional household telephone survey in England (a North West local authority) and Wales (nationally) using landline and mobile numbers stratified by health areas, deprivation quintile and age group and supplemented by an online survey. Data were collected from 4,673 English and Welsh residents aged ≥ 18 years during national COVID-19 restrictions (December 2020 to March 2021). Measures included nine types of ACE; self-reported mental health, physical health and sleep quality at time of survey (in pandemic) and one-year earlier (pre-pandemic); numbers of trusted family members and friends, knowledge of community help; and COVID-19 infection.

RESULTS

ACEs were strongly related to moving into poorer mental health, physical health, and sleep categories during the pandemic, with likelihoods more than doubling in those with ≥ 4 ACEs (vs. 0). ACEs were also associated with increased likelihood of moving out of poorer health and sleep categories although this was for a much smaller proportion of individuals. Individuals with more trusted family members were less likely to move into poorer health categories regardless of ACE counts.

CONCLUSIONS

ACEs are experienced by large proportions of populations and are associated with poorer health even in non-pandemic situations. However, they also appear associated with greater vulnerability to developing poorer health and well-being in pandemic situations. There is a minority of those with ACEs who may have benefited from the changes in lifestyles associated with pandemic restrictions. Connectedness especially with family, appears an important factor in maintaining health during pandemic restrictions.

Obesity and adverse childhood experiences in relation to stress during the COVID-19 pandemic: an analysis of the Canadian Longitudinal Study on Aging

BACKGROUND

People with obesity are at increased risk of chronic stress, and this may have been exacerbated during the COVID-19 pandemic. Adverse childhood experiences (ACE) are also associated with both obesity and stress, and may modify risk of stress among people with obesity. The objectives of this study were to evaluate the associations between obesity, ACEs, and stress during the pandemic, and to determine if the association between obesity and stress was modified by ACEs.

METHODS

A longitudinal study was conducted among adults aged 50-96 years (n = 23,972) from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study. Obesity and ACEs were collected pre-pandemic (2015-2018), and stress was measured at COVID-19 Exit Survey (Sept-Dec 2020). We used logistic, Poisson, and negative binomial regression to estimate relative risks (RRs) and 95% confidence intervals (CIs) for the associations between obesity, ACEs, and stress outcomes during the pandemic. Interaction by ACEs was evaluated on the additive and multiplicative scales.

RESULTS

People with obesity were more likely to experience an increase in overall stressors (class III obesity vs. healthy weight RR = 1.19; 95% CI: 1.12-1.27) as well as increased health related stressors (class III obesity vs. healthy weight RR: 1.25; 95% CI: 1.12-1.39) but did not perceive the consequences of the pandemic as negative. ACEs were also associated an increase in overall stressors (4-8 ACEs vs. none RR = 1.38; 95% CI: 1.33-1.44) and being more likely to perceive the pandemic as negative (4-8 ACEs vs. none RR = 1.32; 95% CI: 1.19-1.47). The association between obesity and stress was not modified by ACEs.

CONCLUSIONS

Increased stress during the first year of the COVID-19 pandemic was observed among people with obesity or ACEs. The long-term outcomes of stress during the pandemic need to be determined.

Adverse childhood experiences, adult trauma, and depressive symptom trajectories

OBJECTIVES

Associations among adverse childhood experiences prior to age 18 (ACEs), subjective reports of trauma during Hurricane Sandy, and trajectories of depressive symptoms reported by community-dwelling older people were examined.

METHODS

We analyzed 6 waves of data from 5,688 people aged 50-74 recruited in 2006 and followed for 12-years using multilevel mixed effects models.

RESULTS

We found that: (1) people who experienced ACEs had trajectories of depressive symptoms in late life that were higher than people not having these experiences, (2) people experiencing two or more ACEs were more likely to report fear and distress when Hurricane Sandy hit than people experiencing either one or no adverse childhood experiences, and (3) while both ACE exposure and peri-traumatic stress were associated with trajectories having higher levels of depressive symptoms, the risk associated with ACEs (especially multiple ACEs) was greater.

CONCLUSION

Findings support life course stress theories including the cumulative inequality theory and stress proliferation theory, suggesting that inequalities are manifested over the life course and that people experiencing adversity during childhood are at increased risk of experiencing adversity in late life. By studying the relationship between adverse childhood experiences and response to Hurricane Sandy our findings demonstrate that adverse childhood experiences can alter the way traumatic events in adulthood are experienced. This finding in turn, has important implications for clinical practice, as it identifies a group of people likely to be at risk for adult trauma.

A study of suicidal thoughts and behaviour in a sample of adults affected by the 9/11 attacks on New York City's World Trade Center

Previous research on suicide risk in relation to disasters has yielded varying findings, likely resulting at least in part from inconsistencies in definitions of disaster exposure and assessment of psychiatric disorders. This study examined suicidal thoughts and behaviour in a sample of 379 adults affected by the 9/11 attacks on New York City, using carefully-defined disaster exposure variables and assessing psychopathology with full diagnostic criteria, nearly 3 years after the disaster. Only 7% of the sample reported any postdisaster suicidal thoughts or behaviour, only 1% of which were new (incident) after the disaster, amounting to very little evidence of incident suicidal risk. The occurrence of a postdisaster psychiatric disorder in nearly one-half of the sample (45%) was significantly associated with postdisaster suicide risk (15% vs 1%). Disaster trauma exposure was not associated with postdisaster suicide risk. The findings of this study are not consistent with the disaster experience itself giving rise to suicide risk. Nonetheless, the postdisaster setting provides opportunities for education about and surveillance for suicide risk and other mental health concerns.

Adverse childhood experiences, exposure to a natural disaster and posttraumatic stress disorder among survivors of the 2011 Great East Japan earthquake and tsunami

AIMS

To investigate whether adverse childhood experiences (ACEs) modify the impact of exposure to a natural disaster (the 2011 Great East Japan earthquake and tsunami) on the occurrence of posttraumatic stress disorder (PTSD) among older people.

METHODS

Data were collected as part of the Japan Gerontological Evaluation Study (JAGES), which is an on-going epidemiological survey investigating social determinants of health among older people across Japan. Information on PTSD symptoms based on the Screening Questionnaire for Disaster Mental Health, traumatic exposure to the earthquake (i.e., house damage and loss of relatives/friends during the earthquake/tsunami) and ACEs was obtained from 580 participants aged 65 or older living in Iwanuma City, Miyagi Prefecture, which suffered severe damage as a result of the earthquake and the subsequent tsunami in March 2011. Associations were examined using Poisson regression analysis with a robust variance estimator after adjusting for covariates.

RESULTS

The prevalence of PTSD was 9.7% in this population; compared to those with no traumatic experience, the prevalence of PTSD was approximately two times higher among those who experienced the loss of close friends/relatives (PR = 1.84, 95% CI = 1.11-3.03, p = 0.018), or whose house was damaged (PR = 2.15, 95% CI = 1.07-4.34, p = 0.032). ACE was not significantly associated with PTSD. Stratified analyses by the presence of ACE showed that damage due to the earthquake/tsunami was associated with PTSD only among those without ACEs; more specifically, among non-ACE respondents the PR of PTSD associated with house damage was 6.67 (95% CI = 1.66-26.80), while for the loss of a relative or a close friend it was 3.56 (95% CI = 1.18-10.75). In contrast, no statistically significant associations were observed among those with ACEs.

CONCLUSION

Following the Great East Japan earthquake/tsunami in 2011 a higher risk of developing PTSD symptoms was observed in 2013 especially among older individuals without ACEs. This suggests that ACEs might affect how individuals respond to subsequent traumatic events later in life.

Is Adolescent Suicidal Ideation Continuous or Categorical? A Taxometric Analysis

Despite the strong association between suicidal ideation and suicidal behavior, a relative minority of ideators transition to attempting suicide. Clarifying the latent structure of suicidal ideation has direct implications for theory, as well as suicidal risk assessment and prevention efforts. Taxometric analysis is a statistical technique specifically designed to assess whether a latent construct is taxonic (i.e., categorical) or continuous (i.e., dimensional) in nature. Although this statistical approach has been increasingly used over the past decade to elucidate the latent structure of various forms of psychopathology and related risk factors, there are no taxometric studies to date of suicidal ideation. The aim of the current project is to apply taxometric methods to a sample of clinically depressed, treatment-seeking adolescents (n = 334). Current suicidal ideation was measured using the Suicidal Ideation Questionnaire-Jr., (SIQ-Jr.). The results of two mathematically non-redundant taxometric approaches (i.e., MAXEIG and L-Mode) are consistent with a continuous latent structure for suicidal ideation. The current findings suggest that suicidal ideation in depressed adolescents is dimensional. The implication of these findings for research, theory, and suicidal risk assessment strategies are discussed.

Polytraumatization in an adult national sample and its association with psychological distress and self-esteem

OBJECTIVE

The objective of this study was to examine the prevalence of self-reported experiences of potential childhood traumas and polytraumatization, and to find cut-off values for different kinds of potential traumatic events in a national representative sample of adults in Sweden. In addition, to analyse the association between polytraumatization and both psychological distress and global self-esteem.

METHOD

A web-based survey - containing SCL-25 and Rosenberg Self-Esteem Scale, and Linköping Difficult Life Events Scale - Adult - was sent out to a nationally reprative sample and 5062 people chose to participate in the study.

RESULTS

Results showed that almost everyone (97%) has experienced at least one potential traumatic event and that polytraumatization (the 10% of the participants with most reported traumas) was significantly (Z = 12.57, P < 0.001, r = 0.18) associated with psychological distress and global self-esteem. Gender differences were significant (Z = 8.44, P < 0.001, r = 0.12), in that men experience more noninterpersonal traumas but women report more symptoms. The effect sizes regarding the impact of potential trauma on self-esteem were largest for women with experience of polytraumatization in the age group 18-25 (r = 0.48). There was almost linear increase in psychological distress and linear decrease in self-esteem with increasing number of traumatic events experienced.

CONCLUSION

Experience of polytrauma can be considered an important factor to take into account in psychiatric settings as well.

Trauma-Related Symptoms in Sri Lankan Adult Survivors After the Tsunami

Limited research has addressed factors associated with psychological distress following disasters among non-Western populations. The 2004 tsunami affected 1.7 million people across South Asia and Africa, with considerable variations in trauma-related outcomes. Pretraumatic and peritraumatic conditions associated with trauma-related symptoms in 305 Sri Lankan adult survivors (28% male, aged 18-83 years; mean = 39.9 years; standard deviation = 15.3), clinically assessed 1 month posttsunami, were evaluated retrospectively. Outcome measures were total scores on 11 trauma-related symptoms. Multivariate linear regression analyses tested for associations between pretraumatic and peritraumatic conditions and symptom scores, with peritraumatic conditions adjusted for pretraumatic variables. Pretraumatic conditions of female gender, employment, prior health and social issues, and substance use and peritraumatic conditions of loss of family, witnessing the tsunami, or suffering an injury were associated with trauma-related symptoms. The findings facilitate understanding cultural contexts that define risk factors associated with trauma-related symptoms in Sri Lankans, which are critical for developing culturally appropriate interventions.

Natural disasters and suicidal behaviours: a systematic literature review

BACKGROUND

Various consequences including suicidal behaviours can arise in the aftermath of natural disasters. The aim of the present review was to systematically analyse the existing literature on the potential impact of natural disasters on suicidal behaviours.

METHODS

A systematic search of English-language articles indexed in electronic databases was conducted. The current review covers 42 papers containing empirical analyses of the relationship between natural disasters and suicidal behaviours.

RESULTS

In total, 19 papers analysed suicide mortality and 23 non-fatal suicidal behaviours. The effects of earthquakes on suicidal behaviours are the most frequently studied among natural disasters (n=20), followed by hurricanes (n=11). Further, there were four papers about tsunamis, three about floods, three about heat waves and drought, and one investigating the effects of multiple natural disasters. The studies show different directions in suicide mortality following natural disasters. Nevertheless, there seems to be a drop in non-fatal suicidal behaviours in the initial post-disaster period, which has been referred to as the 'honeymoon' phase. A delayed increase in suicidal behaviours has been reported in some studies. However, other factors increasing the risk of suicidal behaviours after natural disasters have been reported, such as previous and current mental health problems. Furthermore, contributing factors, such as economic conditions, should also be considered.

LIMITATIONS

The exclusion of non-English articles.

CONCLUSIONS

In light of the various methodological limitations observed, there is a need for further studies using proper designs. Mental health and suicidal behaviours should continue to be monitored for several years after the disaster.

Support, opinion of support and psychological health among survivors of a natural disaster

BACKGROUND

Although formal intervention after disasters is recommended, the evidence base for this is weak. Satisfaction with support after disasters is seldom investigated and the relation to psychological symptoms is unknown.

AIMS

To investigate whether dissatisfaction with social and formalized support are associated with post-disaster psychological symptoms.

METHODS

A total of 1,505 Swedish survivors of the 2004 Indian Ocean tsunami responded to a questionnaire 14 months after the disaster, including the General Health Questionnaire-12, the Impact of Events Scale - Revised, the Crisis Support Scale, and questions concerning the reception and appraisal of social and formalized support from health care, psychological services and insurance agencies. Disaster exposure and background factors were controlled for in the analyses.

RESULTS

Reception of formalized support, but not social support, was associated with both psychological distress and post-traumatic stress. Dissatisfaction with social but not formalized support, with the exception of support from insurance agencies, was associated with psychological distress.

CONCLUSIONS

Social support and formalized support should be differentiated in future studies in order to improve preventive intervention efforts after disasters. The reporting of dissatisfaction with social support merits special attention, since this may indicate increased risk for psychological symptoms.