Coping and Post-Traumatic Stress in Children and Adolescents after an Acute Onset Disaster: A Systematic Review

Population-level effects of Hurricane Sandy on adolescent health

BACKGROUND

Disasters are increasing in frequency and intensity due to climate change. Youth are the largest and most vulnerable group exposed to disasters. More evidence is needed regarding how youth mental health and health behaviors vary based on disaster exposure, how mental health influences health behaviors, and how diverse groups of youth may be differentially affected.

METHODS

Using data from the Youth Risk Behavior Survey and Federal Emergency Management Agency, we examined the impact of Hurricane Sandy (2012) on mental health (sadness, suicidality) and health behaviors (substance use, physical activity, screen time, sexual behaviors) of 240,365 youth. Difference-in-differences regression analyses evaluated pre-disaster (2005-2011) and post-disaster (2013-2019) changes.

RESULTS

There were 83,442 (34.7 %) adolescents (51.2 % female, 18.1 % non-Hispanic White) located in 6 districts exposed to Hurricane Sandy and 156,923 (65.3 %) adolescents located in 13 non-exposed districts. Exposure was associated with differences in substance use, physical (in)activity, and risky sexual behaviors, but not mental health outcomes. Mental health did not moderate the association between disaster exposure and health behaviors. Hispanic adolescents and those identifying as Other races/ethnicities were most vulnerable to post-disaster negative health outcomes.

LIMITATIONS

Study limitations include questionnaire design, cross-sectional data, sampling, and possible response biases.

CONCLUSIONS

Findings provide critical information about youth mental health and health behaviors following disasters, as well as how youth may differ in their responses. Findings provide guidance for early identification and resource allocation for youth at higher risk for post-disaster health issues.

Adolescents' Tsunami Exposure and Mental Health Consequences: Protective Role of Cultural Coping Strategies

There is a knowledge gap regarding the link between disaster exposure and adolescent mental health problems in developing countries. This study examines the case of Sri Lanka to investigate (a) the immediate and long-term mental health impact of the 2004 tsunami disaster on adolescents and (b) the potential moderating effects of unique cultural and family practices that prevail in Sri Lanka. This study used a random sample of 160 adolescents (ages 12-19) and their mothers who were exposed to the tsunami disaster while living in a southern Sri Lankan village and provided prospective data immediately after the disaster (2005) and three years later (2008). A cross-culturally validated instrument assessed adolescent-mother dyads' tsunami exposure, stressful loss, family cultural rituals and familism, and adolescent mental health. Structural equation modeling analysis showed that exposure and perceptions of tsunami-induced stressful experiences were associated with early and later mental health problems in adolescents. In addition, this study found that unique cultural practices and familism moderated the link between adolescent tsunami exposure, stressful experiences, and levels of PTSD and depressive symptoms. The findings of this study could be utilized to develop prevention and intervention programs that are contextually and culturally valid and empirically supported, which would be more effective for trauma-exposed adolescents in developing countries.

Examining the effects of parental migration on youth mental health and substance use: a qualitative study in rural Yucatán, México

Background

Parental migration is common in Mexico and Latin America, where individuals pursue work to improve their family's economic opportunities and children remain home in their community under the care of the remaining parent or extended family. A research gap remains about the impact of parental migration on mental health and substance use in children who remain at home. The current study explored risk and resilience factors relating to mental health and substance use among Mexican youth remaining at home when one or more parents migrate.

Methods

This qualitative study applied attachment theory and thematic analysis to analyze 26 in-depth interviews with youth (17-21 years old), parents, and a focus group with high-school teachers in a town with history of migration both domestically and internationally (Yucatan, México).

Results

Respondents across groups perceived that parental migration was related to 1) less parental/caregiver oversight and support due to family demands on the remaining parent and 2) the deterioration of youth mental health. Lack of youth oversight and the poor mental health of youth were perceived as drivers of youth seeking out and consuming alcohol and substances. In terms of parental remittances, youth reported observing among their peers increased access to material goods such as clothing and technology (e.g., smartphones) and increased access to alcohol. Resilience factors included parental awareness of the role of good communication with youth and teachers and youth access to and utilization of self-care resources such as mutual aid meetings for substance use recovery.

Conclusion

Poor mental health and substance use among youth and parents were perceived to be related to parental absence, stressors on the remaining parent or family, and undermined healthy parent-child attachment. Youth themselves are a source of insight for recommendations on interventions to reduce youth isolation and substance use risk. We recommend the intentional engagement of youth in developing intervention research and tailoring evidence-based interventions to mitigate parental absence's impact and promote parent-child attachment for youth and families remaining at home.

Rebuilding wellbeing: Understanding the role of self-criticism, anger rumination, and death distress after the February 6, 2023, Türkiye Earthquake

This study investigated self-criticism, anger rumination, and death distress in wellbeing after one of the most devastating natural disasters of this century. The study included 399 participants from 56 different cities across Türkiye. Participants were from 3 groups: those who themselves or one of their nuclear families are earthquake survivors (group 1), those who had a loved one other than a nuclear family member who was an earthquake survivor (group 2), and those who were deeply affected by the earthquake through media networks (group 3). Results showed that women experienced higher death distress and anger rumination and lower mental wellbeing compared to men post-earthquake. Individuals in group 1 had significantly lower mental wellbeing and higher death distress than groups 2 and 3. However, the effect size of this significant differentiation depending on earthquake experience was small. Moreover, anger rumination and death distress fully mediated the link between self-criticism and mental wellbeing.

The Impact of Major Earthquakes on Students' Emotional Distress and Internalizing Symptoms, Externalizing Behaviors, and Coping During the Implementation of keepin' it REAL-Mexico

This article reports on effects of two earthquakes in Mexico on adolescents attending middle school. The earthquakes struck in close succession during the implementation of a school-based prevention program, providing an opportunity to assess emotional distress due to the earthquakes and whether the life skills taught in the program affected how students coped with the natural disaster. The objectives were to (1) evaluate the earthquakes' impact on students' distress; (2) assess if distress is associated with internalizing symptomology and externalizing behaviors; and (3) investigate if students receiving the original and adapted versions of the intervention coped better with the events. A Mexico-US research team culturally adapted keepin' it REAL to address connections between substance use among early adolescents in Mexico and exposure to violence. A random sample of public middle schools from three cities (Mexico City, Guadalajara, and Monterrey), stratified by whether they held morning or afternoon sessions, was selected. A total of 5522 7th grade students from 36 schools participated in the study. Students answered pretest and posttest questionnaires; the latter assessed earthquake-related distress and coping strategies. Earthquake-related distress was associated with all measures of undesired internalizing symptomology and externalizing behaviors. Compared to controls, students in the adapted intervention reported less aggressive and rule-breaking externalizing behavior and less violence perpetration. However, these intervention effects were not moderated by the level of earthquake-related distress, and they were not mediated by positive or negative coping. The findings have implications for prevention intervention research and policy as natural and human-made disasters occur more often.

Cross-Sectional and Descriptive Study on the Challenges and Awareness of Hispanic Parents Regarding Their Adolescents' Mental Health during the COVID-19 Pandemic

Research has shown that during the COVID-19 pandemic, approximately 20% of children and adolescents in the United States experienced mental health issues that became a significant social concern. However, recent studies have demonstrated that the majority of adolescents maintain positive emotions despite the crisis. This cross-sectional and descriptive study delves into the emotional states of adolescents during the pandemic, considering the viewpoints of both adolescents and their parents, with a specific focus on Hispanic adolescents. Survey results revealed that most adolescents reported positive and happy moods. However, a percentage of adolescents experienced worry, significant changes in feelings, and loneliness as a result of the physical and social isolation associated with virtual learning. Unfortunately, most surveyed Hispanic parents did not adequately recognize their adolescents' mood changes well. This lack of awareness, caused by factors such as an insufficient understanding about the importance of adolescent mental health, cultural reasons, language barriers, low education, unstable jobs, and more, could lead to missed opportunities for timely mental health interventions. This study seeks to provide a comprehensive discussion on the mental health of adolescents, while also advocating for the emotional wellbeing of Hispanic adolescents.

Maneuvering through Life with Positivity: Estimating the Effects of Foster Youth's Appraisal on Coping Styles

Youth in foster care tend to experience a disproportional number of adverse life experiences and demonstrate high rates of emotional and behavioral difficulties. According to the transactional model of stress and coping, how youth appraise their experiences influences the type of coping strategies they use in response to adversity, and these relations are key components to understanding later adjustment. However, few studies have examined potential effects of appraisal on coping for youth in foster care. Furthermore, it is not well understood if or how such interaction may vary across age. To address this gap, this study examined potential age moderation of contemporaneous primary, threat-based appraisal effects on coping in a large sample of 490 youth in foster care (48% female, ages 8 to 18) using a series of statistical models which were capable of detecting very general forms of effect moderation. Results indicated that primary appraisal positively predicted direct and prosocial coping, and negatively predicted asocial coping. The linear effects of appraisal on coping did not vary based on age of the youth. The findings suggest that primary appraisals of life events for youth in foster care does have a unique influence on certain coping styles, suggesting perhaps new directions for research on youth exposed to multiple adversities. To promote wider use of the non-parametric time-varying effect model in R, the analysis syntax is also included in the appendix.

From acute stress to persistent post-concussion symptoms: The role of parental accommodation and child's coping strategies

Background: Acute stress following mild Traumatic Brain Injury (mTBI) is highly prevalent and associated with Persistent Post-Concussion symptoms (PPCS). However, the mechanism mediating this relationship is understudied. Objective: To examine whether parental accommodation (i.e. parents' attempts to adjust the environment to the child's difficulties) and child's coping strategies mediate the association between acute stress and PPCS in children following mTBI. Method: Participants were 58 children aged 8-16 who sustained a mTBI and their parents. Children's acute stress (one-week post-injury) and coping strategies (three weeks post-injury), and parental accommodation (three weeks and four months post-injury) were assessed. Outcome measures included PPCS (four months post-injury) and neuropsychological tests of cognitive functioning (attention and memory). A baseline for PPCS was obtained by a retrospective report of pre-injury symptoms immediately after the injury. Results: Children's acute stress and negative coping strategies (escape-oriented coping strategies) and four-months parental accommodation were significantly related to PPCS. Acute stress predicted PPCS and attention and memory performance. Parental accommodation significantly mediated the association between acute stress and PPCS. Conclusions: Stress plays an important role in children's recovery from mTBI and PPCS. Parental accommodation mediates this relationship, and thus, clinical attention to parental reactions during recovery is needed.

Initial Psychological Reactions to COVID-19 of Middle Adolescents in Portugal

In its early stage, the COVID-19 pandemic and the subsequent public health measures brought several challenges to people in general, with adolescents being one of the most affected groups. To assess the psychological reactions of Portuguese adolescents in that early phase of the COVID-19 pandemic, we conducted an online survey that was filled by a sample of 340 (67.6% female and 32.4% male) middle adolescents (aged 16 and 17 years). Using the Impact Event Scale-Revised and the Depression, Anxiety, and Stress Scale, we found that most participants reported a normal score for depression, anxiety, and stress. However, 47.1% reported some level of pandemic-related traumatic distress, and 25.6% reported high severity values. The girls' levels of depression, anxiety, stress, and traumatic distress were significantly higher than those of the boys. Regression models showed that gender, number of symptoms experienced in the past days, self-reported health status, and concern with family were significant predictors of these mental health indicators. Our findings underscore the need for future research on the long-term traumatic psychological impact of the COVID-19 pandemic in adolescents, and on the gender differences in this group. This will allow the development of strategies to identify and address at-risk adolescents, since the promotion of mental health and the prevention of pathology are imperative for the health of current and future generations.

Analysis of the intellectual and social structure of health system response plan to earthquake studies adopting word co-occurrence and narrative approaches

BACKGROUND AND AIM

Earthquake is a natural disaster severely affecting the societies' health, hygiene, and welfare as such the most effective method to respond to its damages is to develop a readiness plan. This study aimed to discover thematic patterns and co-author relationships extracted from relevant publications to plan an earthquake response.

MATERIALS AND METHODS

This descriptive-analytical study adopted the scientometric approach and used word co-occurrence and social network analysis. The published articles indexed in PubMed were retrieved from 1970 to 2021 using a combination of keywords "earthquake and response." The data were analyzed in VOSviewer, UCINET, and NetDraw software.

RESULTS

The following six thematic clusters with a social map were extracted: Initial response of the healthcare system, response to probabilistic risks after the hazard, response to mental health and community resilience, response to public health, response to post-traumatic stress disorders, and staff's response to the needs assessment and continuity of diagnostic treatment services. Moreover, social network analysis revealed the great impact of Japanese and Chinese authors and institutes.

CONCLUSION

The present study detected many gaps in the literature on earthquake response, which can contribute to developing a general framework to prepare integrated healthcare earthquake response plans to promote the performance of this system.

Universal crisis psychoeducational interventions in schools: A scoping review

In times of crisis, schools are expected to help students deal with the situation and any help offered should consider the social and emotional problems arising from the critical event. Therefore, school-based activities enabling children to recognize the experience and work through it are essential to sustain their normal development and prevent academic and mental health problems. This paper provides an overview of the literature on universal school crisis interventions. We performed a scoping literature search in Scopus, ERIC, and Psych Info for articles published between January 2000 and May 2021 and identified 32 universal school-based crisis interventions based on three main crisis types (armed conflict, natural disaster, and Covid-19). Analysis of the methodologies and theoretical backgrounds generated six key psychoeducational factors commonly adopted. Comparing the different programmes in terms of topics, course content, duration, and methodology can help administrators and educators select the most appropriate crisis intervention for their school and situation. We also discuss the collaboration between mental health care specialists, school teams, and other important factors needed to implement these programmes and ensure their effectiveness under real-life conditions.

Association of polygenic risk scores, traumatic life events and coping strategies with war-related PTSD diagnosis and symptom severity in the South Eastern Europe (SEE)-PTSD cohort

OBJECTIVES

Posttraumatic stress disorder (PTSD) is triggered by extremely stressful environmental events and characterized by high emotional distress, re-experiencing of trauma, avoidance and hypervigilance. The present study uses polygenic risk scores (PRS) derived from the UK Biobank (UKBB) mega-cohort analysis as part of the PGC PTSD GWAS effort to determine the heritable basis of PTSD in the South Eastern Europe (SEE)-PTSD cohort. We further analyzed the relation between PRS and additional disease-related variables, such as number and intensity of life events, coping, sex and age at war on PTSD and CAPS as outcome variables.

METHODS

Association of PRS, number and intensity of life events, coping, sex and age on PTSD were calculated using logistic regression in a total of 321 subjects with current and remitted PTSD and 337 controls previously subjected to traumatic events but not having PTSD. In addition, PRS and other disease-related variables were tested for association with PTSD symptom severity, measured by the Clinician Administrated PTSD Scale (CAPS) by liner regression. To assess the relationship between the main outcomes PTSD diagnosis and symptom severity, each of the examined variables was adjusted for all other PTSD related variables.

RESULTS

The categorical analysis showed significant polygenic risk in patients with remitted PTSD and the total sample, whereas no effects were found on symptom severity. Intensity of life events as well as the individual coping style were significantly associated with PTSD diagnosis in both current and remitted cases. The dimensional analyses showed as association of war-related frequency of trauma with symptom severity, whereas the intensity of trauma yielded significant results independently of trauma timing in current PTSD.

CONCLUSIONS

The present PRS application in the SEE-PTSD cohort confirms modest but significant polygenic risk for PTSD diagnosis. Environmental factors, mainly the intensity of traumatic life events and negative coping strategies, yielded associations with PTSD both categorically and dimensionally with more significant p-values. This suggests that, at least in the present cohort of war-related trauma, the association of environmental factors and current individual coping strategies with PTSD psychopathology was stronger than the polygenic risk.

Kidcope and the COVID-19 Pandemic: Understanding High School Students' Coping and Emotional Well-Being

The COVID-19 pandemic has resulted in social isolation, grief, and loss among many adolescents. As the pandemic continues to impact individuals and communities across the globe, it is critical to address the psychological well-being of youths. More studies are needed to understand the effective ways adolescents cope with pandemic-related psychological distress. In this study, 146 students from 1 high school in a U.S. midwestern state completed an adapted version of Kidcope, a widely used coping instrument in disaster research, and measures were taken on generalized distress and COVID-19-related worries. Findings indicated that most students experienced COVID-19-related fears and general emotional distress. Additionally, we found that disengagement coping strategies were associated with lower general distress (p ≤ 0.05) and COVID-19 worries (p ≤ 0.10). Active coping was not associated with general distress and COVID-19 worries. Overall, our findings highlight the need to develop tailored interventions targeting youth coping strategies to reduce and prevent emotional distress and amplify healthy coping skills as the pandemic persists.

Is Experience the Best Teacher? Knowledge, Perceptions, and Awareness of Wildfire Risk

Wildfires represent a natural phenomenon with detrimental effects on natural resources and human health. A better knowledge, perception, and awareness of wildfire risk may help communities at risk of exposure to prevent future events and safeguard their own lives. The aim of this study is to explore differences between individuals with and without previous wildfire experience, in terms of (1) subjective and advanced wildfire knowledge, (2) self-reported perceptions, (3) level of information, (4) self-protection measures, and (5) importance of community involvement. As a second step, we investigated differences in the same variables, focusing more deeply on a group of individuals with previous wildfire experience, classifying them according to fire-related employment (fire-related workers vs. non-workers) and wildland-urban interface (WUI) proximity (WUI residents vs. non-WUI residents). The Kruskal-Wallis test was applied to establish differences between the pairs of subsamples. Our results partially confirmed our hypothesis, that direct experience leads individuals to have a greater preparedness on the topic of wildfires. Perception of knowledge is reflected only at a shallow level of expertise, and, therefore, no relevant within-group differences related to fire-related employment or to WUI proximity were detected. Moreover, available information was perceived to be insufficient, thus we report a strong need for developing effective communication to high-risk groups, such as homeowners and fire-related workers.