Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy

OBJECTIVE

To study the relationship of post-traumatic stress disorder (PTSD) to severity of the disaster experience.

METHOD

A sample of 1785 adult participants of an epidemiological study initiated in the immediate aftermath of the 1988 earthquake in Armenia were interviewed about 2 years following the disaster based on the NIMH DIS-Disaster Supplement. All 154 cases of pure PTSD were compared with 583 controls without symptoms satisfying psychiatric diagnoses of interest.

RESULTS

PTSD cases included more persons from areas with the worst destruction. Having the highest level of education compared to lowest (OR 0.6 [95% CI 0.4-0.9]), being accompanied at the moment of the earthquake (OR 0.6 [95% CI 0.4-0.9]) and making new friends after the earthquake (OR 0.6 [95% CI 0.5-0.8]) were protective for PTSD. PTSD risk increased with the total amount of loss to the family (OR for highest level of loss 4.1 [95% CI 2.3-7.5]).

CONCLUSION

Based on this large population sample, we believe that early support to survivors with high levels of loss may reduce PTSD following earthquakes.

The Children's PTSD Inventory: development and reliability

Information involving the development of the DSM-IV version of the Children's PTSD Inventory is described. Independent ratings by highly experienced judges denote that the instrument encompassed the universe of definition that it was intended to measure (i.e., the DSM-IV criteria for PTSD). The instrument was administered to 82 traumatized and 22 nontraumatized youths at Bellevue Hospital. Moderate to high Cronbach alphas (.53-.89) were evident at the subtest level. An alpha of .95 was evident at the diagnostic level. In terms of inter-rater reliability, 98.1% agreement was evident at the diagnostic level. Inter-rater intraclass correlation coefficients (ICCs) ranged from .88 to .96 at the subtest level and .98 at the diagnostic level. Good to excellent kappas (.66-1.00) were reported for inter-rater reliability at the subtest level. An inter-rater reliability kappa of .96 was evident at the diagnostic level. In terms of test-retest reliability, 97.6% agreement was evident at the diagnostic level. Good to excellent test-retest kappas (.66-1.00) and ICCs (.66-.94) were observed. A test-retest kappa of .91 and an ICC of .88 was observed at the diagnostic level.

Scholastic impairments among traumatized adolescents

This investigation sought to determine if exposure to exceptional stress is associated with academic deficits or whether academic deficits are specifically associated with post-traumatic stress disorder (PTSD). In order to address these questions, the Metropolitan Achievement Test (MAT) as well as a measure of intelligence were administered to three groups of Lebanese adolescents. The first group met diagnostic criteria for PTSD. The second group had been exposed to qualitatively and quantitatively similar stressors but did not meet diagnostic criteria for PTSD. The third group consisted of nontraumatized controls. Data analysis using IQ as a covariate determined that the MAT scores of the PTSD subjects were significantly lower than the scores of the stress exposed PTSD negatives and controls. No significant differences were observed when the MAT scores of the stress exposed PTSD negatives and controls were compared.

Self-efficacy expectations among traumatized adolescents

Bandura's Multidimensional Scales of Perceived Self-Efficacy (MSPSE) were administered to three matched groups of adolescents. The first group met diagnostic criteria for PTSD. The second had been exposed to qualitatively and quantitatively similar stressors and did not meet criteria for PTSD (traumatized PTSD negatives). The third group consisted of non-traumatized controls. Data analysis revealed that the adolescents with PTSD had appreciably lower self-efficacy ratings on eight of the nine subtests that comprise the MSPSE. Non-significant differences were observed when the MSPSE subtest scores of the traumatized PTSD negatives and controls were compared.

Verbally mediated childhood post-traumatic stress disorder

This report chronicles the verbally mediated traumatisation and subsequent PTSD in an 11-year-old girl. Information obtained from parental interviews, academic transcripts, anecdotal teacher comments, structured and unstructured interviews, and standardised anxiety, depression, and misconduct scales was used to highlight the unique distress of the patient.

The development of posttraumatic stress disorder following four different types of traumatization

The Children's Posttraumatic Stress Disorder Inventory (CPTSDI) was used to identify 230 childhood posttraumatic stress disorder (PTSD) cases. Of these cases, 58 had been traumatized through direct experience, 128 through observation, 13 through verbal mediation, and 31 by combinations thereof. The 230 children and 35 controls completed the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). In addition, their conduct was rated on the Connor's Teacher Rating Scale (CTRS) criteria. Each of the PTSD groups had significantly greater RCMAS, CDI, and CTRS scores than the non-clinical controls, but there were no differences between the four types of PTSD cases.

The validity of the DSM-III posttraumatic stress disorder classification as applied to children

Tested three groups of children: The first group (n = 231) presented with posttraumatic stress disorder (PTSD), the second group (n = 32) presented with simple phobia (i.e., test phobia), and the third group (n = 35) was made up of nonclinical controls. The subjects marked the Revised Children's Manifest Anxiety Scale (RCMAS), Children's Depression Inventory (CDI) and their conduct was rated against the Conners Teacher Rating Scale (CTRS) criteria. A MANOVA evinced significant group and gender differences. No significant interaction effects were noted. Univariate F tests and Bonferroni posttests revealed that the PTSD cases evinced markedly higher RCMAS, CDI, and CTRS scores than their phobic and nonphobic peers. Analogously, the RCMAS and CDI scores of the phobia cases were appreciably greater than the control groups. On the other hand, the CTRS scores of the test phobia and control groups were not significantly different.

The use of an in vitro flooding package in the treatment of traumatized adolescents

An in vitro flooding package was used to treat the posttraumatic stress disorders of two adolescents. Traumatic scenes were identified through nonstructured interviews, and stimulus response imagery cues were presented according to a multiple baseline across traumatic scenes design. Posttreatment and 6-month follow-up assessments revealed meaningful improvements in the patients' affective, behavioral, and cognitive parameters.

The validity of the DSM-III posttraumatic stress disorder classification as applied to children

Tested three groups of children: The first group (n = 231) presented with posttraumatic stress disorder (PTSD), the second group (n = 32) presented with simple phobia (i.e., test phobia), and the third group (n = 35) was made up of nonclinical controls. The subjects marked the Revised Children's Manifest Anxiety Scale (RCMAS), Children's Depression Inventory (CDI) and their conduct was rated against the Conners Teacher Rating Scale (CTRS) criteria. A MANOVA evinced significant group and gender differences. No significant interaction effects were noted. Univariate F tests and Bonferroni posttests revealed that the PTSD cases evinced markedly higher RCMAS, CDI, and CTRS scores than their phobic and nonphobic peers. Analogously, the RCMAS and CDI scores of the phobia cases were appreciably greater than the control groups. On the other hand, the CTRS scores of the test phobia and control groups were not significantly different.

An experimental analysis of chronic posttraumatic stress among adolescents

The Fear Survey Schedule (FSS), State Trait Anxiety Inventory (STAI), and the Lebanese Fear Inventory (FLI, an endemic index of war fears) were administered to a sample of Lebanese junior high school students 27 days before the Israeli invasion of 1982. Six months after the disengagement of forces, the investigator located 16 subjects who had been in West Beirut throughout the siege and 46 subjects who had evacuated to safer environs. The inventories were readministered to the subjects according to a counterbalanced regimen and no significant differences were noted between the preinvasion scores of the evacuees and nonevacuees or between the postinvasion scores of the evacuees and nonevacuees. No significant differences were observed when the aggregate FSS and STAI estimates that were recorded before and after the invasion were compared. On the other hand, the aggregate LFI scores were significantly lower after the invasion. The results are discussed from within the social learning framework of fear acquisition.

WISC-R incentives and the academic achievement of conduct disordered adolescent females: a validity study

Selected and randomly assigned 51 institutionalized conduct disordered adolescent females to one of three treatment conditions. Ss' responses to a short form of the WISC-R were followed by examiner praise, neutral feedback, or token reinforcement. A series of Pearson product-moment correlations were calculated between the scaled scores of the three treatment groups and their GPAs. The results revealed that the identified subtests, regardless of treatment condition, were poor predictors of achievement. The correlations were discussed in view of the association between the selected subtests and the curricula of the special education classes, observed variations between the WISC-R treatment scores, and the special characteristics of the Ss.

The effects of a good behavior game on the disruptive behavior of Sundanese elementary school students

An endemic version of the Good Behavior Game was applied in a rural Sudanese second-grade classroom. Official letters of commendation, extra time for recess, victory tags, and a winner's chart were used as backup reinforcers. The class was divided into two teams, and the teacher indicated she would place a check on the board after every rule violation. The students were also told that the team with the fewest marks would win the game and receive the aforementioned prizes. After an initial adaptation period, the rate of disruption was charted across four treatment phases: viz., baseline I, introduction of the game, baseline II, and reintroduction of the game. It was observed that the game phases were associated with marked decreases in the rate of seat leaving, talking without permission, and aggression. The teacher, principal, parents, and students were consequently individually interviewed, and their comments spoke strongly for the social validity of the game.

The Lebanese Fear Inventory: a normative report

Recorded the incidence and type of war-related anxiety reactions that were observed over a 2-year period at a Lebanese outpatient counseling clinic and constructed a 15-item Likert-type inventory. The instrument was administered to 206 outpatients who were suffering from a wide range of somatic illnesses, and descriptive statics as well as estimates of internal consistency were calculated. A series of Hotelling T2 tests and an F test revealed that there were sex differences among 13 of the items as well as between the total scores. Cronbach alpha coefficients were calculated for each item by sex as well as for the overall male and female scores. The observed coefficients spoke well for the instrument's internal consistency. The data were discussed, and recommendations for further research and cross-cultural investigations were made.

Effect of reinforcement of response on internal consistency of selected WISC-R substests

An experimental study of 120 educable mentally retarded subjects was undertaken to examine the differential effects of three types of reinforcers (verbal praise, token, and verbal neutral) and two levels of schedule of reinforcement (continuous and fixed ratio) on the Arithmetic, Picture Completion, and Block Design subtests from the WISC-R. Although the pattern of coefficients was similar for the two schedule conditions, there was a trend for the fixed ratio schedule to result in a greater number of attempted items and higher coefficients of internal consistency. The superiority of any type of reinforcer treatment was not demonstrated.