Children Exposed to Disaster: II. Risk Factors for the Development of Post-Traumatic Symptomatology

doi:10.1097/00004583-199401000-00013

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 33, Issue 1, January 1994, Pages 94-105

https://doi.org/10.1097/00004583-199401000-00013 Get rights and content

ABSTRACT

Objective

To examine the influence of subject and exposure variables on the development of post-traumatic stress disorder (PTSD) symptoms and syndrome in children exposed to disaster.

Method

Three months after Hurricane Hugo, 5,687 school-aged children were surveyed about their experiences and reactions to the hurricane. Self-reports of PTSD symptoms were obtained by use of a PTSD Reaction Index.

Results

The presence of PTSD symptoms was strongly related to children's reported severity of the hurricane, degree of home damage sustained, and continued displacement; however, children's level of trait anxiety and their reported emotional reactivity during the hurricane were more strongly related to the presence of PTSD symptoms than were the exposure factors. Different sets of risk factors appeared to differentially influence the development of the three DSM-III-R PTSD symptom clusters. Little evidence for a differential effect of the risk factors between females and males and younger and older children was found.

Conclusions

Level of trait anxiety appears to be the single strongest risk for the development of severe post-traumatic reactions. The higher rate of post-traumatic symptoms in females and younger children in combination with the absence of differential reaction to the risk factors suggests that females and younger children are more likely to develop posttraumatic reactions following a disaster.

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Cited by (271)

Responses to natural disasters
2023, Encyclopedia of Mental Health, Third Edition: Volume 1-3
Natural disasters such as earthquakes, tornados, hurricanes, tsunamis, wildfires, and mudslides occur frequently and correlate with psychosocial outcomes including posttraumatic stress disorder (PTSD), depression, anxiety, global distress, and physical health problems. As the climate crisis escalates, natural disasters will likely increase in frequency and intensity. While many people display great resiliency in the wake of these community disasters, deleterious outcomes have been associated with a variety of factors including type of disaster, magnitude of destruction, and person-level indicators such as demographic characteristics (age, gender, ethnicity, marital status), socioeconomic status, and pre-disaster mental health. Although studied less frequently, responses to natural disasters have been examined in child populations; effects may persist for decades. Longitudinal assessments are less common than cross-sectional studies, yet they are critical for understanding adaptation and distress over time. Logistical difficulties such as obtaining rapid funding and ethics approval generate challenges for conducting research on natural disasters; variability in measurement tools, populations evaluated, sampling designs, and temporal assessments have hindered cross-study comparisons. Improved methodologies and standardized assessment instruments may help elucidate variability in responses, with the hope of better understanding psychosocial responses and informing outreach services.
Using social media Reddit data to examine foster families' concerns and needs during COVID-19
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COVID-19 is likely to have negatively impacted foster families but few data sources are available to confirm this.
The current study used Reddit social media data to examine how foster families are faring in the pandemic. Discussion topics were identified and examined for changes before and after COVID-19.
Comments were collected from three Reddit online discussion boards dedicated to foster families (N = 11,830).
We used machine learning techniques, including Latent Dirichlet Allocation, for topic modeling and textual analysis for qualitative coding of the Reddit comments.
Results showed that three main topics had both significant quantitative and meaningful qualitative changes before and after COVID-19. There were significant increases in conversation about becoming a foster parent (F = 5.75, p = 0.02) and activities for foster children (F = 10.61, p = 0.001), whereas there was a significant decrease in discussing permanency (F = 9.46, p = 0.003) before and after the onset of COVID-19. Qualitative coding showed that regarding the topic of becoming a parent, excitement over approval of foster care license before COVID-19 shifted to foster families' increased anxieties about delays in their licensing cases after COVID-19. For permanency, content changed from the best interest of the child and reunifications before COVID-19 to concerns over family separations and permanency challenges after COVID-19. Regarding activities for foster children, content related to everyday activities before COVID-19 changed to specific activities foster children and families could do during lockdowns. Results suggest areas child welfare workers may focus on to better support foster families during and after the pandemic.
Specificity of trait anxiety in anxiety and depression: Meta-analysis of the State-Trait Anxiety Inventory
2020, Clinical Psychology Review
Citation Excerpt :
Trait anxiety is also correlated with acute stress disorder symptoms (Suliman, Troeman, Stein, & Seedat, 2013). In two studies of children, trait anxiety was more predictive of PTSD symptom severity than the nature of the traumatic event itself, including severity of cancer diagnosis (Phipps, Jurbergs, & Long, 2009) or strength of hurricane experienced (Lonigan, Shannon, Taylor, Finch, & Sallee, 1994). However, because these studies are cross-sectional in nature, they do not allow researchers to determine who may develop PTSD after a traumatic experience.
The State-Trait Anxiety Inventory – Trait version (STAI-T) was developed to measure an individual’s tendency to experience anxiety, but it may lack discriminant evidence of validity based on strong observed relationships with measures of depression. The present series of meta-analyses compares STAI-T scores among individuals with depressive disorders, anxiety disorders, and nonclinical comparison groups, as well as correlations with measures of anxiety and depressive symptom severity, in order to further examine discriminant and convergent validity. A total of 388 published studies (N = 31,021) were included in the analyses. Individuals with an anxiety disorder and those with a depressive disorder displayed significantly elevated scores on the STAI-T compared to nonclinical comparison groups. Furthermore, anxiety and depressive symptom severity were similarly strongly correlated with the STAI-T (mean r = .59 – .61). However, individuals with a depressive disorder had significantly higher STAI-T scores than individuals with an anxiety disorder (Hedges’s g = 0.27). Given these findings, along with previous factor analyses that have observed a depression factor on the STAI-T, describing the scale as a measure of ‘trait anxiety’ may be a misnomer. It is proposed that the STAI-T be considered a non-specific measure of negative affectivity rather than trait anxiety per se.
Impact of disaster exposure severity: Cascading effects across parental distress, adolescent PTSD symptoms, as well as parent-child conflict and communication
2020, Social Science and Medicine
Natural disasters are common and have potentially deleterious impacts on individuals, as well as on the relationships among family members (Adams et al., 2015; Paul, 2015). Additionally, caregiver-, offspring-, and family-level outcomes are often correlated following disaster.
Thus, longitudinal work is needed to clarify the prospective associations among such constructs following severe disasters.
The current study included 1,271 adolescents and investigated whether disaster exposure impacted adolescent posttraumatic stress disorder (PTSD) symptoms, parent distress, and family parent-child conflict and communication, as well as whether/how these factors influenced one another over time. This study used a dynamic cascade model and included adolescents (ages 12-17) and caregivers present for tornadoes in Missouri and Alabama in 2011. These participants were part of a larger study involving a web-based intervention.
Over and above covariates (i.e., adolescent age, gender, race, treatment, prior trauma, adolescent alcohol use and depressive symptoms, and household income), families who experienced greater severity of disaster exposure had adolescents who reported more baseline PTSD symptoms and caregivers who reported more distress at baseline.
Providing tangible resources (e.g., housing, food, transportation, essential possessions) to families post-disaster may reduce parent distress and adolescent PTSD symptoms. Additionally, reducing adolescent PTSD symptoms may prospectively improve relationships between parents and adolescents.
A spatial analysis of climate gentrification in Orleans Parish, Louisiana post-Hurricane Katrina
2020, Environmental Research
Citation Excerpt :
In the case of Hurricane Katrina, residents able to return to New Orleans but unable to return to their original home (an ability largely split along racial divisions), would have less purchasing power, due to temporary displacement and time away from work, to find a home in a market with limited healthy housing stock – circumstances that have led to displaced residents setline for unsafe housing conditions in other large cities (Desmond and Kimbro, 2015; Sastry and Gregory, 2014). In addition, a resident unable to resettle their former home after Hurricane Katrina due to gentrification can also suffer compounded negative health effects associated with being a victim of a natural disaster including physical injury or illness as well as mental health problems including anxiety, post-traumatic stress disorder, and depression (Acierno et al., 2006; Fussell and Lowe, 2014; Lonigan et al., 1994; Norris et al., 2004). While it is difficult to impossible to attribute an individual weather event to climate change, a growing interest in a phenomenon known as “climate gentrification” (Keenan et al., 2018) suggests that the social and health impacts of sociodemographic changes driven by natural disasters is of increasing importance, particularly given the impact of global climate change on the increasing frequency of extreme weather events and a predicted increase in population migrations away from vulnerable coastal areas (Albrecht et al., 2007; Portier et al., 2010; Stott, 2016).
Hurricane Katrina made landfall in New Orleans, Louisiana as a Category 3 storm in August 2005. Storm surges, levee failures, and the low-lying nature of New Orleans led to widespread flooding, damage to over 70% of occupied housing, and evacuation of 80–90% of city residents. Only 57% of the city's black population has returned. Many residents complain of gentrification following rebuilding efforts. Climate gentrification is a recently described phenomenon whereby the effects of climate change, most notably rising sea levels and more frequent flooding and storm surges, alter housing values in a way that leads to gentrification.
To examine the climate gentrification following hurricane Katrina by (1) estimating the associations between flooding severity, ground elevation, and gentrification and (2) whether these relationships are modified by neighborhood level pre- and post-storm sociodemographic factors.
Lidar data collected in 2002 were used to determine elevation. Water gauge height of Lake Ponchartrain was used to estimate flood depth. Using census tracts as a proxy for neighborhoods, demographic, housing, and economic data from the 2000 decennial census and the 2010 and 2015 American Community Survey 5-year estimates US Census records were used to determine census tracts considered eligible for gentrification (median income < 2000 Orleans Parish median income). A gentrification index was created using tract changes in education level, population above the poverty limit, and median household income. Proportional odds ordinal logistic regression was used with product terms to test for effect measure modification by sociodemographic factors.
Census tracts eligible for gentrification in 2000 were 80.2% black. Median census tract flood depth was significantly lower in areas eligible to undergo gentrification (0.70 m vs. 1.03 m). Residents of gentrification-eligible tracts in 2000 were significantly more likely to be black, less educated, lower income, unemployed, and rent their home rather than own. In 2015 in these same eligible tracts, areas that underwent gentrification became significantly whiter, more educated, higher income, less unemployed, and more likely to live in a multi-unit dwelling. Gentrification was inversely associated with flood depth and directly associated with ground elevation in eligible tracts. Marginal effect modification was detected by the effect of pre-storm black race on the relationships of flood depth and elevation with gentrification.
Gentrification was strongly associated with higher ground elevation in New Orleans. These results provide evidence to support the idea of climate gentrification described in other low-elevation major metropolitan areas like Miami, FL. High elevation, low-income, demographically transitional areas in particular – that is areas that more closely resemble high-income area demographics, may be vulnerable to future climate gentrification.
Avoidance learning and classical eyeblink conditioning as model systems to explore a learning diathesis model of PTSD
2019, Neuroscience and Biobehavioral Reviews
Experiencing a trauma is necessary, but not sufficient, for the development of post-traumatic stress disorder (PTSD) in that most individuals who experience a trauma do not go on to develop PTSD. This suggests that identifiable vulnerabilities (i.e., diatheses) exist that increase the risk for the development of PTSD. One such factor is the personality temperament of behavioral inhibition (BI). Organisms that exhibit BI were studied in the context of avoidance learning and classical eyeblink conditioning. We present a body of evidence supporting a learning diathesis model in which behaviorally inhibited organisms exhibit enhanced acquisition and resistance to extinction in these tasks. Vulnerable individuals show learning-related enhancements when the learning situation involves some degree of uncertainty. We review the known brain circuitry involved in classical eyeblink conditioning in the context of the learning diathesis model. Finally, the data reviewed here demonstrate the value of studying vulnerability factors in humans and a rodent model using cerebellar-dependent learning tasks for understanding the acquisition and endurance of PTSD symptomatology.

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: This research was supported in part by a grant from the Medical University of South Carolina Institutional Research Fund, 1989-1990, to Dr. Shannon (22620-CR12). Portions of this manuscript were completed while Dr. Lonigan was supported by an NICHD Postdoctoral Fellowship (T32HD07226) through the John F. Kennedy Center at Vanderbilt University. The authors thank the children and teachers of the Berkeley County Schools for their cooperation and effort with this project.

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ArticlesChildren Exposed to Disaster: II. Risk Factors for the Development of Post-Traumatic Symptomatology

ABSTRACT

Objective

Method

Results

Conclusions

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Psychiatry

Behavior Therapy

J Am Acad Child Psychiatry

Advances in Behavior Research Therapy

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised (DSM-III-R)

Affective and cognitive characteristics of depression in 10- and 11-year old children

J Pers Soc Psychol

Discriminating patterns of emotions in 10- and 11-year old children's anxiety and depression

J Pers Soc Psychol

Traumatic events and posttraumatic stress disorder in an urban population of young adults

Arch Gen Psychiatry

Changes in children's behavior after a natural disaster

Am J Psychiatry

Lightning-strike disaster: effects on children's fears and worries

J Consult Clin Psychol

Children traumatized by catastrophic situations

Articles
Children Exposed to Disaster: II. Risk Factors for the Development of Post-Traumatic Symptomatology