Academic journal article European Journal of Psychotraumatology

Sixteen-Year Follow-Up of Childhood Avalanche Survivors

Academic journal article European Journal of Psychotraumatology

Sixteen-Year Follow-Up of Childhood Avalanche Survivors

Article excerpt

Every year a substantial number of children are affected by natural disasters worldwide. Mental health research has increasingly focused on the detrimental consequences of disasters on the health of children and more recently has accentuated factors facilitating resilience and posttraumatic growth. Of mental health outcomes, posttraumatic stress disorder (PTSD) is likely the most prevalent post-disaster disorder affecting children (Hoven, Duarte, Turner, & Mandell, 2009). Longitudinal studies (>10 years) of childhood disaster survivors have shown the prevalence of PTSD to range from 2 to 29% (Boe, Holgersen, & Holen, 2011; Green et al., 1994; McFarlane & Van Hooff, 2009; Morgan, Scourfield, Williams, Jasper, & Lewis, 2003; Najarían, Sunday, Labruna, & Barry, 2011), indicating that factors other than the initial disaster exposure influence the progression of PTSD. In light of accumulating evidence of PTSD's adverse effects on multiple areas of children's lives, such as their social functioning and academic performance (Weems et al., 2013), identifying risk factors for PTSD has become an important area of research, providing a gateway to recovery as well as enhancement of preventive measures.

North's (2004) disaster trauma theory proposes a network of risk factors that contribute to post-disaster psychopathology, such as PTSD (Fig. 1). The model classifies risk factors into domains such as disaster agent characteristics (i.e., the subjective experience of the event and injury), individual characteristics (i.e., age and sex), and secondary sequelae (i.e., loss of social support).

An array of potential risk factors for PTSD has been identified among childhood disaster survivors. The literature has, however, been limited to a large extent to examining the first months and year post-disaster (Wang, Chan, & Ho, 2013). Of individual characteristics, previous studies indicate that females are at greater risk for PTSD than males, both in childhood and adolescence (Alisic et al., 2014). The literature on the relationship between age and PTSD among children has revealed mixed findings, as some studies indicate that the younger the children are, the greater the risk for developing PTSD (Brown, Mellman, Alfano, & Weems, 2011; Shannon, Lonigan, Finch, & Taylor, 1994), whereas others show older children experiencing greater symptom severity (Green et al., 1991). In line with this discrepancy, a meta-analysis of 96 child disaster studies found age at time of exposure to have a weak association with PTSD symptoms (Furr, Comer, Edmunds, & Kendall, 2010). In addition, greater number of lifetime traumatic events has been associated with increased PTSD risk, even when PTSD is assessed in relation to an index event. This relationship often appears in a dose-response fashion (Karam et al., 2014; Kilpatrick et al., 2013).

Disaster agent characteristics such as severity of the event and proximity to the disaster, loss of a loved one or friend (Furr et al., 2010), and injury (Adams et al., 2014) have been associated with PTSD symptoms in children. Furthermore, children's subjective experience of the disaster such as perceived life threat and distress at the time of the disaster has been found to yield medium-to-large associations with PTSD symptoms (Bodvarsdottir, Elklit, & Gudmundsdottir, 2006; Furr et al., 2010).

Children are a particularly vulnerable group in the post-disaster period and are likely to have difficulty coping with and recovering from the impact of disasters (Pfefferbaum, Noffsinger, Wind, & Allen, 2014). They are highly reliant on others for information and care and prior research has found low social support post-disaster to be a risk factor for PTSD among children (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012). Caregivers serve as role models for coping, and parental psychopathology can have profound effects on children's recovery in the aftermath of disasters (Green et al. …

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