Disasters typically strike quickly and cause great harm. Unfortunately, because of the spontaneous and chaotic nature of disasters, the psychological consequences have proved exceedingly difficult to ...assess. Published reports have often overestimated a disaster's psychological cost to survivors, suggesting, for example, that many if not most survivors will develop posttraumatic stress disorder (PTSD); at the same time, these reports have underestimated the scope of the disaster's broader impact in other domains. We argue that such ambiguities can be attributed to methodological limitations. When we focus on only the most scientifically sound research—studies that use prospective designs or include multivariate analyses of predictor and outcome measures—relatively clear conclusions about the psychological parameters of disasters emerge. We summarize the major aspects of these conclusions in five key points and close with a brief review of possible implications these points suggest for disaster intervention. 1. Disasters cause serious psychological harm in a minority of exposed individuals. People exposed to disaster show myriad psychological problems, including PTSD, grief, depression, anxiety, stress-related health costs, substance abuse, and suicidal ideation. However, severe levels of these problems are typically observed only in a relatively small minority of exposed individuals. In adults, the proportion rarely exceeds 30% of most samples, and in the vast majority of methodologically sound studies, the level is usually considerably lower. Among youth, elevated symptoms are common in the first few months following a high-impact disaster, but again, chronic symptom elevations rarely exceed 30% of the youth sampled. 2. Disasters produce multiple patterns of outcome, including psychological resilience. In addition to chronic dysfunction, other patterns of disaster outcome are typically observed. Some survivors recover their psychological equilibrium within a period ranging from several months to 1 or 2 years. A sizeable proportion, often more than half of those exposed, experience only transient distress and maintain a stable trajectory of healthy functioning or resilience. Resilient outcomes have been evidenced across different methodologies, including recent studies that identified patterns of outcome using relatively sophisticated data analytic approaches, such as latent growth mixture modeling. 3. Disaster outcome depends on a combination of risk and resilience factors. As is true for most highly aversive events, individual differences in disaster outcomes are informed by a number of unique risk and resilience factors, including variables related to the context in which the disaster occurs, variables related to proximal exposure during the disaster, and variables related to distal exposure in the disaster's aftermath. Multivariate studies indicate that there is no one single dominant predictor of disaster outcomes. Rather, as with traumatic life events more generally, most predictor variables exert small to moderate effects, and it is the combination or additive total of risk and resilience factors that informs disaster outcomes. 4. Disasters put families, neighborhoods, and communities at risk. Although methodologically complex research on this facet of disasters 'impact is limited, the available literature suggests that disasters meaningfully influence relationships within and across broad social units. Survivors often receive immediate support from their families, relatives, and friends, and for this reason many survivors subsequently claim that the experience brought them closer together. On the whole, however, the empirical evidence suggests a mixed pattern of findings. There is evidence that social relationships can improve after disasters, especially within the immediate family. However, the bulk of evidence indicates that the stress of disasters can erode both interpersonal relationships and sense of community. Regardless of how they are affected, postdisaster social relations are important predictors of coping success and resilience. 5. The remote effects of a disaster in unexposed populations are generally limited and transient. Increased incidence of extreme distress and pathology are often reported in remote regions hundreds if not thousands of miles from a disaster's geographic locale. Careful review of these studies indicates, however, that people in regions remote to a disaster may experience transient distress, but increased incidence of psychopathology is likely only among populations with preexisting vulnerabilities (e.g., prior trauma or psychiatric illness) or actual remote exposure (e.g., loss of a loved one in the disaster). Finally, we review the implications for intervention. There is considerable interest in prophylactic psychological interventions, such as critical incident stress debriefing (CISD), that can be applied globally to all exposed survivors in the immediate aftermath of disaster. Multiple studies have shown, however, that CISD is not only ineffective but in some cases can actually be psychologically harmful. Other less invasive and more practical forms of immediate intervention have been developed for use with both children and adults. Although promising, controlled evaluations of these less invasive interventions are not yet available. The available research suggests that psychological interventions are more likely to be effective during the short-and long-term recovery periods (I month to several years postdisaster), especially when used in combination with some form of screening for at-risk individuals. Such interventions should also target the maintenance and enhancement of tangible, informational, and social-emotional support resources throughout the affected community.
Natural disasters, such as hurricanes and floods, are increasing in frequency and scope. Youth exposed to disasters are at risk for developing posttraumatic stress symptoms (PTSS). However, not all ...youth who report initially elevated PTSS report persistent PTSS that last beyond the first three to six months postdisaster. Thus, it is crucial to understand how and why youth differ in their patterns of PTSS. This study reviewed the literature on children's postdisaster PTSS, evaluating the typical number and types of patterns for children's PTSS trajectories, as well as risk and protective factors predicting trajectory membership. This review identified eight empirical studies on youth PTSS trajectories following natural disasters; these studies included 8,306 children aged 3 to 18 years. All studies identified resilience, recovery, and chronic trajectories. Evidence for a delayed trajectory was mixed. Proportions of children falling into each trajectory varied widely across studies, but overall, resilience was the most prevalent trajectory. These findings were consistent across study factors (i.e., analytic strategy, assessment timing, and study selection criteria). Female gender, disaster exposure, negative coping, and lack of social support were significant risk factors for chronic trajectories across several studies. Future research should combine individual level participant data across studies of children's responses to disasters to better understand PTSS trajectories.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
TRAYECTORIAS DE SÍNTOMAS DE ESTRÉS POSTRAUMÁTICO EN NIÑOS DESPUES DE EXPOSICIÓN A UN DESASTRE: UNA REVISIÓN
Trayectorias de síntomas de estrés postraumático en niños
Los desastres naturales, tales como huracanes e inundaciones, están aumentando en frecuencia y magnitud. Los jóvenes expuestos a desastres están en riesgo de desarrollar síntomas de estrés postraumático (TEPT). Sin embargo, no todos los jóvenes que reportan inicialmente elevada sintomatología de estrés postraumático reportan síntomas persistentes que duren más allá de los primeros tres a seis meses post desastres. De esta manera, es crucial entender cómo y qué jóvenes difieren en sus patrones de SEPT. Este estudió revisó la literatura en síntomas de TEPT post desastres en niños, evaluando los números típicos y tipos de patrones de las trayectorias de SEPT como también los factores de riesgo y protectores que predigan la trayectorias de sus miembros. Esta revisión identificó ocho estudios empíricos de las trayectorias de SEPT en jóvenes después de un desastre natural; estos estudios incluyeron 8.306 niños, entre los 3 y 18 años. Todos los estudios identificaron resiliencia, recuperación y trayectorias crónicas. La evidencia por trayectoria retardada fue mixta. La proporción de niños que cayeron en cada trayectoria varió mucho entre los estudios, pero en general, la resiliencia fue la trayectoria más prevalente. Estos hallazgos fueron consistentes entre los factores de los estudios (ej. Estrategia analítica, tiempo de evaluación, y criterios de selección del estudio). El sexo femenino, la exposición al desastre, mecanismos de enfrentamiento negativos y la falta de apoyo social fueron los factores de riesgo significativos para las trayectorias crónicas entre los distintos estudios. La investigación futura debería combinar los datos de los participantes a nivel individual de todos los estudios de respuestas de niños a los desastres para comprender mejor la trayectoria del EPT.
抽象
Traditional and Simplified Chinese s by AsianSTSS
Posttraumatic Stress Symptom Trajectories Among Children After Disaster Exposure: A Review
Traditional Chinese
標題: 一項對兒童經歷天災後的創傷後壓力症狀軌跡評估
撮要: 天災如颶風和水災發生得越來越頻繁和嚴重。曾經歷天災的青少年有風險發展出創傷後壓力症狀(PTSS)。然而༌起初PTSS提升的青少年༌其PTSS在天災發生3至6個月後卻不一定維持。因此༌我們有必要理解青少年的PTSS模式如何及為何有異。本研究檢視過往對兒童災後PTSS的研究༌評估兒童PTSS軌跡裡典型的模式種類和數量༌以及可預測軌跡組別的風險因素與保護因素。我們找到8項對青少年經歷天災後PTSS軌跡的實證研究༌這些研究包含8,306名年齡介乎3至18歲的兒童。這些研究全都發現有具恢復力、康復及慢性軌跡。延遲軌跡的證據則不統一。這些研究在各個軌跡包含的兒童比例都非常不同༌但整體來說༌具恢復力是最普遍的軌跡。這些研究結果在各種研究因素下༈即分析策略、評估時機和研究挑選的準則༉一致。性別為女性、天災經歷、負面的應對方法及欠缺社會支持༌在數個研究裡都是慢性軌跡的顯著風險因素。我們未來應該把個人參與研究的數據༌跟其他對兒童經歷天災的反應研究數據結合分析༌加深對PTSS軌跡的理解
Simplified Chinese
标题: 一项对儿童经历天灾后的创伤后压力症状轨迹评估
撮要: 天灾如飓风和水灾发生得越来越频繁和严重。曾经历天灾的青少年有风险发展出创伤后压力症状(PTSS)。然而༌起初PTSS提升的青少年༌其PTSS在天灾发生3至6个月后却不一定维持。因此༌我们有必要理解青少年的PTSS模式如何及为何有异。本研究检视过往对儿童灾后PTSS的研究༌评估儿童PTSS轨迹里典型的模式种类和数量༌以及可预测轨迹组别的风险因素与保护因素。我们找到8项对青少年经历天灾后PTSS轨迹的实证研究༌这些研究包含8,306名年龄介乎3至18岁的儿童。这些研究全都发现有具恢复力、康复及慢性轨迹。延迟轨迹的证据则不统一。这些研究在各个轨迹包含的儿童比例都非常不同༌但整体来说༌具恢复力是最普遍的轨迹。这些研究结果在各种研究因素下༈即分析策略、评估时机和研究挑选的准则༉一致。性别为女性、天灾经历、负面的应对方法及欠缺社会支持༌在数个研究里都是慢性轨迹的显著风险因素。我们未来应该把个人参与研究的数据༌跟其他对儿童经历天灾的反应研究数据结合分析༌加深对PTSS轨迹的理解
Adolescents’ involvement in bullying is associated with both sleep and mental health problems, but the nature of this association remains unclear; further, its association with academic outcomes has ...received little attention. Thus, the aims of the current study were to (a) determine whether involvement in bullying as a victim, bully, or bully-victim was associated with greater sleep and mental health problems and (b) explore the potential mediating effect of sleep and mental health problems on the association between bullying and academic outcomes. A large 2012 population-based study in Hordaland County, Norway, surveyed 10,220 adolescents (16-19 years; 54% girls) about bullying involvement using the revised version of the Olweus Bully/Victim Questionnaire, detailed sleep assessment, and mental health questionnaires. Academic outcomes were obtained from official administrative registries. 1.7% of the adolescents (n = 156) reported being victims of bullying, 1.0% (n = 92) reported being a bully, and 0.5% (n = 50) reported being a bully-victim. All categories of bullying involvement had higher rates of mental health problems compared with adolescents not involved in bullying. Victims reported more symptoms of anxiety and depression, whereas bullies reported higher rates of conduct problems. Adolescents in all bullying categories also reported significantly shorter sleep duration and higher prevalence of insomnia as well as lower grade point average (GPA) compared with adolescents not involved; however, school absence was not associated with bullying involvement. Bullying involvement and GPA showed complete mediation for bullies and bully-victims and partial mediation for victims through sleep duration, conduct problems, and symptoms of depression and attention deficit hyperactivity disorder (ADHD). Bullying is strongly associated with mental health and sleep problems, in addition to lower academic performance. Findings support the importance of addressing bullying involvement during this important developmental period.
Depression is a public health concern among youth, and it is pertinent to identify factors that can help prevent development of depressive symptoms in adolescence. This study aimed to investigate the ...association between negative life events and depressive symptoms among adolescents, and to examine the influence and relative contributions of personal, social and family protective factors related to resilience. Data stem from the cross-sectional youth@hordaland-survey, conducted in Hordaland, Norway. In all, 9,546 adolescents, aged 16-19 years old (52.8% girls) provided self-report information on depressive symptoms, negative life events and protective factors related to resilience. Experiencing a higher number of negative life events was related to increases in depressive symptoms, while the potential protective factors goal orientation, self-confidence, social competence, social support, and family cohesion individually were associated with fewer symptoms. Although there were small moderating effects of goal orientation and self-confidence, the results mainly supported a compensatory resilience model. When considering the potential protective factors jointly, only self-confidence and family cohesion were significantly associated with fewer depressive symptoms for both genders, with the addition of social support for girls. There were significant interactions between all the potential protective factors and gender, indicating a greater reduction of depressive symptoms with higher levels of protective factors among girls.
This Special Section of the
Journal of Consulting and Clinical Psychology
focuses on research that extends beyond documenting the efficacy and effectiveness of specific psychological treatments or ...preventive interventions for children and youths. In the past 30 years, there have been remarkable advances in the development and evaluation of psychological treatments and preventive interventions for a wide range of child and adolescent problems. At the same time, only a small percentage of youths who suffer from emotional and behavioral problems receive psychological services, and many of these services are not evidence-based. This article discusses key features of the Special Section studies, which examine important issues related to (a) disseminating treatments in diverse community settings (i.e., investigating the transportability of treatment), (b) personalizing mental health care (i.e., investigating predictors and moderators of treatment outcome), and (c) developing evidence-based explanations of treatment (i.e., investigating mediators of treatment). Key issues that are raised in the specific studies are discussed, and important considerations for future research are highlighted. Moving the field forward requires innovation, complex research designs, and a willingness to develop treatment models that reach beyond the current body of treatment outcome and prevention research.
COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must ...assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond.
Public Significance Statement
Clinical psychological science must lead a national response to address mental health issues following COVID-19. This article highlights urgent challenges to confront, and timely opportunities to contemporize a field to better address mental health issues now and long after. The article concludes by discussing implications for new research directions, clinical approaches, and policy issues.
This study used a 2-month prospective research design to examine the bi-directional interplay between peer victimization and social anxiety among adolescents. Participants included 228 adolescents ...(58% female) in grades 10–12. Three types of peer victimization were examined:
overt
(physical aggression or verbal threats),
relational
(malicious manipulation of a relationship, such as by friendship withdrawal), and
reputational
(damaging another’s peer relationships, such as through rumor spreading). Adolescents’ self-reported feelings of social anxiety and peer victimization experiences were assessed at two time points, in November and January of the same school year. Peer victimization was strongly related to adolescents’ social anxiety, and relational victimization explained additional unique variance. Moreover, peer victimization was both a predictor and consequence of social anxiety over time, with the most robust results found for relational victimization. Limited support was obtained for gender as a moderating variable. Findings highlight the deleterious effects of peer victimization, especially relational victimization, and suggest avenues for future research and clinical intervention for adolescents experiencing such victimization.
To investigate whether mental health problems differ between internationally adopted adolescents and their non-adopted peers and examine design and sample characteristics that might underlie ...differences among studies.
Studies published through August 2015 were collected through Embase, Medline, PsychINFO, Web of Science, ERIC, and Svemed+. Combined effect estimates were calculated using random-effects models.
Eleven studies investigating 17,919 adoptees and 1,090,289 non-adopted peers were included in the meta-analysis. Internationally adopted adolescents reported more mental health problems across domains than their peers, with effect estimates (standardized mean differences SMDs) of 0.16 (95% CI 0.03 to 0.28) for questionnaire-based studies and 0.70 (95% CI 0.50 to 0.90) for register-based studies. They also reported significantly more externalizing difficulties (SMD 0.20, 95% CI 0.03 to 0.38), although the effect estimate for internalizing difficulties was not statistically significant (SMD 0.10, 95% CI -0.03 to 0.24). Studies using categorical measurements of mental health problems, indicating more serious problems, yielded larger effect estimates than continuous measurements (SMD 0.31, 95% CI 0.21 to 0.41; SMD 0.13, 95% CI -0.01 to 0.26, respectively). The difference in mental health problems between international adoptees and their peers was somewhat larger when using parent report compared with self-report. More recent studies (conducted in 1995 and later) yielded larger estimates than older studies, although no significant difference was found for this analysis or subgroup analyses investigating sex and age at adoption.
Although most internationally adopted adolescents are well adjusted, adoptees as a group report higher levels of mental health problems compared with non-adopted peers. This difference should be acknowledged and adequate support services should be made available.
The primary purpose of this study was to evaluate the relationship between decreased empathy (i.e., cognitive and affective) and indirect and cyber peer aggression among Latinx adolescents during ...their transition to high school. Further, we examined the degree to which social anxiety moderated this relationship. Participants were 469 Latinx ninth graders, ages 13–17 years (M = 14.52, SD = 0.58; 58% girls). Adolescents completed the Revised Peer Experiences Questionnaire, Cyber Peer Experiences Questionnaire, Basic Empathy Scale, and Social Anxiety Scale for Adolescents at two different time points, 3 months apart. Hierarchical linear regression analyses revealed concurrent and prospective relationships between lower cognitive empathy and the perpetration of both indirect and cyber aggression. In addition, social anxiety moderated the concurrent associations between both types of empathy and both types of aggression perpetration. Results suggest that interventions that facilitate cognitive empathy and decrease social anxiety may help to reduce adolescents' indirect and cyber aggression toward peers throughout the high school transition.
Youth exposed to a wide range of potentially traumatic events, such as natural disasters, acts of violence, terrorism, motor vehicle accidents, and life-threatening illnesses, are at risk for ...developing posttraumatic stress disorder (PTSD) or significant posttraumatic stress symptoms (PTSS). Recent reviews of the existing evidence-base for the treatment of PTSD in children and adolescents identified trauma-focused cognitive behavioral therapy (TF-CBT) and cognitive behavioral therapy (CBT) as well-established treatments. However, studies that evaluated treatment moderators have been scant. Research on treatment moderators is important for guiding clinical decision-making around selecting treatments that might be most effective given the characteristics and circumstances of a particular child or adolescent. Thus, this article provides an updated review of potential moderators evaluated in recent (i.e., past 5 years) meta-analyses and systematic reviews of psychological treatments for PTSD in youth. The moderators examined were in the areas of youth characteristics (age, gender, ethnicity, domicile), parent/caregiver factors (involvement, functioning), trauma type, and treatment factors (dose, individual/group, provider, exposure elements, sudden gains). Some support was identified for age, gender, domicile, parent/caregiver involvement, maternal depressive symptoms, treatment dose, individual/group, and sudden gains as possible treatment moderators, although the strength of the evidence varied and more research is needed to clarify findings. Further study of moderators will be essential to advance the knowledge base in the treatment of PTSD in youth.
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