ArticlePDF AvailableLiterature Review

Children’s Disaster Reactions: the Influence of Exposure and Personal Characteristics

Authors:

Abstract

This paper reviews children's reactions to disasters and the personal and situational factors that influence their reactions. Posttraumatic stress disorder (PTSD) and posttraumatic stress reactions are the most commonly studied outcomes, though other conditions also occur including anxiety, depression, behavior problems, and substance use. More recently, traumatic grief and posttraumatic growth have been explored. New research has delineated trajectories of children's posttraumatic stress reactions and offered insight into the long-term consequences of their disaster experiences. Risk factors for adverse outcomes include pre-disaster vulnerabilities, perception of threat, and loss and life disruptions post-disaster. Areas in need of additional research include studies on the timing and course of depression and anxiety post-event and their interactions with other disorders, disaster-related functional and cognitive impairment, positive outcomes, and coping.
CHILD AND FAMILY DISASTER PSYCHIATRY (B PFEFFERBAUM, SECTION EDITOR)
Childrens Disaster Reactions: the Influence of Exposure
and Personal Characteristics
Betty Pfefferbaum
1,2
&Anne K. Jacobs
2
&Natalie Griffin
2
&J. Brian Houston
3
#Springer Science+Business Media New York 2015
Abstract This paper reviews childrens reactions to disasters
and the personal and situational factors that influence their
reactions. Posttraumatic stress disorder (PTSD) and posttrau-
matic stress reactions are the most commonly studied out-
comes, though other conditions also occur including anxiety,
depression, behavior problems, and substance use. More re-
cently, traumatic grief and posttraumatic growth have been
explored. New research has delineated trajectories of chil-
drens posttraumatic stress reactions and offered insight into
the long-term consequences of their disaster experiences. Risk
factors for adverse outcomes include pre-disaster vulnerabil-
ities, perception of threat, and loss and life disruptions post-
disaster. Areas in need of additional research include studies
on the timing and course of depression and anxiety post-event
and their interactions with other disorders, disaster-related
functional and cognitive impairment, positive outcomes, and
coping.
Keywords Adolescents .Anxiety .Children .Coping .
Depression .Disaster .Exposure .Mental health .
Posttraumatic growth .Posttraumatic stress .Posttraumatic
stress disorder (PTSD) .Recovery .Resilience .Terr o r ism .
Trauma .Traumatic grief
Introduction
Children have been recognized as especially vulnerable to
disasters [1]. A nationally representative survey conducted in
the USA established a lifetime rate of disaster exposure at
13.9 % in children and adolescents [2]; almost one fourth of
those who experienced a lifetime disaster reported more than
one disaster. In another nationally representative US survey of
adolescents, exposure to natural or human-caused disasters
was 14.8 %, second only to unexpected death of a loved one
at 28.2 % as the most common potentially traumatic event [3].
Rates in other parts of the world, especially in less developed
regions, are likely to be higher due to less durable infrastruc-
tures, rapid expansion of populations and industrialization,
and political conflict.
This paper reviews childrens emotional and behavioral
reactions to disasters with a focus on recent studies that have
explored an expanded range of outcomes, trajectories of re-
sponse and long-term disaster effects, and nuances of expo-
sure and childrens personal characteristics that affect their
recovery. A companion paper reviews the environmental in-
fluences, such as family and community factors, on childrens
reactions [4••].
This article is part of the Topical Collection on Child and Family Disaster
Psychiatry
*Betty Pfefferbaum
Betty-Pfefferbaum@ouhsc.edu
Anne K. Jacobs
akzerg@yahoo.com
Natalie Griffin
Natalie-Griffin@ouhsc.edu
J. Brian Houston
houstonjb@missouri.edu
1
Department of Psychiatry and Behavioral Sciences, College of
Medicine, University of Oklahoma Health Sciences Center,
P.O. Box 26901, WP3217, Oklahoma City, OK 73126-0901, USA
2
Terrorism and Disaster Center, University of Oklahoma Health
Sciences Center, P.O. Box 26901, WP3217, Oklahoma
City, OK 73126-0901, USA
3
Department of Communication, University of Missouri, 115 Switzler
Hall, Columbia, MO 65211-2310, USA
Curr Psychiatry Rep (2015) 17:56
DOI 10.1007/s11920-015-0598-5
Childrens Reactions to Disasters
The literature describes a range of disaster outcomes in
children from transient emotional distress and behavior
changes to enduring psychopathology and impaired func-
tioning [5,6]. Many children, while experiencing distress
in association with their disaster experiences, do not de-
velop psychopathology, but instead adapt to their experi-
ences and environment. Commonly studied post-disaster
outcomes are internalizing reactions and conditions such
as posttraumatic stress disorder (PTSD) and posttraumatic
stress reactions, anxiety, and depression. Externalizing be-
havior problems including substance use, cognitive ef-
fects, and traumatic grief have also been investigated.
Some children are resilient, and some experience posttrau-
matic growth. Recent studies have illustrated the trajecto-
ry of childrens reactions over time, but few long-term
follow-up studies have been conducted.
Rates of PTSD and posttraumatic stress in children post-
disaster vary depending on the samples assessed, the specific
outcomes measured, and the research methodology used. For
example, rates of significantly elevated symptom severity
have been estimated to be below 30 % [7], and the rate of
moderate posttraumatic stress symptoms in the acute post-
disaster period has been estimated at 50 % [6]. A recent
meta-analysis of studies of children and adolescents from
countries around the world revealed that overall, 15.9 % of
youth exposed to a traumatic event developed PTSD,
which reflects 9.7 % of children exposed to non-
interpersonal trauma, such as accidents and natural disas-
ters, and 25.2 % of youth exposed to interpersonal trauma
[8]. Posttraumatic stress symptoms appear to be common
in the first months post-event with a decline over the first
year or longer [7].
Depression and anxiety are common reactions to disas-
ters often comorbid with PTSD or posttraumatic stress [7,
9]. Depression may occur secondary to loss and grief, un-
resolved trauma and posttraumatic stress, and/or secondary
adversities [9]. Depression also may precede posttraumatic
stress symptoms [10]. Lai and colleagues [10]foundco-
morbid posttraumatic stress and depression in their hurri-
cane study in which loss of life was relatively low with 10
and 7 % of children evidencing comorbid posttraumatic
stress and depression symptoms 8 and 15 months post-di-
saster, respectively; recovery was slower in those with co-
morbid posttraumatic stress and depression. A recent re-
view study reported elevated prevalence rates for post-
disaster depression ranging from 2 to 69 % in children
relative to cited general populationratesfrom1to9%
[11••]. Another review of depression in children after nat-
ural disasters revealed prevalence rates in children ranging
from 7.5 to 44.8 % across studies [12]. Given these high
rates, more empirical work is warranted to explore the
varied etiologies and time course of depression as well as
its relationship to other disorders.
Disaster exposure may initiate a path to the develop-
ment of anxiety disorders such as specific phobias, panic
disorder, and separation anxiety [6]. Studies have docu-
mented increases in childrens generalized anxiety in re-
lation to disaster exposure [7], but post-disaster anxiety
may represent the continuation of pre-event anxiety or
trait anxiety [13]. Not all longitudinal studies have con-
firmed an increase in anxiety symptoms post-event,
though this may simply reflect an absence of the normal
decline in rates over the course of development [14].
Thus, additional work is needed to clarify findings relat-
ed to post-disaster anxiety in children, to identify predis-
posing influences, and to explore the progression of anx-
iety symptomatology and its relationship to other disaster
reactions.
Behavior problems also have been studied in children in
the context of disasters with conflicting results. For example,
research has documented both an increase in externalizing
conditions [e.g., 15,16] and improvement in childrensbehav-
ior post-event with a return to pre-event levels over time [e.g.,
17,18]. Recent work in the Middle East suggests that expo-
sure to chronic terrorism and political violence is linked to
behavior problems [e.g., 19]. For example, Pat-Horenczyk
and colleagues [19] found that preschool children exposed to
ongoing political violence had higher rates of behavior prob-
lems as well as PTSD and depression symptoms than children
without chronic exposure. Moreover, maternal distress was
associated with child distress in the form of externalizing,
internalizing, and posttraumatic stress symptoms, and the ac-
cumulated and continuous exposure to political violence and
danger increased maternal distress which further affected the
child [19].
Recent literature has examined substance use in association
with disaster exposure in youth [e.g., 2024]. In a sample of
New York City high school students assessed 6 months after
the September 11 attacks, increased smoking was associated
with prior trauma and PTSD while increased drinking was
associated with direct exposure to the attacks [24]. A longitu-
dinal study of adolescents assessed 5 months following a
deadly café fire in the Netherlands revealed that students in
the affected school had significantly greater increases in ex-
cessive drinking than students in unaffected schools [22].
Twelve months later, increases in excessive use of alcohol
from baseline to follow-up also were significantly greater in
students from the affected school than in the comparison
group but the effects had decreased compared to those at
5 months, and there were no differences between the two
groups in behavioral and emotional problems or in the use
of other substances [23]. Long-term follow-up studies also
suggest that problem alcohol [25] and problem substance
[26] use may not persist in disaster samples.
56 Page 2 of 6 Curr Psychiatry Rep (2015) 17:56
Functioning and Cognitive Impairment
While the importance of addressing childrens post-disaster
functioning in general has been recognized for some time,
little research has focused on cognitive effects or on the rela-
tionship between functioning and other post-disaster prob-
lems. Impairment in childrens functioning post-disaster may
be most evident in school where they are required to perform
both academically and socially, sometimes in altered environ-
ments with damaged school facilities and disruptions in sched-
ules and routines. Scrimin and colleagues found difficulties in
attention, memory [27,28], and visual-spatial performance as
well as lower grades [28] in children exposed to the Beslan
school hostage crisis. In a study examining six domains of
school and interpersonal functioning in relationship to alcohol
and drug use in middle and high school students attending
schools near the World Trade Center at the time of the Sep-
tember 11 attacks, students with increased substance use ex-
perienced more impairment in school work and school behav-
ior compared to those without increased substance use
18 months post-incident [20].
Grief, Complicated Grief, and Traumatic Grief
Children who lose loved ones in a disaster suffer grief which
may be exacerbated in the context of the familyssocialand
economic adversities such as financial problems and lack of
housing [29]. Some children suffer complicated griefthe per-
sistence of acute grief or the development of complications in
the context of the grief process [30]and/or traumatic grief
the intrusion of trauma symptoms into the bereavement pro-
cess [31]in relationship to their loss. Little empirical re-
search has addressed these grief reactions. Dyregrov and col-
leagues [32] found a high prevalence of complicated grief,
posttraumatic stress reactions, and general psychological dis-
tress in parents and siblings 1.5 years after a 2011 terrorist
attack on a youth camp in Norway that killed 69 youth and
adults. Intense contemporaneous exposure through telephone
or text messaging with the victims as the event unfolded, ex-
tensive media coverage, and the previously peaceful context of
the environment were thought to influence reactions [32].
Posttraumatic Growth
Posttraumatic growth includes psychological (e.g., greater ap-
preciation for life, modified values, increased sense of person-
al strength), interpersonal (e.g., improved relationships), and/
or functional (e.g., ways of coping) gains that were not appar-
ent pre-disaster but arose from the disaster experience [33,
34]. Posttraumatic growth and distress are not two ends on a
spectrum, and they may co-occur [35]. The traumatic circum-
stances that cause distress can also mobilize the coping at-
tempts and adaptation that result in growth. For example,
posttraumatic stress predicted posttraumatic growth in a study
of children from the Gulf Coast 1 year after Hurricane Katrina,
demonstrating that distress may spark growth [36].
Trajectories of Response and Long-Term Recovery
Recent research examining trajectories of childrensdisaster
reactions has identified adaptive and maladaptive outcomes
[13,37,38••]. For example, La Greca and colleagues [13]
identified three trajectories of posttraumatic stress symptoms
in children during the first year (3, 7, and 10 months) after
Hurricane Andrew. Approximately 20 % of the sample had a
chronic course, 43 % of the sample was characterized as re-
covering, and 37 % of the sample was described as resilient.
Mean posttraumatic stress symptom scores decreased signifi-
cantly over time in all three trajectories. Removing children
with minimal exposure in recalculating their findings, Weems
and Graham [38••] found the proportion of resilient children
in their sample dropped from 43 % to only 16 %, highlighting
the importance of considering exposure in determining resil-
ience. La Greca and colleagues [13] found that childrens
disaster exposureboth perceived and actual threatdid
not distinguish the recovering and chronic trajectories from
the resilient trajectory, but that children who reported per-
ceived life threat and/or more loss and disruption were more
likely to fit in the recovering or chronic trajectories rather than
the resilient trajectory.
Long-term follow-up studies suggest recovery for most
children following disasters. In a 20-year follow-up study,
McFarlane and Van Hooff [25] reported no significant differ-
ence in PTSD rates in Australian children exposed to a mas-
sive bushfire relative to a non-exposed comparison group, and
the risk of developing an anxiety disorder was small relative to
the controls except in those exposed to multiple traumas. Mor-
gan and colleagues [26] reported that 29 % of the child survi-
vors of a deadly 1966 coal pile collapse had current PTSD
33 years after the disaster though the comparison group from a
village nearby in the same economically depressed area of the
country also had high rates of psychopathology. Survivors
were at no greater risk for developing anxiety, depression, or
substance use than controls [26].
The Influence of Exposure on Childrens Disaster
Reactions
The extant research supports a dose-response relationship be-
tween disaster exposure and outcomes, with the severity of
outcomes associated with the intensity or severity of expo-
sures [39,40••]. In their meta-analysis of 96 child disaster
studies, Furr and colleagues [39] concluded that it is not mere
proximity to an event but specific aspects of exposure that
Curr Psychiatry Rep (2015) 17:56 Page 3 of 6 56
determine risk for adverse outcomes. For example, the childs
perception of threat and other subjective reactions; the extent
of disruption, destruction, injury, and death; and the childs
specific disaster experiences such as being injured, witnessing
the event, and loss of loved ones are aspects of disaster expo-
sure that influence posttraumatic stress [39] and depression
[11••,12]. The dose-response relationship applies to interper-
sonal disaster exposure through, for example, the closeness of
family and associates [41].
The Influence of Personal Factors on Childrens
Disaster Reactions
A number of child characteristics affect childrens disaster
reactions and recovery including demographics, preexisting
vulnerabilities, and post-disaster experiences. Girls are com-
monly identified as being at greater risk than boys for adverse
outcomes such as posttraumatic stress reactions [39] and de-
pression [11••], but it may be that boys and girls display dis-
tress differently with girls suffering more internalizing symp-
toms and boys evidencing more externalizing difficulties.
Moreover, boys and girls may interpret and report events dif-
ferently [40••]. Childrens age or stage of development influ-
ences their understanding of an event, the specific presentation
of their reactions [42], and adaptation [40••], but findings on
the effects of age or development on outcomes are inconclu-
sive [40••]. Children of ethnic minority heritage may be at
greater risk for adjustment problems post-disaster than chil-
dren from the majority culture, but these differences may rep-
resent, or be influenced by, differences in disaster experiences,
socioeconomic status, exposure to prior trauma, and/or family
or other social influences [6]. Childrens pre-event emotional
status, prior trauma, and major life events post-incident influ-
ence their disaster reactions and recovery [6,11••,12,40••].
Coping
Coping entails both involuntary and deliberate cognitive, be-
havioral, and emotional efforts to reconcile a perceived dis-
crepancy between the demands of environmental stressors and
the childs own personal resources [43]. Coping strategies can
be adaptive or maladaptive depending on their relationship to
adverse outcomes [44••]. Childrens ability to cope, their ap-
proach to coping, and their repertoire for coping vary with age
and development [44••,45], gender [45], and culture [e.g.,
46]. Other factors that may influence coping include aspects of
the childs event exposure [e.g., 47,48] or the interaction of
personal and exposure characteristics [e.g., 49], time since the
disaster [e.g., 50], the degree of perceived control the child has
over the situation [e.g., 51], and the childs disposition [45]
and self-esteem [e.g., 52]. The literature in general approaches
mass trauma as single incidents, though coping has been ex-
plored in the context of ongoing political violence [44••]. Lit-
tle disaster research has explored coping in relationship to
positive outcomes such as well-being [44••].
Conclusions and Future Directions
An impressive literature over several decades has documented
childrens reactions to disasters and the various event, exposure,
and personal factors that influence those reactions. Recent re-
search has extended the examination of outcomes beyond in-
ternalizing conditions (e.g., PTSD, anxiety, depression) to in-
clude externalizing conditions (e.g., behavior problems, sub-
stance use), functioning and cognitive impairment, traumatic
grief, and posttraumatic growth. With a primary focus on PTSD
and posttraumatic stress reactions, relatively little is known
about pre- and post-event comorbid conditions that may affect
outcome [13]. Longitudinal assessment of children has charted
childrens reactions over several years post-disaster and delin-
eated trajectories of response. Many children exposed to disas-
ters are resilient. Studies suggest that in addition to aspects of
disaster exposure such as perceived life threat, preexisting child
characteristics and pre- and post-event life experiences are im-
portant determinants of the childs disaster outcomes. The liter-
ature has begun to address childrens coping in the context of
disasters, but the studies are too few and too diverse to draw
definitive conclusions about the strategies and determinants that
influence outcomes. Additional research to benefit the field
would include exploring the timing and course of depression
and anxiety post-event and their interactions with other disor-
ders and the effects of disasters on childrens quality of life and
potential growth as well as on psychopathology.
Acknowledgments This work was conducted by the Terrorism and
Disaster Center (TDC), at the University of Missouri and the University
of Oklahoma Health Sciences Center, a partner in the National Child
Traumatic Stress Network (NCTSN). TDC is funded by the Substance
Abuse and Mental Health Services Administration (SAMHSA), U.S.
Department of Health and Human Services (HHS). Points of view in this
document are those of the authors and do not necessarily represent the
official position of HHS, NCTSN, SAMHSA, the University of Missouri,
or the University of Oklahoma Health Sciences Center.
Compliance with Ethics Guidelines
Conflict of Interest Natalie Griffin and J. Brian Houston declare that
they have no conflict of interest.
Betty Pfefferbaum has received a grant from the Substance Abuse and
Mental Services Administration.
Anne K. Jacobs has received consulting fees/honorarium from the
University of Oklahoma Health Sciences Center and the University of
Missouri, Columbia, MO.
Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by any
of the authors.
56 Page 4 of 6 Curr Psychiatry Rep (2015) 17:56
References
Papers of particular interest, published recently, have been
highlighted as:
Of importance
•• Of major importance
1. National Commission on Children and Disasters. 2010 Report
to the President and Congress. AHRQ Publication No. 10-
M037. Rockville: Agency for Health Care Research and
Quality; 2010.
2. Becker-Blease KA, Turner HA, Finkelhor D. Disasters, victimiza-
tion, and childrens mental health. Child Dev. 2010;81(4):104052.
3. McLaughlin KA, Koenen KC, Hill ED, Petukhova M, Sampson
NA, Zaslavsky AM, et al. Trauma exposure and posttraumatic
stress disorder in a national sample of adolescents. J Am Acad
Child Adolesc Psychiatry. 2013;52(8):81530.
4.•• Pfefferbaum B, Jacobs AK, Houston JB, Griffin N. Childrensdi-
saster reactions: the influence of family and social factors. Curr
Psychiatry Rep. in press. This article examined family and social
factors that influence childrens disaster reactions.
5. Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz D, Kaniasty
K. 60,000 disaster victims speak: part I. An empirical review of the
empirical literature, 19812001. Psychiatry. 2002;65(3):20739.
6. La Greca AM, Silverman WK. Treating children and adolescents
affected by disasters and terrorism. In: Kendall PC, editor. Child
and adolescent therapy. Third edition: cognitive-behavioral proce-
dures. New York: The Guilford Press; 2006. p. 35682.
7. Bonanno GA, Brewin CR, Kaniasty K, La Greca AM. Weighing
the costs of disaster: consequences, risks, and resilience in individ-
uals, families, and communities. Psychol Sci Public Interest.
2010;11(1):149.
8. Alisic E, Zalta AK, van Wesel F, Larsen SE, Hafstad GS,
Hassanpour K, et al. Rates of post-traumatic stress disorder in
trauma-exposed children and adolescents: meta-analysis. Br J
Psychiatry. 2014;204(5):33540.
9. La Greca AM, Silverman WK. Interventions for youth following
disasters and acts of terrorism. In: Kendall PC, editor. Child and
adolescent therapy. Fourth edition: cognitive-behavioral proce-
dures. New York: The Guilford Press; 2011. p. 32444.
10. Lai BS, La Greca AM, Auslander BA, Short MB. Childrenssymp-
toms of posttraumatic stress and depression after a natural disaster:
comorbidity and risk factors. J Affect Dis. 2013;146(1):718.
11.•• Lai BS, Auslander BA, Fitzpatrick SL, Podkowirow V. Disasters
and depressive symptoms in children. A review. Child Youth Care
Forum. 2014;43(4):489504. This paper reviewed quantitative
studies of depression in children in the disaster context.
12.Tang B, Liu X, Liu Y, Xue C, Zhang L. A meta-analysis of risk
factors for depression in adults and children after natural disasters.
BMC Public Health. 2014;14:623. doi:10.1186/1471-2458-14-623.
This paper reported the results of a meta-analysis of observa-
tional disaster studies researching depression in children and
adults after natural disasters.
13.La Greca AM, Lai BS, Llabre MM, Silverman WK, Vernberg EM,
Prinstein MJ. Childrens postdisaster trajectories of PTS symptoms:
predicting chronic stress. Child Youth Care Forum. 2013;42(4):
35169. This longitudinal study examined childrens disaster
exposure, coping, and social support and identified distinct tra-
jectories of childrens distress over the first year post disaster.
14. Weems CF, Pina AA, Costa NM, Watts SE, Taylor LK, Cannon
MF. Predisaster trait anxiety and negative affect predict posttrau-
matic stress in youths after Hurricane Katrina. J Consult Clin
Psychol. 2007;75(1):1549.
15. Boer F, Smit C, Morren M, Roorda J, Yzermans J. Impact of a
technological disaster on young children: a five-year postdisaster
multiinformant study. J Trauma Stress. 2009;22(6):51624.
16. Hoven CW, Duarte CS, Lucas CP, Wu P, Mandell DJ, Goodwin
RD, et al. Psychopathology among New York City public school
children 6 months after September 11. Arch Gen Psychiatry.
2005;62(5):54552.
17. Shaw JA, Applegate B, Tanner S, Perez D, Rothe E, Campo-Bowen
AE, et al. Psychological effects of Hurricane Andrew on an elemen-
tary school population. J Am Acad Child Adolesc Psychiatry.
1995;34(9):118592.
18. Stuber J, Galea S, Pfefferbaum B, Vandivere S, Moore K,
Fairbrother G. Behavior problems in New York Citys children
after the September 11, 2001 terrorist attacks. Am J
Orthopsychiatry. 2005;75(2):190200.
19. Pat-Horenczyk R, Ziv Y, Asulin-Peretz L, Achituv M, Cohen S,
Brom D. Relational trauma in times of political violence: continu-
ous versus past traumatic stress. Peace Conflict J Peace Psychol.
2013;19(2):12537.
20. Chemtob CM, Nomura Y, Josephson L, Adams RE, Sederer L.
Substance use and functional impairment among adolescents direct-
ly exposed to the 2001 world trade center attacks. Disasters.
2009;33(3):33752.
21. Overstreet S, Salloum A, Badour C. A school-based assessment of
secondary stressors and adolescent mental health 18 months post-
Katrina. J School Psychol. 2010;48(5):41331.
22. Reijneveld SA, Crone MR, Verhulst FC, Verloove-Vanhorick SP.
The effect of a severe disaster on the mental health of adolescents: a
controlled study. Lancet. 2003;362(9385):6916.
23. Reijneveld SA, Crone MR, Schuller AA, Verhulst FC, Verloove-
Vanhorick P. The changing impact of a severe disaster on the mental
health and substance misuse of adolescents: follow-up of a con-
trolled study. Psychol Med. 2005;35(3):36776.
24. Wu P, Duarte C, Mandell DJ, Fan B, Liu X, Fuller CJ, et al.
Exposure to the world trade center attack and the use of cigarettes
and alcohol among New York City public high-school students.
Am J Public Health. 2006;96(5):8047.
25. McFarlane AC, Van Hooff M. Impact of childhood exposure to a
natural disaster on adult mental health: 20-year longitudinal follow-
up study. Br J Psychiatry. 2009;195(2):1428.
26. Morgan L, Scourfield J, Williams D, Jasper A, Lewis G. The
Aberfan disaster: 33-year follow-up of survivors. Br J Psychiatry.
2003;182(6):5326.
27. Scrimin S, Axia G, Capello F, Moscardino U, Steinberg AM,
Pynoos RS. Posttraumatic reactions among injured children and
their caregivers 3 months after the terrorist attack in Beslan.
Psychiatry Res. 2006;141(3):3336.
28. Scrimin S, Moscardino U, Capello F, Axia G. Attention and
memory in school-age children surviving the terrorist attack
in Beslan, Russia. J Clin Child Adolesc Psychol. 2009;38(3):
40214.
29. Kalantari M, Vostanis P. Behavioural and emotional problems in
Iranian children four years after parental death in an earthquake. Int
J Soc Psychiatry. 2010;56(2):15867.
30.Dyregrov A, Salloum A, Kristensen P, Dyregrov K. Grief and trau-
matic grief in children in the context of mass trauma. Curr
Psychiatry Rep. in press. This paper reviewed grief in children
exposed to mass trauma and described grief interventions.
31. Cohen JA, Mannarino AP, Greenberg T, Padlo S, Shipley C.
Childhood traumatic grief. Concepts and controversies. Trauma
Violence Abuse. 2002;3(4):30727.
32. Dyregrov K, Dyregrov A, Kristensen P. Traumatic bereavement
and terror: thepsychosocial impact on parents and siblings 1.5 years
after the July 2011 terror killings in Norway. J Loss Trauma. 2014.
doi:10.1080/15325024.2014.957603.
Curr Psychiatry Rep (2015) 17:56 Page 5 of 6 56
33. Cryder CH, Kilmer RP, Tedeschi RG, Calhoun LG. An exploratory
study of posttraumatic growth in children following a natural disas-
ter. Am J Orthopsychiatry. 2006;76(1):659.
34. Williams R. The psychosocial consequences for children of mass
violence, terrorism, and disasters. Int Rev Psychiatry. 2007;19(3):
26377.
35. Kilmer RP, Gil-Rivas V. Exploring posttraumatic growth in children
impacted by Hurricane Katrina: correlates of the phenomenon and
developmental considerations. Child Dev. 2010;81(4):121127.
36. Kilmer RP, Gil-Rivas V, Tedeschi RG, Cann A, Calhoun LG,
Buchanan T, et al. Use of the revised posttraumatic growth inven-
tory for children. J Trauma Stress. 2009;22(3):24853.
37. Kronenberg ME, Hansel TC, Brennan AM, Osofsky HJ, Osofsky
JD,LawrasonB.ChildrenofKatrina: lessons learned about
postdisaster symptoms and recovery patterns. Child Dev.
2010;81(4):124159.
38.•• Weems CF, Graham RA. Resilience and trajectories of posttraumat-
ic stress among youth exposed to disaster. J Child Adolesc
Psychopharmacol. 2014;24(1):28. This longitudinal study ex-
amined children exposed to two major natural disasters and
identified outcome trajectories.
39. Furr JM, Comer JS, Edmunds JM, Kendall PC. Disasters and
youth: a meta-analytic examination of posttraumatic stress. J
Consult Clin Psychol. 2010;78(6):76580.
40.•• Masten AS, Narayan AJ. Child development in the context of di-
saster, war, and terrorism: pathways of risk and resilience. Ann Rev
Psychol. 2012;63:22757. This review article presented the the-
oretical and conceptual framework for child resilience and ex-
plored the factors that contribute to risk and resilience in chil-
dren in the context of mass trauma.
41.Pfefferbaum B, Weems CF, Scott BG, Nitiéma P, Noffsinger MA,
Pfefferbaum RL, et al. Research methods in child disaster studies: a
review of studies generated by the September 11, 2001, terrorist
attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina.
Child Youth Care Forum. 2013;42(4):285337. This paper exam-
ined the methodology of child research studies of three major
disasters and provided a review of the outcomes and predictors
of childrens disaster reactions.
42. Wooding S, Raphael B. Psychological impact of disasters and ter-
rorism on children and adolescents: experiences from Australia.
Prehospital Dis Med. 2004;19(1):1020.
43. Compas BE, Connor-Smith JK, Saltzman H, Thomsen AH,
Wadsworth ME. Coping with stress during childhood and adoles-
cence: problems, progress, and potential in theory and research.
Psychol Bull. 2001;127(1):87127.
44.•• Braun-Lewensohn O. Coping and social support in children
exposed to mass trauma. Curr Psychiatry Rep. in press. This
review evaluated the recent literature on childrenscoping
with mass trauma, identified areas for future investigation,
and presented a comprehensive model on childrensdisas-
ter coping.
45.Pfefferbaum B, Noffsinger MA, Wind LH, Allen JR.
Childrens coping in the context of disasters and terrorism. J
Loss Trauma. 2014;19(1):7897. This review of childrens
coping in the context of mass trauma linked conceptuali-
zations of stress and coping to empirical information about
childrens disaster reactions.
46. Braun-Lewensohn O. Coping resources and stress reactions among
three cultural groups one year after a natural disaster. Clin Soc Work
J. 2013;42(4):36674.
47. Tatar M, Amram S. Israeli adolescentscoping strategies in relation
to terrorist attacks. Br J Guid Couns. 2007;35(2):16473.
48. Zhang Y, Kong F, Wang L, Chen H, Gao X, Tan X, et al. Mental
health and coping styles of children and adolescent survivors one
year after the 2008 Chinese earthquake. Child Youth Serv Rev.
2010;32(10):14039.
49. Moscardino U, Scrimin S, Capello F, Altoè G, Axia G.
Psychological adjustment of adolescents 18 months after the ter-
rorist attack in Beslan, Russia: a cross-sectional study. J Clin
Psychiatry. 2008;69(5):8549.
50. Zhang W, Liu H, Jiang X, Wu D, Tian Y. A longitudinal study of
posttraumatic stress disorder symptoms and its relationship with
coping skill and locus of control in adolescents after an earthquake
in China. PLoS One. 2014;9(2):e88263.
51. Jensen TK, Ellestad A, Dyb G. Children and adolescentsself-
reported coping strategies during the Southeast Asian Tsunami.
Br J Clin Psychol. 2013;52(1):92106.
52. Chen W, Wang L, Zhang XL, Shi JN. Understanding the impact of
trauma exposure on posttraumatic stress symptomatology: a struc-
tural equation modeling approach. J Loss Trauma. 2012;17(1):98
110.
56 Page 6 of 6 Curr Psychiatry Rep (2015) 17:56
... Elangovan & Kasi [13] summarised that providing psychological preparedness for disasters through teachers is one of the best ways to prepare children for the psychosocial consequences of disasters. Another study showed that teachers are well-positioned to provide critical support for children before and after disasters and other potentially traumatizing events [14], [15]. The intensive cooperation between parents and educators can help children's development [16]. ...
... Similar to the research conducted by Elangovan and Kasi [13], providing psychological preparedness for disasters through teachers is one of the best ways to prepare children for the psychosocial consequences of disasters. Another study showed that teachers are well-positioned to provide critical support for children before and after disasters and other potentially traumatizing events [14], [15]. This supports the findings of Boylan & Lawrence [49] and Dhillon & Sasidharan [50], which state that psychological disaster training is important in improving teachers' readiness to assist children in facing disasters ...
... There are reports of functional and scholastic deterioration, and probably disaster-related cognitive impairment among children and adolescents. [12] In addition, disasters have cumulative detrimental effects on adolescent mental health; greater or more exposure to catastrophe leads to a higher degree of psychological distress among children which may continue after a long period following exposure. [4,9] Children and adolescents are known to have higher vulnerability to developing postdisaster symptoms following major stressful events or exposure to stressful situations. ...
... [23] Coping and PTG in children and adolescents require further research. [12] ...
Article
Full-text available
Children and adolescents are more vulnerable to disaster-related trauma. The specific aim of this paper was to review the coping strategies used by children and adolescents in the aftermath of disasters. The relationship of coping methods with psychological consequences were also explored, along with the effectiveness of specific strategies in dealing with traumatic experiences of disasters. A literature search of electronic databases, involving the keywords "coping," "children" and "adolescents," and "disaster" was done along with secondary searches of the cross references. It was evident that children and adolescents use a range of coping strategies, and a large proportion of them are helpful, while others could be detrimental to their mental health. Many children and adolescents cope with disaster trauma and are resilient. Facilitation of positive coping methods can be used as an intervention along with other supportive activities and as a part of other psychological interventions. Coping can be supported by family, nonprofessional caregivers, community, and clinicians. There is a research need to develop consensus about the terminologies and culture-specific coping assessments and to explore the short-and long-term effectiveness of interventions focused on coping.
... Children have special vulnerabilities at all stages of development particularly with regard to disasters such as extreme weather events [25]. The impact to children and adolescents includes physical and mental health effects as well as disruptions secondary to the impact on caretakers such as parents or teachers who may be displaced during a disaster [26][27][28][29]. Studies have shown that in the aftermath of disasters there can be heightened reports of somatic symptoms in children [29,31]. ...
... Studies have shown that in the aftermath of disasters there can be heightened reports of somatic symptoms in children [29,31]. As many as 50% of children report post-traumatic stress symptoms including depression or loss of interest in activities, anxiety, and fears about safety [26,27]. Notably, the vulnerability to a disaster can be determined by the exposure risk and the capability or capacity to prepare for and respond to the disaster. ...
Article
Full-text available
Purpose of Review We highlight the disparate effects of climate change and unhealthy environments on children and youth and suggest pragmatic steps for pediatricians to address the harms both inside and outside the clinic space. Recent Findings Environment and climate can inflict long-term, multi-faceted harms on children. As trusted resources by families and policy makers, pediatricians have a unique role in addressing these harms. Summary Environmental toxins and climate change pose significant threats to the health and well-being of children and adolescents. There are inequities in how these threats are distributed in communities, resulting in many disparities. Pediatricians must prioritize addressing climate and environmental threats out of duty to their patients and as a matter of environmental justice. This can be done through research, advocacy, working with policymakers, and supporting youth in their advocacy and preparedness efforts, as well as through patient screening and clinical care.
... Major natural disasters could elicit posttraumatic reactions in children, such as posttraumatic stress symptoms, anxiety, and depression (Belleville et al., 2021;Pfefferbaum et al., 2015). In addition to these negative psychological reactions, studies have found that individuals who experienced natural disasters can resume normal functioning (Saeed & Gargano, 2022) and even exhibit better functioning than they did before the trauma (Marshall et al., 2020;Mesidor & Sly, 2019). ...
Article
Full-text available
Objective: We aimed to elucidate the temporal relationship between perceived social support, emotional self-disclosure and posttraumatic growth (PTG) in children. Method: The super typhoon Lekima occurred on August 10, 2019, in China. Three waves of self-report questionnaires were administered to children at 3 months (T1, N = 1596), 15 months (T2, N = 1072), and 27 months (T3, N = 483) following the typhoon. The main analysis was based on data from 351 children who completed all three waves of assessment. We constructed cross-lagged panel models to examine temporal associations between perceived social support, emotional self-disclosure, and posttraumatic growth. Results: Controlling for trauma exposure, age, gender, monthly income of family and parental marital status, results revealed that perceived social support at T1 and T2 was longitudinally related to emotional self-disclosure and PTG at T2 and T3. Emotional self-disclosure at T1 and T2 positively connected with perceived social support and PTG at T2 and T3. However, PTG did not relate to subsequent perceived social support. Mediation analyses revealed that perceived social support at T1 was positively connected with PTG at T3 through emotional self-disclosure at T2, and that emotional self-disclosure at T1 was positively connected with PTG at T3 through perceived social support at T2. Conclusions: These results demonstrated that perceived social support and emotional self-disclosure were mutually reinforcing, and both could facilitate PTG among children. Post-disaster psychological interventions could work to enrich social support resources and encourage children’s emotional self-disclosure.
... Decades of research have established the vulnerability of children and adolescents (henceforth in this paper, children and adolescents are referred to as children) to political violence (war, political conflict, and terrorism), natural disasters, technological accidents and disasters, and other mass trauma events [1][2][3]. More recent studies have documented the effects of the COVID-19 pandemic on children [4][5][6]. ...
Article
Full-text available
Purpose of Review The goals of this analysis were to identify practice elements frequently used in child mass trauma interventions and to determine if these elements differed across interventions with respect to type of event addressed. Recent Findings The most frequent elements used were psychoeducation for the child, affect modulation, relaxation, cognitive techniques, exposure, support networking, and narrative. The most frequently used elements were similar for political violence and natural disaster interventions but differed for COVID-19 interventions. Summary Similarities in elements used in political violence and natural disaster interventions reflect the all-hazards approach to mass trauma response. Differences for COVID-19 interventions may address distinctions between the pandemic and these events and underscore the importance of considering an expanded set of elements in future research. The findings suggest that characteristics of the event as well as the population receiving the intervention and the context should guide the selection of interventions and intervention elements.
... Experiencing a traumatic natural disaster can lead to increased psychological distress (La Greca et al., 1996), the exacerbation of existing mental health conditions (Bonanno et al., 2010), and a higher likelihood of mental health diagnoses in the future (Hrabok et al., 2020;Lai et al., 2014). Some researchers have demonstrated as many as 50% of children report posttraumatic stress symptoms following a natural disaster (La La Greca et al., 2013Pfefferbaum et al., 2015. Such mental health effects are even observed years after the event (Osofsky et al., 2015). ...
... The adverse psychological impacts of disasters for young people can range from transient psychological distress and poor mental health to chronic psychopathology (Norris et al., 2002). This includes post-traumatic stress disorder (PTSD), depression, anxiety and externalising behavioural problems, including substance abuse (Pfefferbaum et al., 2015). The mental health of young people can be impacted by the initial disaster exposure, as well as the cumulative stressors that disasters trigger (Chen et al., 2023), which can persist for many years post-disaster (Brown et al., 2017). ...
Article
Full-text available
Disasters are distressing and disorientating. They often result in enduring community-wide devastation. Consequently, young people may seek support from trusted adults to scaffold their emotional responses and to support their psychosocial recovery. An important non-familial adult in a student’s life is their teacher. However, few studies have examined teachers’ perspectives on the support they provide to students after exposure to disasters, such as earthquakes and tsunamis, particularly in low- and middle-income countries (LMIC) with collectivistic cultural orientations. Given the potential for teachers to foster students’ resilience, the goal of this study was to examine how teachers conceptualise their role following a major disaster. Forty teachers were interviewed from three schools in Central Sulawesi, Indonesia, after a major earthquake and tsunami in September 2018. Thematic analysis shows that teachers act as agents of community resilience after a disaster. The two themes presented converge on support-based aspects. Teachers provided: (1) psychoeducational support (i.e. supporting students’ well-being and educational continuity, including encouraging their return to school) and (2) practical support (i.e. assisting administrative roles, aid distribution and disaster risk reduction). Within these themes, socioculturally specific practices are elucidated, including the Indonesian value of mutual assistance (‘gotong royong’), storytelling (‘tutura’) and the role of religiosity as a form of psychosocial support. Overall, our results highlight the capacity and willingness of teachers to play a central role in the psychosocial recovery of students and their families, contributing to community resilience. We identify implications such as the importance of providing accessible psychological training and support for teachers.
Article
Full-text available
Introduction: Weather-related disasters pose significant risks to youth mental health. Exposure to multiple disasters is becoming more common; however, the effects of such exposure remain understudied. This study demonstrates the application of integrative data approaches and FAIR (Findable, Accessible, Interoperable, Reusable) data principles to evaluate the relationship between cumulative disaster exposure and youth depression and suicidality in the United States, taking into account contextual factors across levels of social ecology. Methods: We combined data from five public sources, including the Youth Risk Behavior Surveillance System (YRBS), Federal Emergency Management Agency (FEMA), United States Census Bureau, Center for Homeland Defense and Security School Shooting Safety Compendium, and Global Terrorism Database. The integrative dataset included 415,701 youth from 37 districts across the United States who completed the YRBS between 1999 and 2021. The YRBS served as the core dataset. Results: This data note highlights strategies for harmonizing diverse data formats, addressing geographic and temporal inconsistencies, and validating integrated datasets. Automated data cleaning and visualization techniques enhance accuracy and efficiency. Planning for sensitivity analyses before data cleaning is recommended to improve the data integration process and enhance the robustness of findings. Discussion: This integrative approach demonstrates how leveraging FAIR principles can advance trauma research by facilitating large-scale analyses of complex public health questions. The methods provide a replicable framework for examining population-level impacts of phenomena and highlight opportunities for expanding trauma research.
Book
Full-text available
This manual is aimed at helping mental health professionals to provide trauma-informed care to children and adolescents who have survived disasters. The interventions described in this manual can be used by counsellors and other mental health professionals (e.g., social workers, psychologists, psychiatrists etc) who have training in mental health. These brief interventions can be applied in any modality ( in-person or remote) It can be accessed at https://ndma.gov.in/sites/default/files/PDF/Technical%20Documents/Child_Trauma_Manual_RAHBAR_TISS.pdf
Article
Full-text available
The purpose of this study was to examine first responders’ lived experiences with children during emergency events and to assess their needs to best support the children and families affected. First responders play a critical role in psychosocial support and trauma mitigation for children during emergency events; however, more support is needed. This study completed 16 semi-structured open-ended interviews with eight first responders, using phenomenology methods. Interviews focused on first responders’ perceptions of children’s reactions to the event, their roles in supporting children’s psychosocial needs, and their perceived gaps in services to support children. Results indicated four phenomena related to experienced child reactions during emergency events 1) lack of reactions, 2) emotion-based reactions, 3) information seeking reactions, and 4) observant reactions. First responders identified their role in supporting children on the scene in using distraction, providing calming and reassurance, and education, yet they identified gaps in their education and training for working with children, as well as a need for direct trained and professional support for children and families. Psychosocial providers, such as Certified Child Life Specialists, are trained and qualified to support the gaps identified and should both collaborate with first responders to enhance support during emergency events and provide training to first responders in pediatric trauma-informed care practices.
Article
Full-text available
This review examines family (demographics, parent reactions and interactions, and parenting style) and social (remote effects, disaster media coverage, exposure to secondary adversities, and social support) factors that influence children's disaster reactions. Lower family socioeconomic status, high parental stress, poor parental coping, contact with media coverage, and exposure to secondary adversities have been associated with adverse outcomes. Social support may provide protection to children in the post-disaster environment though more research is needed to clarify the effects of certain forms of social support. The interaction of the factors described in this review with culture needs further exploration.
Article
Full-text available
The goal of this paper was to critically evaluate the literature on children coping with mass trauma published between the years 2011 and 2014 and to emphasize interesting and important findings with the aim of proposing a new comprehensive model for better understanding the process of coping with these events in this unique developmental stage. Using a variety of databases, 26 research papers were selected. The papers were divided into two main categories, natural and manmade disasters. The findings suggest that several areas in this context still lack foundational knowledge and should be further investigated. Thus, it has been suggested that future research should emphasize the developmental stage of the children, the cultural context and atmosphere in which the investigated children grow up and live, and the type of event (acute vs. chronic; natural vs. manmade). A more comprehensive coping model which addresses these omissions and combines main theories is suggested for use in future research as well.
Article
Full-text available
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.
Article
Full-text available
makes every effort to ensure the accuracy of all the information (the "Content") contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Article
Full-text available
Children’s exposure to political violence has been found to be associated with posttraumatic symptoms and emotional and behavioral problems. However, little distinction has been made between the impact of exposure to continuous political violence and exposure to past political violence. This study in Israel compared a sample of preschool children and mothers (N = 85) with ongoing and recurring exposure to missile and rocket attacks (“Continuous sample”) to a sample (N = 177) from a recent time-limited war (“Past sample”). Mothers completed self-report questionnaires, including exposure to both political violence and other traumatic events, the Posttraumatic Diagnostic Scale (PDS), and a Depression Scale (CES-D). Mothers also reported on the child’s exposure to political violence and other traumatic events, posttraumatic symptoms, and the Child Behavior Checklist (CBCL). The results indicate the severe consequences of living in the face of ongoing traumatic stress. Children and mothers from the continuous exposure sample had more posttraumatic distress and their children had higher behavior problem scores compared with those in the past exposure sample, supporting the allostatic load hypothesis that cumulative stress exacts a heavier toll. Because the mother–child relationship is challenged in situations of exposure to violence, we compared relational trauma (measured by co-occurrence of posttraumatic distress in both mother and child) and found, as hypothesized, that relational trauma was more prevalent in the Continuous sample than in the Past sample. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Article
In a representative sample of 2,030 U.S. children aged 2-17, 13.9% report lifetime exposure to disaster, and 4.1% report experiencing a disaster in the past year. Disaster exposure was associated with some forms of victimization and adversity. Victimization was associated with depression among 2- to 9-year-old disaster survivors, and with depression and aggression among 10- to 17-year-old disaster survivors. Children exposed to either victimization only or both disaster and victimization had worse mental health compared to those who experienced neither. More research into the prevalence and effects of disasters and other stressful events among children is needed to better understand the interactive risks for and effects of multiple forms of trauma.
Article
Children who have had someone close die as a result of a mass trauma event such as war, armed conflict, acts of terror, political violence, torture, mass accidents, and natural disasters are at risk for biopsychosocial problems. Research on how to classify when grief becomes complicated or traumatic in children is scarce, and while functioning level may provide a good indication, assessing functioning may be difficult in mass trauma environments where routines and structure are often lacking. There are promising trauma- and grief-focused interventions for children post-mass trauma, which are mostly provided in school settings. However, more advanced multi-method interventions are needed that address grief and trauma in the context of the child's overall mental health, parent/caregiver role in assisting the child, family system issues, ways to provide safe caring environments amidst chaos and change, and interventions that take into account local consumer perspectives, including the voices of children.
Article
Background: Disasters are destructive, potentially traumatic events that affect millions of youth each year. Objective: The purpose of this paper was to review the literature on depressive symptoms among youth after disasters. Specifically, we examined the prevalence of depression, risk factors associated with depressive symptoms, and theories utilized in this research area. Methods: We searched MEDLINE, PsycInfo, and PubMed electronic databases for English language articles published up to May 1, 2013. Reference lists from included studies were reviewed to capture additional studies. Only quantitative, peer reviewed studies, conducted with youth under the age of 18 years, that examined postdisaster depressive symptoms were included. Seventy-two studies met inclusion criteria. Prevalence of depressive symptoms, disaster type, correlates of depressive symptoms, and theories of depressive symptoms were reviewed. Results: Only 27 studies (38%) reported on prevalence rates among youth in their sample. Prevalence rates of depression among youth postdisaster ranged from 2% to 69%. Potential risk factors were identified (e.g., female gender, exposure stressors, posttraumatic stress symptoms). Theories were examined in less than one-third of studies (k = 21). Conclusions: Given the variability in prevalence rates, difficulty identifying a single profile of youth at risk for developing depressive symptoms, and lack of a unifying theory emerging from the studies, recommendations for future research are discussed. Use of established batteries of assessments could enable comparisons across studies. Merging existing theories from children's postdisaster and depression literatures could aid in the identification of risk factors and causal pathways.