Abstract
There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors. At 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate-severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D). (1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1-22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses. Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.
Highlights
The field of Disaster Psychiatry has become well-established and is anchored in numerous studies of the psychological sequelae among survivors of various types of natural and manmade disasters
Reviews of posttraumatic stress disorder (PTSD) studies among children and adolescents exposed to disasters have shown that only about 10% of studies have extended beyond 3 years (Terasaka et al, 2015; Wang et al, 2013)
This is the first long-term prospective study examining the 25-year status of PTSD and depressive symptoms, risk and protective factors, and treatment outcome among adults who experienced a catastrophic earthquake as early adolescents
Summary
The field of Disaster Psychiatry has become well-established and is anchored in numerous studies of the psychological sequelae among survivors of various types of natural and manmade disasters. Reviews of posttraumatic stress disorder (PTSD) studies among children and adolescents exposed to disasters have shown that only about 10% of studies have extended beyond 3 years (Terasaka et al, 2015; Wang et al, 2013) Some of these studies have been cross-sectional (Agustini, Asniar, & Matsuo, 2011; Goenjian et al, 2009; Jia et al, 2013; Karakaya, Ağaoğlu, Coskun, Sişmanlar, & Yildiz Oc, 2004; Morgan, Scourfield, Williams, Jasper, & Lewis, 2003; Thordardottir et al, 2016), while others have been longitudinal (Goenjian et al, 2005; Green et al, 1994; Kronenberg et al, 2010; McFarlane & Van Hooff, 2009; Najarian, Sunday, Labruna, & Barry, 2011; Piyasil et al, 2011; Sahin, Batigün, & Yilmaz, 2007; Udwin, Boyle, Yule, Bolton, & O’Ryan, 2000; Ularntinon et al, 2008; Yule et al, 2000). Traumafocused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs
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