Psychosocial Implications of Disaster on Children and Pediatric Care

Abstract

To the Editor.With much interest I read the clinical report “Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician.”1 Pediatricians can have an important task in providing care to children and families that have been affected by disasters. Recently, a disaster occurred in the Netherlands that affected a group of people consisting almost entirely of adolescents. By coincidence, we were able to obtain highest-level evidence2 regarding its effects on the mental health of adolescents, because our study resembled an experiment on the effects of disaster.3,4 This evidence may add to the evidence needed for adequate care as described in the report.The disaster concerned a severe fire during an adolescents' New Year's Eve party in a café that affected 31 adolescents (mean age: 15.5 years) from 1 school who already participated in a running study; it constituted the control condition of that quasi-experimental study jointly with 2 other schools. The results of this “natural experiment” of disaster showed that the main effects of such a disaster on adolescents are depression, aggression, and concentration problems, as indicated in the report.3,4 However, alcohol misuse, which was not mentioned in the report, was an important effect also.Moreover, the girls reported somewhat larger effects on mental health than the boys, contrary to what the report states. In fact, the adolescent boys had higher rates of behavioral problems in general, but the increase was not larger among them. Also, very important for the planning of care, the 93 students from the same school who were not present at the fire showed mental health effects similar to those of their affected classmates after 5 months, although these effects had resolved to a higher degree after 1 year. Finally, additional research on the same population shows that it is very difficult for preventive child health services to motivate adolescents for referral to mental health services. Of those with increased levels of problems, only a quarter followed the advice of preventive child health services to do so,4 whereas a very large majority visited a primary care physician, most of them several times. This implies that advice and help are most effective when delivered by a (community) pediatrician or a primary care physician and in the school setting.1 Adolescent training and support may be needed to do so in an effective way. Inclusion of this evidence may add to the American Academy of Pediatrics report.1