Advertisement

Child Indicators Research

, Volume 12, Issue 6, pp 2173–2187 | Cite as

Patterns of Posttraumatic Stress Disorder and Depression Among Adolescents Following an Earthquake: a Latent Profile Analysis

  • Rui Zhen
  • Xiao Zhou
  • Xinchun WuEmail author
Article

Abstract

Posttraumatic stress disorder (PTSD) had been found to be comorbid with depression in victims following trauma. However, few studies have used latent profile analysis (LPA) to examine the comorbidity of PTSD and depression in adolescents exposed to natural disasters. Here, we used LPA to examine the comorbidity of PTSD and depression in 2059 adolescents who completed self-reported questionnaires 1.5 years after the Wenchuan earthquake in Sichuan Province, China. We found that the data were best fit by a four-class solution, including a depressive symptoms group (39.2%), a non-symptoms group (34.7%), a mild comorbidity symptoms group (20.7%), and a serious comorbidity symptoms group (5.4%). Compared with individuals in the non-symptoms group, those in the comorbidity symptoms groups were more likely to report lower levels of parental trust, a greater degree of parental communication, and greater alienation. Compared with individuals in the depressive symptoms group, those in the comorbidity symptoms groups were more likely to report parental alienation. These results indicate that PTSD and depression reflect independent posttraumatic responses rather than a single disorder structure. Further, parental attachment may be an important predictor for differentiating the distinct comorbid patterns of PTSD and depression.

Keywords

PTSD Depression Parental attachment Latent profile analysis 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures in this study were approved by the Research Ethics Committee of Beijing Normal University.

Informed Consent

Informed consent was obtained from all individual participants in this study.

References

  1. Adams, Z. W., Sumner, J. A., Danielson, C. K., Mccauley, J. L., Resnick, H. S., Grös, K., et al. (2014). Prevalence and predictors of PTSD and depression among adolescent victims of the spring 2011 tornado outbreak. Journal of Child Psychology & Psychiatry, 55, 1047–1055.  https://doi.org/10.1111/jcpp.12220.CrossRefGoogle Scholar
  2. Angelakis, S., & Nixon, R. D. V. (2015). The comorbidity of PTSD and MDD: implications for clinical practice and future research. Behaviour Change, 32, 1–25.  https://doi.org/10.1017/bec.2014.26.CrossRefGoogle Scholar
  3. Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.  https://doi.org/10.1111/1469-7610.00424.CrossRefGoogle Scholar
  4. Armour, C., Contractor, A., Elhai, J. D., Stringer, M., Lyle, G., Forbes, D., & Richardson, J. D. (2015). Identifying latent profiles of posttraumatic stress and major depression symptoms in Canadian veterans: exploring differences across profiles in health related functioning. Psychiatry Research, 228, 1–7.  https://doi.org/10.1016/j.psychres.2015.03.011.CrossRefGoogle Scholar
  5. Au, T. M., Dickstein, B. D., Comer, J. S., Salters-Pedneault, K., & Litz, B. T. (2013). Co-occurring posttraumatic stress and depression symptoms after sexual assault: a latent profile analysis. Journal of Affective Disorders, 149, 209–216.  https://doi.org/10.1016/j.jad.2013.01.026.CrossRefGoogle Scholar
  6. Bachem, R., Levin, Y., Zhou, X., Zerach, G., & Solomon, Z. (2017). The role of parental posttraumatic stress, marital adjustment, and dyadic self-disclosure in intergenerational transmission of trauma: a family system approach. Journal of Marital and Family Therapy, 44, 543–555.  https://doi.org/10.1111/jmft.12266.CrossRefGoogle Scholar
  7. Baker, A. J. L. (2005). The long-term effects of parental alienation on adult children: a qualitative research study. American Journal of Family Therapy, 33, 289–302.  https://doi.org/10.1080/01926180590962129.CrossRefGoogle Scholar
  8. Baker, A. J. L., & Verrocchio, M. C. (2016). Exposure to parental alienation and subsequent anxiety and depression in Italian adults. American Journal of Family Therapy, 44, 255–271.  https://doi.org/10.1080/01926187.2016.1230480.CrossRefGoogle Scholar
  9. Binggeli, N. J., Hart, S. N., & Brassard, M. R. (2001). Psychological maltreatment of children. Newbury Park: SAGE.Google Scholar
  10. Blanchard, E. B., Buckley, T. C., Hickling, E. J., & Taylor, A. E. (1998). Posttraumatic stress disorder and comorbid major depression: is the correlation an illusion? Journal of Anxiety Disorders, 12, 21–37.  https://doi.org/10.1016/S0887-6185(97)00047-9.CrossRefGoogle Scholar
  11. Bowlby, J. (1988). A secure base: parent–child attachment and healthy human development. New York: Basic Books.Google Scholar
  12. Cao, X., Wang, L., Cao, C., Zhang, J., Liu, P., Zhang, B., et al. (2015). Patterns of DSM-5 posttraumatic stress disorder and depression symptoms in an epidemiological sample of Chinese earthquake survivors: a latent profile analysis. Journal of Affective Disorders, 186, 58–65.  https://doi.org/10.1016/j.jad.2015.06.058.CrossRefGoogle Scholar
  13. Cénat, J. M., & Derivois, D. (2015). Long-term outcomes among child and adolescent survivors of the 2010 Haitian earthquake. Depression and Anxiety, 32, 57–63.  https://doi.org/10.1002/da.22275.CrossRefGoogle Scholar
  14. Contractor, A. A., Elhai, J. D., Fine, T. H., Tamburrino, M. B., Cohen, G., Shirley, E., et al. (2015). Latent profile analyses of posttraumatic stress disorder, depression and generalized anxiety disorder symptoms in trauma-exposed soldiers. Journal of Psychiatric Research, 68, 19–26.  https://doi.org/10.1016/j.jpsychires.2015.05.014.CrossRefGoogle Scholar
  15. Contractor, A. A., Roleyroberts, M. E., Lagdon, S., & Armour, C. (2017). Heterogeneity in patterns of DSM-5 posttraumatic stress disorder and depression symptoms: latent profile analyses. Journal of Affective Disorders, 212, 17–24.  https://doi.org/10.1016/j.jad.2017.01.029.CrossRefGoogle Scholar
  16. Curzik, D., & Salkicevic, S. (2016). Perceived parent and peer alienation and its relations to anxiety sensitivity, pathological worry, and generalised anxiety disorder symptoms. Australian Psychologist, 51, 223–230.  https://doi.org/10.1111/ap.12183.CrossRefGoogle Scholar
  17. Dansby, V. S., & Marinelli, R. P. (1999). Adolescent children of Vietnam combat veteran fathers: a population at risk. Journal of Adolescence, 22, 329–340.  https://doi.org/10.1006/jado.1999.0225.CrossRefGoogle Scholar
  18. Dekel, R., & Goldblatt, H. (2008). Is there intergenerational transmission of trauma? The case of combat veterans' children. American Journal of Orthopsychiatry, 78, 281–289.  https://doi.org/10.1037/a0013955.CrossRefGoogle Scholar
  19. Díaz, C. A., Quintana, G. R., & Vogel, E. H. (2012). Depression, anxiety and post-traumatic stress disorder symptoms in adolescents seven months after the february 27 2010 earthquake in Chile. Terapia Psicológica, 30, 37–43.CrossRefGoogle Scholar
  20. Dunn, M. J., Rodriguez, E. M., Barnwell, A. S., Grossenbacher, J. C., Vannatta, K., Gerhardt, C. A., & Compas, B. E. (2012). Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis. Health Psychology, 31, 176–185.  https://doi.org/10.1037/a0025545.CrossRefGoogle Scholar
  21. Elhai, J. D., Grubaugh, A. L., Kashdan, T. B., & Frueh, B. C. (2008). Empirical examination of a proposed refinement to DSM-IV posttraumatic stress disorder symptom criteria using the National Comorbidity Survey Replication data. Journal of Clinical Psychiatry, 69, 597–602.  https://doi.org/10.4088/JCP.v69n0411.CrossRefGoogle Scholar
  22. Fendrich, M., Weissman, M. M., & Warner, V. (1990). Screening for depressive disorder in children and adolescents: validating the center for epidemiologic studees depression scale for children. American Journal of Epidemiology, 131, 538–551.  https://doi.org/10.1093/oxfordjournals.aje.a115529.CrossRefGoogle Scholar
  23. Feo, P., Gioia, S. D., Carloni, E., Vitiello, B., Tozzi, A. E., & Vicari, S. (2014). Prevalence of psychiatric symptoms in children and adolescents one year after the 2009 L'Aquila earthquake. BMC Psychiatry, 14, 270.  https://doi.org/10.1186/s12888-014-0270-3.CrossRefGoogle Scholar
  24. Foa, E. B., Johnson, K. M., Feeny, N. C., & Treadwell, K. R. H. (2001). The child PTSD symptom scale: a preliminary examination of its psychometric properties. Journal of Clinical Child Psychology, 30, 376–384.  https://doi.org/10.1207/S15374424JCCP3003_9.CrossRefGoogle Scholar
  25. Fraley, R. C., Fazzari, D. A., Bonanno, G. A., & Dekel, S. (2006). Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the world trade center. Personality and Social Psychology Bulletin, 32, 538–551.  https://doi.org/10.1177/0146167205282741.CrossRefGoogle Scholar
  26. Gibb, J. (2014). Communication and confiding in mothers (and others): relationships with anxiety and somatic symptoms among children aged seven to eleven. London: Doctor, University of London.Google Scholar
  27. Ginzburg, K., Eindor, T., & Solomon, Z. (2010). Comorbidity of posttraumatic stress disorder, anxiety and depression: a 20-year longitudinal study of war veterans. Journal of Affective Disorders, 123, 249–257.  https://doi.org/10.1016/j.jad.2009.08.006.CrossRefGoogle Scholar
  28. Gullone, E., & Robinson, K. (2005). The inventory of parent and peer attachment—Revised (IPPA-R) for children: a psychometric investigation. Clinical Psychology & Psychotherapy, 12, 67–79.  https://doi.org/10.1002/cpp.433.CrossRefGoogle Scholar
  29. Han, M. (2006). Relationship among perceived parental trauma, parental attachment, and sense of coherence in southeast Asian American college students. Journal of Family Social Work, 9, 25–45.  https://doi.org/10.1300/J039v09n02_02.CrossRefGoogle Scholar
  30. Hasan, N., & Power, T. G. (2004). Children's appraisal of major life events. American Journal of Orthopsychiatry, 74, 26–32.  https://doi.org/10.1037/0002-9432.74.1.26.CrossRefGoogle Scholar
  31. Hellenthal, R. L. (2006). The separate and combined effects of mother, father, and peer attachment on young adolescents' social, behavior, and emtoional adjustment. Athens: Master, Ohio University.Google Scholar
  32. Hikichi, H., Tsuboya, T., Aida, J., Matsuyama, Y., Kondo, K., Subramanian, S., & Kawachi, I. (2017). Social capital and cognitive decline in the aftermath of a natural disaster: a natural experiment from the 2011 Great East Japan earthquake and tsunami. The Lancet Planetary Health, 1, e105–e113.  https://doi.org/10.1016/S2542-5196(17)30041-4.CrossRefGoogle Scholar
  33. Hruska, B., Irish, L. A., Pacella, M. L., Sledjeski, E. M., & Delahanty, D. L. (2014). PTSD symptom severity and psychiatric comorbidity in recent motor vehicle accident victims: a latent class analysis. Journal of Anxiety Disorders, 28, 644–649.  https://doi.org/10.1016/j.janxdis.2014.06.009.CrossRefGoogle Scholar
  34. Ikin, J. F., Creamer, M. C., Sim, M. R., & McKenzie, D. P. (2010). Comorbidity of PTSD and depression in Korean war veterans: prevalence, predictors, and impairment. Journal of Affective Disorders, 125, 279–286.  https://doi.org/10.1016/j.jad.2009.12.005.CrossRefGoogle Scholar
  35. Johnsen, G. E., Kanagaratnam, P., Nordling, T., Wilberg, C., & Asbjørnsen, A. E. (2017). Psychophysiological responses to an executive task in refugees with chronic PTSD and comorbid depression. Nordic Psychology, 69, 177–194.  https://doi.org/10.1080/19012276.2016.1245157.CrossRefGoogle Scholar
  36. Kar, N., & Bastia, B. K. (2006). Post-traumatic stress disorder, depression and generalised anxiety disorder in adolescents after a natural disaster: a study of comorbidity. Clinical Practice and Epidemiology in Mental Health, 2, 1–7.  https://doi.org/10.1186/1745-0179-2-17.CrossRefGoogle Scholar
  37. Lai, B. S., La Greca, A. M., Auslander, B. A., & Short, M. B. (2013). Children's symptoms of posttraumatic stress and depression after a natural disaster: comorbidity and risk factors. Journal of Affective Disorders, 146, 71–78.  https://doi.org/10.1016/j.jad.2012.08.041.CrossRefGoogle Scholar
  38. Lai, B. S., Kelley, M. L., Harrison, K. M., Thompson, J. E., & Self-Brown, S. (2015). Posttraumatic stress, anxiety, and depression symptoms among children after hurricane Katrina: a latent profile analysis. Journal of Child and Family Studies, 24, 1262–1270.  https://doi.org/10.1007/s10826-014-9934-3.CrossRefGoogle Scholar
  39. Lenferink, L. I., de Keijser, J., Smid, G. E., Djelantik, A. M. J., & Boelen, P. A. (2017). Prolonged grief, depression, and posttraumatic stress in disaster-bereaved individuals: latent class analysis. European Journal of Psychotraumatology, 8, 1298311.  https://doi.org/10.1080/20008198.2017.1298311.CrossRefGoogle Scholar
  40. Liang, L., Hou, Z., & Tian, L. (2006). Adolescent attachment to father, mother, and peers. Chinese Mental Health Journal, 20, 639–642.Google Scholar
  41. Lopez, F. G., & Brennan, K. A. (2000). Dynamic processes underlying adult attachment organization: toward an attachment theoretical perspective on the healthy and effective self. Journal of Counseling Psychology, 47, 283–300.  https://doi.org/10.1037/0022-0167.47.3.283.CrossRefGoogle Scholar
  42. Mikulincer, M. (1998). Attachment working models and the sense of trust: an exploration of interaction goals and affect regulation. Journal of Personality and Social Psychology, 74, 1209–1224.  https://doi.org/10.1037/0022-3514.74.5.1209.CrossRefGoogle Scholar
  43. Morris, D. (1982). Attachment and intimacy. In D. Morris (Ed.), Intimacy (pp. 305–323). New York: Springer.CrossRefGoogle Scholar
  44. Muthén, L. K., & Muthén, B. O. (2012). Mplus statistical modeling software: Release 7.0. Los Angeles: Muthén & Muthén.Google Scholar
  45. Nixon, R. D., Meiser-Stedman, R., Dalgleish, T., Yule, W., Clark, D. M., Perrin, S., & Smith, P. (2013). The child PTSD symptom scale: an update and replication of its psychometric properties. Psychological Assessment, 25, 1025–1031.  https://doi.org/10.1037/a0033324.CrossRefGoogle Scholar
  46. Norris, F. H., Friedman, M. J., & Watson, P. J. (2002). 60,000 disaster victims speak: part II. Summary and implications of the disaster mental health research. Psychiatry-Interpersonal & Biological Processes, 65, 240–260.  https://doi.org/10.1521/psyc.65.3.240.20169.CrossRefGoogle Scholar
  47. O’Donnell, M. L., Creamer, M., & Pattison, P. (2004). Posttraumatic stress disorder and depression following trauma: understanding comorbidity. American Journal of Psychiatry, 161, 1390–1396.  https://doi.org/10.1176/appi.ajp.161.8.1390.CrossRefGoogle Scholar
  48. Okello, J., Nakimuli-Mpungu, E., Musisi, S., Broekaert, E., & Derluyn, I. (2014). The association between attachment and mental health symptoms among school-going adolescents in northern Uganda: the moderating role of war-related trauma. PLoS One, 9, e88494.  https://doi.org/10.1371/journal.pone.0088494.CrossRefGoogle Scholar
  49. Pfefferbaum, B., Newman, E., & Nelson, S. D. (2014). Mental health interventions for children exposed to disasters and terrorism. Journal of Child and Adolescent Psychopharmacology, 24, 24–31.  https://doi.org/10.1089/cap.2013.0061.CrossRefGoogle Scholar
  50. Rosellini, A. J., Coffey, S. F., Tracy, M., & Galea, S. (2014). A person-centered analysis of posttraumatic stress disorder symptoms following a natural disaster: predictors of latent class membership. Journal of Anxiety Disorders, 28, 16–24.  https://doi.org/10.1016/j.janxdis.2013.11.002.CrossRefGoogle Scholar
  51. Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. American Journal of Public Health, 99, 1651–1658.  https://doi.org/10.2105/AJPH.2008.150284.CrossRefGoogle Scholar
  52. Shannon, M. P., Lonigan, C. J., Finch, A., & Taylor, C. M. (1994). Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles. Journal of the American Academy of Child & Adolescent Psychiatry, 33, 80–93.  https://doi.org/10.1097/00004583-199401000-00012.CrossRefGoogle Scholar
  53. Stander, V. A., Thomsen, C. J., & Highfill-McRoy, R. M. (2014). Etiology of depression comorbidity in combat-related PTSD: a review of the literature. Clinical Psychology Review, 34, 87–98.  https://doi.org/10.1016/j.cpr.2013.12.002.CrossRefGoogle Scholar
  54. Sullivan, P. F., Kessler, R. C., & Kendler, K. S. (1998). Latent class analysis of lifetime depressive symptoms in the national comorbidity survey. American Journal of Psychiatry, 155, 1398–1406.  https://doi.org/10.1176/ajp.155.10.1398.CrossRefGoogle Scholar
  55. Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1–18.  https://doi.org/10.1207/s15327965pli1501_01.CrossRefGoogle Scholar
  56. Thabet, A. A., Tawahina, A. A., Sarraj, E. E., & Vostanis, P. (2008). Exposure to war trauma and PTSD among parents and children in the Gaza strip. European Child & Adolescent Psychiatry, 17, 191–199.  https://doi.org/10.1007/s00787-007-0653-9.CrossRefGoogle Scholar
  57. Trickey, D., Siddaway, A. P., Meiser-Stedman, R., Serpell, L., & Field, A. P. (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical Psychology Review, 32, 122–138.CrossRefGoogle Scholar
  58. Viana, A. G., & Rabian, B. (2008). Perceived attachment: relations to anxiety sensitivity, worry, and GAD symptoms. Behaviour Research and Therapy, 46, 737–747.  https://doi.org/10.1016/j.cpr.2011.12.001.CrossRefGoogle Scholar
  59. Weissman, M. M., Orvaschel, H., & Padian, N. (1980). Children's symptom and social functioning self-report scales comparison of mothers' and children's reports. The Journal of Nervous and Mental Disease, 168, 736–740.CrossRefGoogle Scholar
  60. Ying, L., Wu, X., & Lin, C. (2012). Longitudinal linkages between depressive and posttraumatic stress symptoms in adolescent survivors following the Wenchuan earthquake in China: a three-wave, cross-lagged study. School Psychology International, 33, 416–432.  https://doi.org/10.1177/0143034311421271.CrossRefGoogle Scholar
  61. Ying, L., Wu, X., & Chen, C. (2013). Prevalence and predictors of posttraumatic stress disorder and depressive symptoms among child survivors 1 year following the Wenchuan earthquake in China. European Child & Adolescent Psychiatry, 22, 567–575.  https://doi.org/10.1007/s00787-013-0400-3.CrossRefGoogle Scholar
  62. Zhou, X., Levin, Y., Stein, J. Y., Zerach, G., & Solomon, Z. (2017). Couple forgiveness and its moderating role in the intergenerational transmission of veterans’ posttraumatic stress symptoms. Journal of Marital and Family Therapy, 43, 410–421.  https://doi.org/10.1111/jmft.12200.CrossRefGoogle Scholar
  63. Zoellner, L. A., Pruitt, L. D., Farach, F. J., & Jun, J. J. (2014). Understanding heterogeneity in PTSD: fear,dysphoria,and distress. Depression and Anxiety, 31, 97–106.  https://doi.org/10.1002/da.22133.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Institute of Psychological ScienceHangzhou Normal UniversityHangzhouChina
  2. 2.Department of Psychology and Behavioral SciencesZhejiang UniversityHangzhouChina
  3. 3.Beijing Key Laboratory of Applied Experimental Psychology, Faculty of PsychologyBeijing Normal UniversityBeijingChina

Personalised recommendations