Skip to main content

Post-traumatic stress disorder symptom clusters in Turkish child and adolescent trauma survivors

Abstract

This study identified post-traumatic stress disorder (PTSD) symptom clusters in Turkish children and adolescents who experienced the 1999 Marmara Earthquake, which was classified as one of the world’s six deadliest earthquakes in the 20th century. Two hundred ninety three children and adolescents (152 females and 141 males between the ages of 8 and 15) living in Izmit, the epicenter of the earthquake, participated in this study. The Post-Traumatic Stress Disorder Reaction Index for Children (CPTSD-RI) was administered to assess PTSD symptoms. A confirmatory factor analysis (CFA), using data from the CPTSD-RI, was conducted to determine whether the DSM-IV-TR symptom structure of PTSD was valid in Turkish children and adolescents. The CFA model supported the three-symptom cluster model. Limitations and implications for future research studies are included in the discussion.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Amaya-Jackson L, March J (1995) Posttraumatic stress disorder: risk factors, diagnosis and intervention. Adolesc Med 6:251–269

    PubMed  Google Scholar 

  2. 2.

    American Psychiatric Association (1987) Diagnostic and statistical manual of mental health disorders: Revised 3rd edition (DSM-III-R). Washington, DC: APA

    Google Scholar 

  3. 3.

    American Psychiatric Association (2000) Diagnostic and statistical manual of mental health disorders: text revision, 4th edn. Author, Washington

  4. 4.

    American Psychological Association (2003) Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Am Psychol 58:377–402

    Article  Google Scholar 

  5. 5.

    Anthony JL, Lonigan CJ, Hecht SA (1999) Dimensionality of posttraumatic stress disorder symptoms in children exposed to disaster: results from confirmatory factor analyses. J Abnorm Psychol 108:326–336

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Bal A (In press) Posttraumatic Stress Disorder in Turkish child and adolescent survivors three years after the Marmara Earthquake. Child and Adolescent Mental Health

  7. 7.

    Basoglu M, Kilic C, Salcioglu E, Livanau M (2004) Prevalence of posttraumatic stress disorder and comorbid depression in earthquake survivors in Turkey: an epidemiological study. J Trauma Stress 17:133–141

    PubMed  Article  Google Scholar 

  8. 8.

    Basoglu M, Salcioglu E, Livanou M, Ozeren M, Aker T, Kilic C, Mestcioglu O (2001) A study of the validity of a screening instrument for traumatic stress in earthquake survivors in Turkey. J Trauma Stress 14:491–509

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Basoglu M, Salcioglu E, Livanou M (2002) Traumatic stress responses in earthquake survivors in Turkey. J Trauma Stress 15:269–276

    PubMed  Article  Google Scholar 

  10. 10.

    Boomsma A (1985) Nonconvergence, improper solutions, and starting values in LISREL maximum likelihood estimation. Psychometrika 50:229–242

    Article  Google Scholar 

  11. 11.

    Boomsma A (1987) The robustness of maximum likelihood estimation in structural equation models. In: Cuttance P, Ecob R (eds) Structural modeling by example: applications in educational, sociological, and behavioral research. Cambridge University Press, New York, pp 160–188

    Google Scholar 

  12. 12.

    Breslau N (2002) Epidemiological studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry 47:923–929

    PubMed  Google Scholar 

  13. 13.

    Bulut S, Bulut S, Tayli A (2005) The dose of exposure and prevalence rates of post traumatic stress disorder in a sample of Turkish children eleven months after the 1999 Marmara earthquakes. Sch Psychol Int 26:55–70

    Article  Google Scholar 

  14. 14.

    Byrne B (2006) Structural equation modeling with EQS: basic concepts, applications, and programming, 2nd edn. Mahwah, Erlbaum

    Google Scholar 

  15. 15.

    Calhoun LG, Cann A, Tedeschi RG, McMillan J (2000) A correctional test of the relationship between posttraumatic growth, religion, and cognitive processing. J Trauma Stress 13:521–527

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Cohen JA (1998) Practice parameters for the assessment and treatment of children adolescents with posttraumatic stress disorder. Am Acad Child Adolesc Psychiatry 37:4S–26S

    Google Scholar 

  17. 17.

    Cole M (1996) Cultural psychology: a once and future discipline. Harvard University, Cambridge

    Google Scholar 

  18. 18.

    Cordova MJ, Studts JL, Hann DH, Jacobsen PB, Andrykowski MA (2000) Symptom structure of PTSD following breast cancer. J Trauma Stress 13:301–320

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Dinicola VF (1996) Ethnocultural aspects of PTSD and related disorders among children and adolescents. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM (eds) Ethnocultural aspects of posttraumatic stress disorder. American Psychological Association, Washington, pp 389–414

    Chapter  Google Scholar 

  20. 20.

    Dyregrov A, Kuterovac G, Barath A (1996) Factor analysis of the impact of event scale with children in war. Scand J Psychol 37:339–350

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Erdur O (2002) Psychological reactions of Turkish earthquake survivors. Unpublished Doctoral Dissertation, University of Texas at Austin

  22. 22.

    Flouri E (2005) Post-traumatic stress disorder (PTSD): what we have learned and what we still have not found out. J Interpers Violence 20:373–379

    PubMed  Article  Google Scholar 

  23. 23.

    Foa EB, Riggs DS, Gershuny BS (1995) Arousal, numbing, and intrusion: symptom structure of PTSD following assault. Am J Psychiatry 1:116–120

    Google Scholar 

  24. 24.

    Frederick C, Pynoos RS, Nader K (1992) Child post-traumatic stress disorder reaction index (CPTSD-RI). Department of Psychiatry, University of California at Los Angeles, Los Angeles

    Google Scholar 

  25. 25.

    Friedman MJ, Marsella AJ (1996) Posttraumatic stress disorder: An overview of the concept. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM (eds.) Ethnocultural aspects of posttraumatic stress disorder. Washington, DC: APA, pp. 11–32

    Chapter  Google Scholar 

  26. 26.

    Gordon SN, Farberow NL, Maida CA (1999) Children and disasters. Brunner/Mazel, Philadelphia

    Google Scholar 

  27. 27.

    Gordon R, Wraith R (1993) Responses of children and adolescents to disaster. In: Wilson JP, Raphael B (eds) International handbook of traumatic stress syndromes. Plenum, New York, pp 561–575

    Google Scholar 

  28. 28.

    Gokler I (2001) The predictor variables of post-traumatic stress symptoms in children and adolescents following 1999 Marmara Earthquake: exposure to traumatic experiences and coping. Unpublished master thesis, Middle East Technical University, Ankara, Turkey

  29. 29.

    Green SB, Thompson MS (2003) Structural equation modeling in clinical research. In: Roberts MC, Illardi SS (eds.) Methods of research in clinical psychology: a handbook. Blackwell, London, pp 138–175

    Chapter  Google Scholar 

  30. 30.

    Hadi AF, Llabre MM (1998) The Gulf crisis experience of Kuwait children: psychological and cognitive factors. J Trauma Stress 11:45–57

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Harrald JR, Tanali IR, Perkins JB (2006) The collection, synthesis, and quality assessment of data describing the response to human needs following the 1999 Turkey earthquakes. Retrieved on July 25, from http://www.seas.gwu.edu/~icdm/Turkey_Report.htm

  32. 32.

    Jöreskog KG (1993) Testing structural equation models. In: Bollen KA, Long JS, (eds) Testing structural equation models. Sage, Newbury Park, pp 294–316

    Google Scholar 

  33. 33.

    Keppel-Benson JM, Ollendick TH (1993) Post-traumatic stress disorder in children and adolescents. In: Saylor JF (ed) Children and disasters. Plenum, NewYork, pp 29–44

    Google Scholar 

  34. 34.

    Kilic C, Ulusoy M (2003) Psychological effects of the November 1999 earthquake in Turkey: an epidemiological study. Acta Psychiatr Scand 108:232–238

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Kline R (2005) Principles and practice of structure equation modeling, 2nd edn. Guilford, New York

    Google Scholar 

  36. 36.

    Kolaitis G, Kotsopoulus J, Tsiantis J, Haritaki S, Rigizou F, Zacharaki L, Riga E, Augoustatou A, Bimbou A, Kanari N, Liakopoulou M, Katerelos P (2003) Posttraumatic stress reactions among children following the Athens earthquake of September 1999. Eur Child Adolesc Psychiatry 12:273–280

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Laurence M (1999) Treating posttraumatic stress disorder in children and families: basic principles and clinical applications. Am J Fam Ther 27:14–21

    Google Scholar 

  38. 38.

    Long JS (1983) Confirmatory factor analysis. Sage, Thousand Oaks

    Google Scholar 

  39. 39.

    Lonigan CJ, Shannon MP, Finch AJ Jr, Daugherty TK, Taylor CM (1991) Children’s reactions to a natural disaster: Symptom severity and degree of exposure. Adv Behav Res Theory 13:135–154

    Article  Google Scholar 

  40. 40.

    MacCallum RC, Browne MW, Sugawara HM (1996) Power analysis and determination of sample size for covariance structure modeling. Psychol Methods 1:130–149

    Article  Google Scholar 

  41. 41.

    Marsella AJ, Friedman MJ, Spain EH (1996) Ethocultural aspects of PTSD: an overview of issues and research directions. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM (eds) Ethnocultural aspects of posttraumatic stress disorder. American Psychological Association, Washington, pp 105–129

    Chapter  Google Scholar 

  42. 42.

    Neuner F, Schauer E, Catani C, Ruf M, Elbert T (2006) Post-tsunami stress: a study of posttraumatic stress disorder in children living in three severely affected regions in Sri Lanka. J Trauma Stress 19:339–347

    PubMed  Article  Google Scholar 

  43. 43.

    Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K (2002) 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry 65:207–239

    PubMed  Google Scholar 

  44. 44.

    OFDA/CRED International Disasters Data Base (EM-DAT) (2006) Disaster statistics 1991–2005. Retrieved on July 26, from http://www.unisdr.org/disaster-statistics/introduction.htm

  45. 45.

    Palmieri PA, Fitzgerald LF (2006) Confirmatory factor analysis of posttraumatic stress symptoms in sexually harassed women. J Trauma Stress 18:657–666

    Article  Google Scholar 

  46. 46.

    Perrin S, Smith P, Yule W (2000) Practitioner review: the assessment and treatment of post-traumatic stress disorder in children and adolescents. J Child Psychiatry 41:277–289

    Article  CAS  Google Scholar 

  47. 47.

    Pynoos RS, Goenjian A, Tashjian M, Karakashian M, Manjikian R., Manoukian G, Steinberg AM, Fairbanks LA (1998) Post-traumatic stress reactions in children after the 1988 Armenian earthquake. Br J Psychiatry 163:239–247

    Article  Google Scholar 

  48. 48.

    Pynoos RS, Nader K (1990) Children’s exposure to violence and traumatic death. Psychiatr Ann 20:334–344

    Google Scholar 

  49. 49.

    Sack HW, Seeley JR, Clarke GN (1997) Does PTSD transcend cultural barriers? A study from the Khmer adolescents refugee project. J Am Acad Child Adolesc Psychiatry 36:49–54

    PubMed  CAS  Article  Google Scholar 

  50. 50.

    Sahin NH, Sahin N, Batigun AD, Yimaz B (2001) Turkish Ministry of Education—UNICEF psychosocial school project: assessment and evaluation report. Turkey

  51. 51.

    Salmon K, Bryant RA (2002) Posttraumatic stress disorder in children: the influence of developmental factors. Child Psychol Rev 22:163–188

    Google Scholar 

  52. 52.

    Searle C, Skinner D (2000) A school-based intervention programme for refugee children. Social Work/Maatskaplike Werk 36:237–246

    Google Scholar 

  53. 53.

    Thabet AA, Vostanis P, Karim K (2005) Group crisis intervention for children during ongoing war conflict. Eur Child Adolesc Psychiatry 14:262–269

    PubMed  Article  Google Scholar 

  54. 54.

    Tural U, Coskun B, Onder E, Corapcioglu, Yildiz M, Kesepara C, Karakaya I, Aydin M, Erol A, Torun F, Aybar G (2004) Psychological consequences of the 1999 earthquake in Turkey. J Trauma Stress 17:451–459

  55. 55.

    World Health Organization (2007) International statistical classification of diseases and related health problems 10th Revision Version for 2006. Retrieved on January 19, from http://www.who.int/classifications/apps/icd/icd10online/

  56. 56.

    Yule W (2001) Post-traumatic stress disorder in children and adolescents. Int Rev Psychiatry 13:194–200

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Aydın Bal.

Additional information

Authors’ note: We are indebt to Dr. Robert B. Rutherford, Jr. and Dr. Steven R. Forness for their invaluable feedback in the preparation of this manuscript. However, we remain solely responsible for the paper’s shortcomings.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bal, A., Jensen, B. Post-traumatic stress disorder symptom clusters in Turkish child and adolescent trauma survivors. Eur Child Adolesc Psychiatry 16, 449–457 (2007). https://doi.org/10.1007/s00787-007-0618-z

Download citation

Keywords

  • post-traumatic stress disorder
  • PTSD symptom structure
  • children
  • Turkey
  • earthquake