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Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study

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Abstract

Despite the occurrence of several earthquakes, only a few studies were conducted in Italy on the psychological impact in children and adolescents, with data mostly collected within one year after the disaster. This cross-sectional study aimed at exploring the prevalence of both post-traumatic stress disorder (PTSD) and emotional/behavioral difficulties, as well as at identifying their main predictors, among youths 2 years after the earthquake that hit Northern Italy in 2012. 682 children and adolescents (9–14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The prevalence of a likely PTSD in the earthquake zone was 1.9% (4.4% near the epicenter) and the total PTSD score in the affected area was significantly higher than in the control zone. 14.9% of youths living in the earthquake zone had a borderline/abnormal SDQ total difficulties score and 87.5% of youth with a likely PTSD also had a SDQ total score in the borderline/abnormal range. Regression analysis showed that the number of lifetime traumatic events (e.g., death of a relative) was the best predictor of children/adolescents psychological difficulties 2 years after the earthquake, followed by severity of exposure (personal injuries and losses) and parental psychopathology. Despite some limitations, this study highlights that youths may exhibit PTSD symptoms years after disasters, often in comorbidity with behavioral/emotional difficulties, stressing the need for long-term surveillance and interventions in exposed populations.

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References

  1. Davidson JR, McFarlane AC (2006) The extent and impact of mental health problems after disaster. J Clin Psychiatry 67(2):9–14

    PubMed  Google Scholar 

  2. 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(3):207–239 

    Article  PubMed  Google Scholar 

  3. Caffo E, Forresi B, Strik Lievers L (2005) Impact, psychological sequelae and management of trauma affecting children and adolescents. Curr Opin Psychiatry 18(4):422–428. https://doi.org/10.1097/01.yco.0000172062.01520.ac

    Article  PubMed  Google Scholar 

  4. Laor N, Wolmer L, Kora M, Yucel D, Spirman S, Yazgan Y (2002) Posttraumatic, dissociative and grief symptoms in Turkish children exposed to the 1999 earthquakes. J Nerv Ment Dis. 190:824–832. https://doi.org/10.1097/01.NMD.0000041959.54021.A7

    Article  PubMed  Google Scholar 

  5. Salcioğlu E, Başoğlu M (2008) Psychological effects of earthquakes in children: prospects for brief behavioral treatment. World J Pediatr. 4(3):165–172. https://doi.org/10.1007/s12519-008-0032-8

    Article  PubMed  Google Scholar 

  6. Piccardi L, Boccia M, Colangeli S, Bianchini F, Marano A, Giannini AM, Palmiero M, D'Amico S (2016) Neuro-functional alterations due to PTSD after environmental disasters: fMRI evidence and clinical suggestions. J Psychopathol 22:165–171

    Google Scholar 

  7. Dai W, Chen L, Lai Z, Li Y, Wang J, Liu A (2016) The incidence of post-traumatic stress disorder among survivors after earthquakes: a systematic review and meta-analysis. BMC Psychiatry 16:188. https://doi.org/10.1186/s12888-016-0891-9

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hong C, Efferth T (2016) Systematic review on post-traumatic stress disorder among survivors of the Wenchuan earthquake. Trauma Violence Abuse 17(5):542–561. https://doi.org/10.1177/1524838015585313

    Article  PubMed  Google Scholar 

  9. Farooqui M, Quadri SA, Suriya SS, Khan MA, Ovais M, Sohail Z, Shoaib S, Tohid H, Hassan M (2017) Posttraumatic stress disorder: a serious post-earthquake complication. Trends Psychiatry Psychother 39(2):135–143. https://doi.org/10.1590/2237-6089-2016-0029

    Article  PubMed  Google Scholar 

  10. Ying LH, Wu XC, Lin CD, Chen C (2013) Prevalence and predictors of posttraumatic stress disorder and depressive symptoms among child survivors 1 year following the Wenchuan earthquake in China. Eur Child Adolesc Psychiatry 22(9):567–575. https://doi.org/10.1007/s00787-013-0400-3

    Article  PubMed  Google Scholar 

  11. Ayub M, Poongan I, Masood K, Gul H, Ali M, Farrukh A, Shaheen A, Chaudhry HR, Naeem F (2012) Psychological morbidity in children 18 months after Kashmir Earthquake of 2005. Child Psychiatry Hum Dev 43(3):323–336. https://doi.org/10.1007/s10578-011-0267-9

    Article  PubMed  Google Scholar 

  12. Blanc J, Bui E, Mouchenik Y, Derivois D, Birmes P (2015) Prevalence of post-traumatic stress disorder and depression in two groups of children 1 year after the January 2010 earthquake in Haiti. J Affect Disord 172:121–126. https://doi.org/10.1016/j.jad.2014.09.055

    Article  PubMed  Google Scholar 

  13. Feo P, Di Gioia S, Carloni E, Vitiello B, Tozzi AE, 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

    Article  PubMed  PubMed Central  Google Scholar 

  14. Galea S, Nandi A, Vlahov D (2005) The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev 27:78–91. https://doi.org/10.1093/epirev/mxi003

    Article  PubMed  Google Scholar 

  15. Cénat JM, Derivois D (2015) Long-term outcomes among child and adolescent survivors of the 2010 Haitian earthquake. Depress Anxiety 32(1):57–63. https://doi.org/10.1002/da.22275

    Article  PubMed  Google Scholar 

  16. Galatzer-Levy IR, Huang SH, Bonanno GA (2018) Trajectories of resilience and dysfunction following potential trauma: a review and statistical evaluation. Clin Psychol Rev 63:41–55. https://doi.org/10.1016/j.cpr.2018.05.008

    Article  PubMed  Google Scholar 

  17. Bonanno GA, Mancini A (2008) The human capacity to thrive in the face of potential trauma. Pediatrics 121:369–375. https://doi.org/10.1542/peds.2007-1648

    Article  PubMed  Google Scholar 

  18. Bonanno GA, Westphal M, Mancini AD (2011) Resilience to loss and potential trauma. Annu Rev Clin Psychol 7:511–535. https://doi.org/10.1146/annurev-clinpsy-032210-104526

    Article  PubMed  Google Scholar 

  19. Osofsky JD, Osofsky HJ, Weems CF, King LS, Hansel TC (2015) Trajectories of post-traumatic stress disorder symptoms among youth exposed to both natural and technological disasters. J Child Psychol Psychiatry 56(12):1347–1355. https://doi.org/10.1111/jcpp.12420

    Article  PubMed  Google Scholar 

  20. Fan F, Long K, Zhou Y, Zheng Y, Liu X (2015) Longitudinal trajectories of post-traumatic stress disorder symptoms among adolescents after the Wenchuan earthquake in China. Psychol Med 45(13):2885–2896. https://doi.org/10.1017/S0033291715000884

    Article  CAS  PubMed  Google Scholar 

  21. Yule W, Bolton D, Udwin O, Boyle S, O’Ryan D, Nurrish J (2000) The long-term psychological effects of a disaster experienced in adolescence: I: the incidence and course of PTSD. J Child Psychol Psychiatry 41:503–511

    Article  CAS  PubMed  Google Scholar 

  22. Goenjian AK, Roussos A, Steinberg AM, Sotiropoulou C, Walling D, Kakaki M, Karagianni S (2011) Longitudinal study of PTSD, depression, and quality of life among adolescents after the Parnitha earthquake. J Affect Disord 133(3):509–515. https://doi.org/10.1016/j.jad.2011.04.053

    Article  PubMed  Google Scholar 

  23. McFarlane AC, Hooff M (2009) Impact of childhood exposure to a natural disaster on adult mental health: 20-year longitudinal follow-up study. Br J Psychiatry 195(2):142–148. https://doi.org/10.1192/bjp.bp.108.054270

    Article  PubMed  Google Scholar 

  24. Terasaka A, Tachibana Y, Okuyama M, Igarashi T (2015) Post-traumatic stress disorder in children following natural disasters: a systematic review of the long-term follow-up studies. Int J Child Youth Family Stud 6(1):111–133. https://doi.org/10.18357/ijcyfs.61201513481

    Article  Google Scholar 

  25. Zhang Z, Ran MS, Li YH, Ou GJ, Gong RR, Li RH, Fan M, Jiang Z, Fang DZ (2012) Prevalence of post-traumatic stress disorder among adolescents after the Wenchuan earthquake in China. Psychol Med 42(8):1687–1693. https://doi.org/10.1017/S0033291711002844

    Article  CAS  PubMed  Google Scholar 

  26. Jia Z, Shi L, Duan G, Liu W, Pan X, Chen Y, Tian W (2013) Traumatic experiences and mental health consequences among child survivors of the 2008 Sichuan earthquake: a community-based follow-up study. BMC Public Health 13:104. https://doi.org/10.1186/1471-2458-13-104

    Article  PubMed  PubMed Central  Google Scholar 

  27. Goenjian AK, Pynoos RS, Steinberg AM, Najarian LM, Asarnow JR, Karayan I, Ghurabi M, Fairbanks LA (1995) Psychiatric comorbidity in children after the 1988 earthquake in Armenia. J Am Acad Child Adolesc Psychiatry 34(9):1174–1184. https://doi.org/10.1097/00004583-199509000-00015

    Article  CAS  PubMed  Google Scholar 

  28. Pollice R, Bianchini V, Roncone R, Casacchia M (2012) Distress psicologico e disturbo post-traumático da stress (DPTS) in una popolazione di giovani sopravvissuti al terremoto dell’Aquila. Riv Psichiatr 47(1):59–64

    PubMed  Google Scholar 

  29. Raccanello D, Burro R, Hall R (2017) Children's emotional experience two years after an earthquake: an exploration of knowledge of earthquakes and associated emotions. PLoS ONE 12(12):e0189633. https://doi.org/10.1371/journal.pone.0189633

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. D’Amico S, Marano A, Geraci MA, Legge E (2013) Perceived self-efficacy and coping styles related to stressful critical life events. PLoS ONE 8(7):e67571. https://doi.org/10.1371/journal.pone.0067571

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Piccardi L, Marano A, Geraci MA, Legge E, D'Amico S (2016) Differences in coping strategies of preadolescents with and without exposure to the L'Aquila (Central Italy) 2009 earthquake. Epidemiol Prev 40(2/1):53–58. https://doi.org/10.19191/EP16.2S1.P053.049

    Article  PubMed  Google Scholar 

  32. Dell’Osso L, Carmassi C, Massimetti G, Conversano C, Daneluzzo E, Riccardi I, Stratta P, Rossi A (2011) Impact of traumatic loss on post-traumatic spectrum symptoms in high school students after the L’Aquila 2009 earthquake in Italy. J Affect Disord 134:59–64. https://doi.org/10.1016/j.jad.2011.06.025

    Article  PubMed  Google Scholar 

  33. Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, Field AP (2012) A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev 32(2):122–138. https://doi.org/10.1016/j.cpr.2011.12.001

    Article  PubMed  Google Scholar 

  34. Ma X, Liu X, Hu X, Qiu C, Wang Y, Huang Y, Wang Q, Zhang W, Li T (2011) Risk indicators for post-traumatic stress disorder in adolescents exposed to the 5.12 Wenchuan earthquake in China. Psychiatry Res 189(3):385–391. https://doi.org/10.1016/j.psychres.2011.02.016

    Article  PubMed  Google Scholar 

  35. Kun P, Han S, Chen X, Yao L (2009) Prevalence and risk factors for posttraumatic stress disorder: a cross-sectional study among survivors of the Wenchuan 2008 earthquake in China. Depress Anxiety 26(12):1134–1140. https://doi.org/10.1002/da.20612

    Article  PubMed  Google Scholar 

  36. Furr JM, Comer JS, Edmunds JM, Kendall PC (2010) Disasters and youth: a meta-analytic examination of posttraumatic stress. J Consult Clin Psychol 78(6):765–780. https://doi.org/10.1037/a0021482

    Article  PubMed  Google Scholar 

  37. Tian Y, Wong TK, Li J, Jiang X (2014) Posttraumatic stress disorder and its risk factors among adolescent survivors 3 years after an 8.0 magnitude earthquake in China. BMC Public Health 14:1073. https://doi.org/10.1186/1471-2458-14-1073

    Article  PubMed  PubMed Central  Google Scholar 

  38. Tang B, Deng Q, Glik D, Dong J, Zhang L (2017) A meta-analysis of risk factors for post-traumatic stress disorder (PTSD) in adults and children after earthquakes. Int J Environ Res Public Health 14(12):E1537. https://doi.org/10.3390/ijerph14121537

    Article  PubMed  Google Scholar 

  39. Sharma A, Kar N (2018) Posttraumatic stress, depression, and coping following the 2015 Nepal earthquake: a study on adolescents. Disaster Med Public Health Prep 24:1–7. https://doi.org/10.1017/dmp.2018.37

    Article  Google Scholar 

  40. Silwal S, Dybdahl R, Chudal R, Sourander A, Lien L (2018) Psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquakes. J Affect Disord 234:239–246. https://doi.org/10.1016/j.jad.2018.03.002

    Article  PubMed  Google Scholar 

  41. Shi X, Zhou Y, Geng F, Li Y, Zhou J, Lei B, Chen S, Chen X, Fan F (2018) Posttraumatic stress disorder symptoms in parents and adolescents after the Wenchuan earthquake: a longitudinal actor-partner interdependence model. J Affect Disord 226:301–306. https://doi.org/10.1016/j.jad.2017.10.011

    Article  PubMed  Google Scholar 

  42. Wong SS, Kletter H, Wong Y, Carrion VG (2013) A prospective study on the association between caregiver psychological symptomatology and symptom clusters of pediatric posttraumatic stress disorder. J Trauma Stress 26(3):385–391. https://doi.org/10.1002/jts.21816

    Article  PubMed  Google Scholar 

  43. Koplewicz HS, Vogel JM, Solanto MV, Morrissey RF, Alonso CM, Abikoff H, Novick RM (2002) Child and parental response to the 1993 World Trade Center bombing. J Trauma Stress 15:77–85. https://doi.org/10.1023/A:1014339513128

    Article  PubMed  Google Scholar 

  44. Juth V, Silver RC, Seyle DC, Widyatmoko CS, Tan ET (2015) Post-disaster mental health among parent-child dyads after a major earthquake in Indonesia. J Abnorm Child Psychol 43(7):1309–1318. https://doi.org/10.1007/s10802-015-0009-8

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kiliç C, Kiliç EZ, Aydin IO (2011) Effect of relocation and parental psychopathology on earthquake survivor-children's mental health. J Nerv Ment Dis 199(5):335–341. https://doi.org/10.1097/NMD.0b013e3182174ffa

    Article  PubMed  Google Scholar 

  46. Bianchini V, Roncone R, Tomassinia A, Necozione S, Cifone MG, Casacchia M, Pollice R (2013) Cognitive behavioral therapy for young people after L’Aquila earthquake. Clin Pract Epidemiol Ment Health 9:238–242. https://doi.org/10.2174/1745017901309010238

    Article  PubMed  PubMed Central  Google Scholar 

  47. Cohen JA, Bukstein O, Walter H, Benson SR, Chrisman A, Farchione TR, Hamilton J, Keable H, Kinlan J, Schoettle U, Siegel M, Stock S, Medicus J, AACAP Work Group On Quality Issues (2010) Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry 49(4):414–430

    PubMed  Google Scholar 

  48. Pynoos R, Rodriguez N, Steinberg A, Stuber M, Frederick C (1998) UCLA PTSD Index for DSM-IV. UCLA Trauma Psychiatry Program, Los Angeles

    Google Scholar 

  49. Steinberg AM, Brymer MJ, Decker KB, Pynoos RS (2004) The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index. Curr Psychiatry Rep 6:96–100

    Article  PubMed  Google Scholar 

  50. Rodriguez N, Steinberg AS, Saltzman WS, Pynoos RS (2001) PTSD Index: preliminary psychometric analyses of child and parent versions. In: Symposium conducted at the Annual Meeting of the International Society for Traumatic Stress Studies, New Orleans, LA, USA.

  51. Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 38:581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x

    Article  CAS  PubMed  Google Scholar 

  52. Marzocchi GM, Di Pietro M, Vio C, Bassi E, Filoramo G, Salmaso A (2002) Il questionario SDQ per insegnanti (Strength and Difficulties Questionnaire): uno strumento di screening per difficoltà comportamentali ed emotive in età evolutiva. Diffic Apprendimento 8:75-84 https://doi.org/10.1177/0734282912473456

    Article  Google Scholar 

  53. Tobia V, Marzocchi GM (2018) The Strengths and Difficulties Questionnaire-parents for italian school-aged children: psychometric properties and norms. Child Psychiatry Hum Dev 49(1):1–8. https://doi.org/10.1007/s10578-017-0723-2

    Article  PubMed  Google Scholar 

  54. Tobia V, Gabriele MA, Marzocchi GM (2013) The Italian version of the Strengths and Difficulties Questionnaire (SDQ)-teacher: psychometric properties. J Psychoeduc Assess 31:493–505. https://doi.org/10.1177/0734282912473456

    Article  Google Scholar 

  55. Derogatis LR, Lipman RS, Covi L (1973) The SCL–90: an outpatient psychiatric rating scale—preliminary report. Psychopharmacol Bull 9:13–28

    CAS  PubMed  Google Scholar 

  56. Derogatis LR (1994) Symptom Checklist 90-R: administration, scoring, and procedures manual, 3rd edn. National Computer Systems, Minneapolis

    Google Scholar 

  57. Sarno I, Preti E, Prunas A, Madeddu F (2011) SCL-90-R Symptom Checklist-90-R Adattamento italiano. Giunti Organizzazioni Speciali, Firenze

    Google Scholar 

  58. Neria Y, Nandi A, Galea S (2008) Post-traumatic stress disorder following disasters: a systematic review. Psychol Med 38:467–480. https://doi.org/10.1017/S0033291707001353

    Article  CAS  PubMed  Google Scholar 

  59. De Girolamo G, Polidori G, Morosini P, Scarpino V, Reda V, Serra G, Mazzi F, Alonso J, Vilagut G, Visonà G, Falsirollo F, Rossi A, Warner R (2006) Prevalence of common mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD). Soc Psychiatry Psychiatr Epidemiol 41(11):853–861

    Article  PubMed  Google Scholar 

  60. Pryce JG, Shackelford KK, Price DH (2007) Secondary traumatic stress and the child welfare professional. Lyceum Books, Inc, Chicago

    Google Scholar 

  61. Jin Y, Li J (2015) Prospective study of posttraumatic stress in adolescents 6 and 24 months after the 2010 Yushu earthquake in China. J Nerv Ment Dis 203(9):679–683. https://doi.org/10.1097/NMD.0000000000000351

    Article  PubMed  Google Scholar 

  62. Vezzali L, Cadamuro A, Versari A, Giovannini D, Trifiletti E (2014) Feeling like a group after a natural disaster: common ingroup identity and relations with outgroup victims among majority and minority young children. Br J Soc Psychol 54(3):519–538. https://doi.org/10.1111/bjso.12091

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank E. Carluccio, E. Famiglietti, O. Daolio, D. Gueraldi, L. Giamboni, I. Maini, S. Leonardi, and R. la Torre.

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Authors and Affiliations

  1. Sigmund Freud University, Milan, Italy

    B. Forresi & S. Scaini

  2. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    F. Soncini, E. Bottosso, E. Di Pietro, G. Scarpini, G. Aggazzotti, E. Caffo & E. Righi

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Forresi, B., Soncini, F., Bottosso, E. et al. Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study. Eur Child Adolesc Psychiatry 29, 227–238 (2020). https://doi.org/10.1007/s00787-019-01370-0

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