Journal of Child and Family Studies

, Volume 26, Issue 5, pp 1422–1431 | Cite as

Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients

  • Ellen J. Sole
  • Julia J. Rucklidge
  • Neville M. Blampied
Original Paper
First Online:

Abstract

This study examined the effects of micronutrients on children with clinically elevated stress and anxiety 23–36 months after experiencing a natural disaster (a major earthquake). A single-case multiple-baseline design allocated 14 children (7 males, 7 females; aged 8–11 years; 10 with formal anxiety-disorder diagnoses) randomly to 1, 2 or 3 week baselines. Participants then took eight capsules/day of a micronutrient formula (EMPowerplus) during an 8-week open-label trial. Assessment instruments were the Children’s Global Assessment Scale (CGAS), the Screen for Child Anxiety-Related Emotional Disorders (SCARED), the Pediatric Emotional Distress Scale (PEDS), and the Revised Children’s Manifest Anxiety Scale (RCMAS). Symptom severity declined slightly in baseline for some children and declined much more during intervention for all children. Effect sizes at end of treatment were −1.40 (RCMAS), −1.92 (SCARED), +1.96 (CGAS), and −2.13 (PEDS). Modified Brinley plots revealed decreases in anxiety and improvements in overall functioning for 10 out of 11 completing participants. Side effects were mild and transient. The study provided evidence that treatment with a dietary supplement containing micronutrients reduced children’s post-disaster anxiety to a clinically significant degree. Future placebo-controlled randomized-controlled trials and treatment-comparison research is recommended to determine if this is true of anxiety in general.

Keywords

Anxiety Stress Earthquake Natural disaster Micronutrients Children 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

The authors gratefully acknowledge support from the Vic Davis Memorial Trust, Marie Lockie, and the Department of Psychology University of Canterbury, and Truehope Nutritional Support Ltd, Raymond, Alberta, Canada who supplied the micronutrients gratis.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was given by the Southern Health and Disability Ethics Committee and the University of Canterbury Human Ethics Committee and the trial was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12612000671864).

References

  1. Achenbach, T. M., Howell, C. T., McConaughy, S. H., & Stanger, C. (1995). Six-year predictors of problems in a national sample of children and youth: I. Cross-informant syndromes. Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 336–347. doi: 10.1097/00004583-199503000-00020.CrossRefPubMedGoogle Scholar
  2. Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. In E. J. Mash, R. A. Barkley (Eds.), Child psychopathology. (2nd ed.). New York, NY: The Guilford Press.Google Scholar
  3. Ames, B. N. (2004). A role for supplements in optimizing health: The metabolic tune-up. Archives of Biochemistry and Biophysics, 423(1), 227–234. doi: 10.1016/j.abb.2003.11.002.CrossRefPubMedGoogle Scholar
  4. Ames, B. N. (2010). Optimal micronutrients delay mitochondrial decay and age-associated diseases. Mechanisms of Ageing and Development, 131(7–8), 473–479. doi: 10.1016/j.mad.2010.04.005.CrossRefPubMedGoogle Scholar
  5. Ames, B. N., Elson-Schwab, I., & Silver, E. A. (2002). High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): Relevance to genetic disease and polymorphisms. The American Journal of Clinical Nutrition, 75(4), 616–658.PubMedGoogle Scholar
  6. Ardagh, M. W., Richardson, S. K., Robinson, V., Than, M., Gee, P., & Henderson, S., et al. (2012). The initial health-system response to the earthquake in Christchurch, New Zealand, in February, 2011. The Lancet, 379(9831), 2109–2115.CrossRefGoogle Scholar
  7. Barlow, D. H. (2000). Anxiety and its disorders (2nd ed.). New York, NY: Guilford.Google Scholar
  8. Barrett, P. M. (2000). Treatment of childhood anxiety: Developmental aspects. Clinical Psychology Review, 20, 479–494. doi: 10.1016/s0272-7358(99)00038-0.CrossRefPubMedGoogle Scholar
  9. Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236. doi: 10.1097/00004583-199910000-00011.CrossRefPubMedGoogle Scholar
  10. Blampied, N. M. (2013). Single-case research designs and the scientist-practitioner ideal in applied psychology. In G. Madden (Ed.), APA handbook of behavior analysis (Vol. 1, pp. 177–197). Washington, DC: American Psychological Association.Google Scholar
  11. Blampied, N. M. (2017). Analyzing therapeutic change using modified Brinley plots: History, construction, and interpretation. Behavior Therapy, 48(1), 115–127. doi: 10.1016/j.beth.2016.09.002.
  12. Bloch, M. H., & McGuire, J. F. (2011). Pharmacological treatment for phobias and anxiety disorders. In D. McKay, E. A. Storch (Eds.), Handbook of child and adolescent anxiety disorders (pp. 339–354). New York, NY: Springer Science + Business Media.CrossRefGoogle Scholar
  13. Brinley, J. F. (1965). Rigidity and the control of cognitive sets in relation to speed and accuracy of performance in the elderly. (26). http://ezproxy.canterbury.ac.nz/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=1966-00448-001&site=ehost-live. Available from EBSCOhost psyh database.Google Scholar
  14. Cénat, J. M., & Derivois, D. (2015). Long‐term outcomes among child and adolescent survivors of the 2010 Haitian earthquake. Depression and Anxiety, 32(1), 57–63. doi: 10.1002/da.22275.CrossRefPubMedGoogle Scholar
  15. Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18.CrossRefPubMedGoogle Scholar
  16. Cobham, V. E., & McDermott, B. (2014). Perceived parenting change and child posttraumatic stress following a natural disaster. Journal of Child and Adolescent Psychopharmacology, 24(1), 18–23.CrossRefPubMedGoogle Scholar
  17. Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2010). Trauma-focused cognitive-behavioral therapy for traumatized children. In J. R. Weisz, A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed.) (pp. 295–311). New York, NY: Guilford Press.Google Scholar
  18. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson.Google Scholar
  19. Cumming, G. (2012). Understanding the new statistics: Effect sizes, confidence intervals, and meta-analysis. New York: Routledge.Google Scholar
  20. Ford, T., Goodman, R., & Meltzer, H. (2003). The British child and adolescent mental health survey 1999: The prevalence of DSM-IV disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 42(10), 1203–1211. doi: 10.1097/00004583-200310000-00011.CrossRefPubMedGoogle Scholar
  21. France, K. G., Blampied, N. M., & Wilkinson, P. (1999). A multiple-baseline, double-blind evaluation of the effects of trimeprazine tartrate on infant sleep disturbance. Experimental and Clinical Psychopharmacology, 7(4), 502–513.CrossRefPubMedGoogle Scholar
  22. Frazier, E. A., Fristad, M. A., & Arnold, L. E. (2009). Multinutrient supplement as treatment: Literature review and case report of a 12-year-old boy with bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 19(4), 453–460. doi: 10.1089/cap.2008.0157.CrossRefPubMedGoogle Scholar
  23. Frazier, E. A., Fristad, M. A., & Arnold, L. E. (2012). Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders. Journal of Alternative and Complementary Medicine, 18(7), 678–685. doi: 10.1089/acm.2011.0270.CrossRefPubMedGoogle Scholar
  24. Friedberg, R. G., McCLure, J. M., & Garcia, J. H. (2009). Cognitive therapy techniques for children and adolescents. New York, NY: Guilford.Google Scholar
  25. Garfin, D. R., Silver, R. C., Gil-Rivas, V., Guzmán, J., Murphy, J. M., & Cova, F., et al. (2014). Children’s reactions to the 2010 Chilean earthquake: The role of trauma exposure, family context, and school-based mental health programming. Psychological Trauma: Theory, Research, Practice, and Policy, 6(5), 563–573. doi: 10.1037/a0036584.CrossRefGoogle Scholar
  26. Goodwin, R. D., Fergusson, D. M., & Horwood, L. J. (2004). Early anxious/withdrawn behaviours predict later internalising disorders. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45(4), 874–883. doi: 10.1111/j.1469-7610.2004.00279.x.CrossRefGoogle Scholar
  27. Gordon, H. A., Rucklidge, J. J., Blampied, N. M., & Johnstone, J. M. (2015). Clinically significant symptom reduction in children with attention-deficit/hyperactivity disorder treated with micronutrients: An open-label reversal design study. Journal of Child and Adolescent Psychopharmacology, 25(10), 783–798. doi: 10.1089/cap.2015.0105.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Grissom, R. J. (1996). The magical number .7+/−.2: Meta-meta-analysis of the probability of superior outcome in comparisons involving therapy, placebo, and control. Journal of Consulting and Clinical Psychology, 64(5), 973–982.CrossRefPubMedGoogle Scholar
  29. Hensley, L., & Varela, R. E. (2008). PTSD symptoms and somatic complaints following Hurricane Katrina: The roles of trait anxiety and anxiety sensitivity. Journal of Clinical Child and Adolescent Psychology, 37(3), 542–552. doi: 10.1080/15374410802148186.CrossRefPubMedGoogle Scholar
  30. Jackson, J., Eaton, W., Cascella, N., Fasano, A., & Kelly, D. (2012). Neurologic and psychiatric manifestations of Celiac disease and gluten sensitivity. Psychiatric Quarterly, 83(1), 91–102. doi: 10.1007/s11126-011-9186-y.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefPubMedGoogle Scholar
  32. Kaplan, B. J., Rucklidge, J. J., McLeod, K., & Romijn, A. (2015). The emerging field of nutritional mental health: Inflammation, the microbiome, oxidative stress, and mitochondrial function. Clinical Psychological Science, 3(6), 964–980. doi: 10.1177/2167702614555413.CrossRefGoogle Scholar
  33. Kaplan, B. J., Rucklidge, J. J., Romijn, A. R., & Dolph, M. (2015). A randomized trial of nutrient supplements to minimize psychological stress after a natural disaster. Psychiatry Research, 228, 373–379.CrossRefPubMedGoogle Scholar
  34. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., & Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 980–987. doi: 10.1097/00004583-199707000-00021.CrossRefPubMedGoogle Scholar
  35. Kratochwill, T. R., Hitchcock, J. H., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2013). Single-case intervention research design standards. Remedial and Special Education, 34(1), 26–38. doi: 10.1177/0741932512452794.CrossRefGoogle Scholar
  36. La Greca, A. M., Lai, B. S., Llabre, M. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. J. (2013). Children’s postdisaster trajectories of PTS symptoms: Predicting chronic distress. Child & Youth Care Forum, 42(4), 351–369. doi: 10.1007/s10566-013-9206-1.CrossRefGoogle Scholar
  37. La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Roberts, M. C. (2002). Helping children cope with disasters and terrorism. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  38. Lakens, D. (2013). Calculating and reporting effect sizes to facilitate cumulative science: A practical primer for t-tests and ANOVAs. Frontiers in Psychology, 4, 863 doi: 10.3389/fpsyg.2013.00863.CrossRefPubMedPubMedCentralGoogle Scholar
  39. Liu, M., Wang, L., Shi, Z., Zhang, Z., Zhang, K., & Shen, J. (2011). Mental health problems among children one-year after Sichuan earthquake in China: A follow-up study. PloS ONE, 6(2), e14706 doi: 10.1371/journal.pone.0014706.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Lothian, J., Rucklidge, J.J., & Blampied, N. (2016). Effect of a vitamin-mineral formula on insomnia in adults: A multiple baseline design. Clinical Psychological Science, 46, 1112–1124. doi: 10.1177/2167702616631740.
  41. McCann, J. C., & Ames, B. N. (2009). Vitamin K, an example of triage theory: Is micronutrient inadequacy linked to diseases of aging? American Journal of Clinical Nutrition, 90(4), 889–907.CrossRefPubMedGoogle Scholar
  42. Mehl-Madrona, L., Leung, B., Kennedy, C., Paul, S., & Kaplan, B. J. (2010). Micronutrients versus standard medication management in autism: A naturalistic case-control study. Journal of Child and Adolescent Psychopharmacology, 20(2), 95–103. doi: 10.1089/cap.2009.0011.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Moffitt, T. E., Caspi, A., Harrington, H., Milne, B. J., Melchior, M., Goldberg, D., & Poulton, R. (2007). Generalized anxiety disorder and depression: Childhood risk factors in a birth cohort followed to age 32. Psychological Medicine, 37(3), 441–452. doi: 10.1017/s0033291706009640.CrossRefPubMedGoogle Scholar
  44. 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. Journal of Traumatic Stress, 19(3), 339–347. doi: 10.1002/jts.20121.CrossRefPubMedGoogle Scholar
  45. Popper, C. W. (2014). Single-micronutrient and broad-spectrum micronutrient approaches for treating mood disorders in youth and adults. Child and Adolescent Psychiatric Clinics of North America, 23(3), 591–672. doi: 10.1016/j.chc.2014.04.001.CrossRefPubMedGoogle Scholar
  46. Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A revised measure of children’s manifest anxiety. Journal of Abnormal Child Psychology, 6, 271–280. doi: 10.1007/BF00919131.CrossRefPubMedGoogle Scholar
  47. Rucklidge, J. J., Andridge, R., Gorman, B., Blampied, N. M., Gordon, H., & Boggis, A. (2012). Shaken but unstirred? Effects of micronutrients on stress and trauma after an earthquake: RCT evidence comparing formulas and doses. Human Psychopharmacology: Clinical and Experimental, 27(5), 440–454. doi: 10.1002/hup.2246.CrossRefGoogle Scholar
  48. Rucklidge, J. J., Blampied, N., Gorman, B., Gordon, H., & Sole, E. (2014). Psychological functioning one year after a brief intervention using micronutrients to treat stress and anxiety related to the 2011 Christchurch earthquakes: A naturalistic follow-up. Human Psychopharmacology: Clinical and Experimental, 29(3), 230–243.CrossRefGoogle Scholar
  49. Rucklidge, J. J., & Blampied, N. M. (2011). Post earthquake functioning in adults with Attention-Deficit/Hyperactivity Disorder: Positive effects of micronutrients on resilience. New Zealand Journal of Psychology, 40(4), 51–57.Google Scholar
  50. Rucklidge, J. J., Frampton, C. M., Gorman, B., & Boggis, A. (2014). Vitamin-mineral treatment of ADHD in adults: A double-blind, randomized, placebo controlled trial. British Journal of Psychiatry, 204, 306–315.CrossRefPubMedGoogle Scholar
  51. Rucklidge, J. J., & Kaplan, B. J. (2013). Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: A systematic review. Expert Review of Neurotherapeutics, 13(1), 49–73. doi: 10.1586/ern.12.143.CrossRefPubMedGoogle Scholar
  52. Rush, A., First, M., & Blacker, D. (2008). Handbook of psychiatric measures. (2nd ed.). Arlington, TX: American Psychiatric Publishing Inc.Google Scholar
  53. Saylor, C. F., Swenson, C. C., Reynolds, S. S., & Taylor, M. (1999). The pediatric emotional distress scale: A brief screening measure for young children exposed to traumatic events. Journal of Clinical Child Psychology, 28(1), 70–81. doi: 10.1207/s15374424jccp2801_6.CrossRefPubMedGoogle Scholar
  54. Shaffer, D., Gould, M. S., & Brasic, J. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231.CrossRefPubMedGoogle Scholar
  55. Sparrow, J. D. (2007). Understanding stress in children. Pediatric Annals, 36(4), 187–194.CrossRefPubMedGoogle Scholar
  56. Sprague, C. M., Kia-Keating, M., Felix, E., Afifi, T., Reyes, G., & Afifi, W. (2015). Youth psychosocial adjustment following wildfire: The role of family resilience, emotional support, and concrete support. Child & Youth Care Forum, 44(3), 433–450. doi: 10.1007/s10566-014-9285-7.CrossRefGoogle Scholar
  57. Stallard, P., Velleman, R., Langsford, J., & Baldwin, S. (2001). Coping and psychological distress in children involved in road traffic accidents. British Journal of Clinical Psychology, 40(Pt 2), 197–208.CrossRefPubMedGoogle Scholar
  58. 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(2), 122–138. doi: 10.1016/j.cpr.2011.12.001.CrossRefPubMedGoogle Scholar
  59. Uemoto, M., Asakawa, A., Takamiya, S., Asakawa, K., & Inui, A. (2012). Kobe earthquake and post-traumatic stress in school-aged children. International Journal of Behavioral Medicine, 19(3), 243–251. doi: 10.1007/s12529-011-9184-3.CrossRefPubMedGoogle Scholar
  60. Usami, M., Iwadare, Y., Kodaira, M., Watanabe, K., Aoki, M., Katsumi, C., et al. (2012). Relationships between traumatic symptoms and environmental damage conditions among children 8 months after the 2011 Japan Earthquake and Tsunami. PloS ONE, 7(11). doi: 10.1371/journal.pone.0050721.
  61. Watson, H. J. (2011). Combined psychological and pharmacological treatment of pediatric anxiety disorders. In D. McKay, E. A. Storch (Eds.), Handbook of child and adolescent anxiety disorders (pp. 379–402). New York, NY: Springer Science+Business Media.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Ellen J. Sole
    • 1
  • Julia J. Rucklidge
    • 1
  • Neville M. Blampied
    • 1
  1. 1.Department of PsychologyUniversity of CanterburyChristchurchNew Zealand

Personalised recommendations