Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients
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.
KeywordsAnxiety Stress Earthquake Natural disaster Micronutrients Children
- 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
- 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
- Barlow, D. H. (2000). Anxiety and its disorders (2nd ed.). New York, NY: Guilford.Google Scholar
- 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
- 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
- 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.
- 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
- 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
- Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson.Google Scholar
- Cumming, G. (2012). Understanding the new statistics: Effect sizes, confidence intervals, and meta-analysis. New York: Routledge.Google Scholar
- Friedberg, R. G., McCLure, J. M., & Garcia, J. H. (2009). Cognitive therapy techniques for children and adolescents. New York, NY: Guilford.Google Scholar
- 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
- 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
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- Rush, A., First, M., & Blacker, D. (2008). Handbook of psychiatric measures. (2nd ed.). Arlington, TX: American Psychiatric Publishing Inc.Google Scholar
- 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
- 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.