Research reportImpact of traumatic loss on post-traumatic spectrum symptoms in high school students after the L'Aquila 2009 earthquake in Italy
Introduction
Earthquakes are one of the major natural disasters of the contemporary era, often striking unexpectedly, threatening lives and leading to large scale destruction (Bland et al., 2005, Bödvarsdottir and Elklit, 2004, Chang et al., 2005, Lai et al., 2004, McFarlane, 2010, Önder et al., 2006, Priebe et al., 2010, Pynoos et al., 1998, Su et al., 2010).
Italy is one of the most seismically active countries in Europe and despite minor tremors that are common, it is unusual for the country to experience deadly earthquakes. On April 6th 2009, at 3:32 a.m., an earthquake (Richter Magnitude 6.3) struck L'Aquila, Italy, a town with a population of 72,000 residents and a health district of 105,000 residents. In the town of L'Aquila many buildings collapsed and large parts of the town were destroyed. The L'Aquila earthquake caused the death of 309 people, with more than 1,600 individuals injured among whom 200 were severely injured and hospitalized, and 66,000 displaced.
For children and adolescents, as for adults, the psychopathology following natural disasters, such as earthquakes, is mostly represented by post-traumatic stress disorder (PTSD). In a previous study (Dell'Osso et al., 2011a), we first reported the rates of full and partial PTSD among 512 students who survived the L'Aquila 2009 earthquake 10 months after exposure. Consistently with previous findings in adolescent and young adult populations (Bal and Jensen, 2007, Cohen, 2008, Cohen and Scheeringa, 2009, Foa et al., 2006, Goenjian et al., 2009, Green, 2003, Lai et al., 2004, McFarlane et al., 2009, Najarian et al., 2001, Pratchett et al., 2010, Pynoos et al., 1993), we reported a diagnosis of PTSD in 37.5% of the students, with significantly higher rates in women than men, and of partial PTSD in an additional 29.9% of the sample. Women also presented significantly higher PTSD symptoms with respect to men.
Extensive research has been conducted on factors influencing the onset of PTSD symptoms after earthquake exposure and traumatic bereavement seems to represent one of the most relevant events both in adolescents and adults (Cao et al., 2003, Goenjian et al., 1994, Hsu et al., 2002, Johannesson et al., 2009, Kiliç and Ulusoy, 2003, Kristensen et al., 2009, Kun et al., 2009a, Kun et al., 2010, Liu et al., 2011, Parvaresh and Bahramnezhad, 2009, Su et al., 2010, Wang et al., 2009a, Wang et al., 2009b). In this regard, Armenian et al. (2000) reported loss as a major determinant of PTSD in a large population sample of subjects exposed to the 1988 earthquake in the Northern part of the Armenian Republic. In a sample of 323 junior high school students, victims of the 1999 earthquake in Taiwan, Hsu et al. (2002) found that being physically injured and experiencing the death of a close family member were the two major risk factors for PTSD 6 weeks after the earthquake. Parvaresh and Bahramnezhad (2009) detected the onset of PTSD in 36.3% of 433 students who survived the 2003 Bam (Iran) earthquake and reported the loss of family members to form one of the major bases for developing post-disaster psychopathology. Nevertheless, conflicting results were recently reported by Goenjian et al. (2009) in a study on 48 parentally bereaved adolescents 6 and 1/2 years after the Spitak earthquake in northern Armenia. The authors reported in fact the loss of both parents and, to a lesser degree, the loss of a father to be a significant risk factor for depression but not for PTSD.
The aim of this study was to investigate, in a sample of adolescents exposed to the L'Aquila 2009 earthquake 21 months earlier, whether the loss of close friends or relatives in the framework of the earthquake was associated with higher full or partial PTSD rates or post-traumatic symptom levels.
Section snippets
Study participants
The target population was the residents attending the last year of high school in L'Aquila, who had experienced, 21 months earlier, the April 6th 2009 earthquake.
All subjects were living in L'Aquila before the earthquake; all of them had been exposed to the earthquake and its consequences. The school council approved the project with recruitment and assessment procedures. All eligible subjects provided informed consent after receiving a complete description of the study and having an opportunity
Results
Full data were available for 475 adolescents (94.2% of the overall sample), 203 women and 272 men. The subjects had a mean age of 17.66 ± 0.78 years (17.55 ± 0.65 and 17.75 ± 0.86 years in women and men, respectively).
Within this sample 146 (30.7%) subjects presented a diagnosis of PTSD according to DSM-IV-TR (APA, 2000) criteria with a significant difference (χ2 = 44.28, p < 0.001) between women (N = 96, 47.3%) and men (N = 50, 18.4%). Other 149 (31.4%) subjects fulfilled the criteria for partial PTSD with a
Discussion
This study was conducted 21 months after a major devastating earthquake. The results of the present study showed a PTSD diagnosis in 30.7% of the adolescents recruited among those attending the last year of high school, and a diagnosis of partial PTSD in a further 31.4% of subjects. These data are in agreement with previous reports on earthquake young adult survivors (Bland et al., 2005, Bödvarsdottir and Elklit, 2004). Consistently with the literature (Lai et al., 2004), we also found that
Role of funding source
No pharmaceutical company supported the present study, all support are derived from the funding of the Department of Experimental Medicine (Section of Psychiatry), of the University of L'Aquila (L'Aquila, Italy), and of the Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology of the University of Pisa (Pisa, Italy), for observational and clinical studies.
Conflict of interest
The authors declare that they have no grant and pharmaceutical support, affiliations, and honoraria received for past and present material.
References (46)
Helping adolescents affected by war, trauma, and displacement
J. Am. Acad. Child Adolesc. Psychiatry
(2008)- et al.
A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR)
Compr. Psychiatry
(2009) - et al.
Full and partial PTSD among young adult survivors 10 months after the L'Aquila 2009 earthquake: gender differences
J. Affect. Disord.
(2011) - et al.
Depression and PTSD symptoms among bereaved adolescents 6(1/2) years after the 1988 Spitak earthquake
J. Affect. Disord.
(2009) - et al.
Posttraumatic stress disorder among adolescent earthquake victims in Taiwan
J. Am. Acad. Child Adolesc. Psychiatry
(2002) - et al.
Prevalence of post-traumatic stress disorder in Sichuan Province, China after the 2008 Wenchuan earthquake
Public Health
(2009) - et al.
Public health status and influence factors after 2008 Wenchuan earthquake among survivors in Sichuan province, China: cross-sectional trial
Public Health
(2010) - et al.
Full and partial PTSD among earthquake survivors in rural Taiwan
J. Psychiatr. Res.
(2004) - et al.
Trauma and violence: are women the weaker sex?
Psychiatr. Clin. N. Am.
(2010) - et al.
A public mental health approach to the postdisaster treatment of children and adolescents
Child Adolesc. Psychiatr. Clin. N. Am.
(1998)
Diagnostic and Statistical Manual of Mental Disorders
Loss as a determinant of PTSD in a cohort of adult survivors of the 1988 earthquake in Armenia: implications for policy
Acta Psychiatr. Scand.
Post-traumatic stress disorder symptom clusters in Turkish child and adolescent trauma survivors
Eur. Child Adolesc. Psychiatry
Long-term follow-up of psychological distress following earthquake experiences amongst working Italian males: a cross-sectional analysis
J. Nerv. Ment. Dis.
Psychological reactions in Icelandic earthquake survivors
Scand. J. Psychol.
Partial PTSD versus full PTSD: an empirical examination of associated impairment
Psychol. Med.
Prevalence of psychiatric disorder following the 1988 Yun Nan (China) earthquake—the first 5-month period
Soc. Psychiatry Psychiatr. Epidemiol.
Predictors of posttraumatic outcomes following the 1999 Taiwan earthquake
J. Nerv. Ment. Dis.
Post-traumatic stress disorder diagnosis in children: challenges and promises
Dialogues Clin. Neurosci.
Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS)
Clin. Pract. Epidemol. Ment. Health
Complicated grief and suicidality: the impact of subthreshold mood symptoms
CNS Spectr.
Symptomatology and psychopathology of mental health problems after disaster
J. Clin. Psychiatry
Posttraumatic stress disorder in elderly and younger adults after the 1988 earthquake in Armenia
Am. J. Psychiatry
Cited by (75)
Longitudinal changes in trauma narratives over the first year and associations with coping and mental health
2020, Journal of Affective DisordersAdult Autism Subthreshold Spectrum (AdAS Spectrum) in parents of pediatric patients with epilepsy: Correlations with post-traumatic stress symptoms
2018, Comprehensive PsychiatryCitation Excerpt :Nevertheless, this is the first study exploring the possible relationships between Post-Traumatic Stress Spectrum symptoms and Subthreshold Autism Spectrum symptoms among parents of children with a diagnosis of epilepsy. In line with existing literature on other trauma exposed populations [23–27], our results showed higher PTSD rates among women with respect to men with a 10.4% of parents (13,3% of the mothers and 4.5% of the fathers) presenting PTSD and a further 37.3% (43.3% of the mothers and 25.0% of the fathers) presenting partial forms of the disorder. These findings corroborate also a previous study of some of us on a smaller sample [22] as well as the scant literature on parents exposed to a severe illness of a child [28].