Disaster-related PTSD may persist for decades, but psychotherapy soon after helps
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PTSD and depressive symptoms may persist for decades among adolescent survivors of a catastrophic natural disaster, according to study findings published in Psychological Medicine. Researchers noted that those who received psychotherapy soon after a disaster experienced health benefits into adulthood.
“School-based screening of children for PTSD and depression, as well as the provision of trauma- and grief-focused therapy, after a major disaster is strongly recommended,” Armen K. Goenjian, MD, LDFAPA, of the department of psychiatry and biobehavioral sciences at the University of California, Los Angeles, told Healio Psychiatry. “These types of interventions have the potential to benefit generations of adolescents over their transition to adulthood. In addition, the alleviation of post-disaster adversities, the improvement of social ecology and monitoring for chronic medical illnesses are considered essential components of post-disaster recovery programs.”
According to the researchers, most prospective disaster studies conducted among children and adolescents do not have treatment outcome data beyond 12 months. They also noted a lack of research on the natural course and predictors of the psychological sequelae beyond a decade, mainly because of difficulties inherent in conducting longer-term post-disaster research.
To address this research gap, Goenjian and colleagues assessed data at 1.5 and 25 years on 142 early adolescent survivors of a 1988 earthquake in Armenia. They included survivors from two Armenian cities — Gumri, which had moderate-to-severe exposure, and Spitak, which had very severe exposure. The Spitak group included untreated survivors, whereas the Gumri group included treated and untreated survivors. The researchers assessed outcomes using instruments including DSM-III-R PTSD-Reaction Index (PTSD-RI), DSM-5 PTSD-Checklist (PCL), Depression Self-Rating Scale (DSRS) and Center for Epidemiological Studies-Depression Scale (CES-D).
Goenjian and colleagues found PTSD mean scores and rates decreased more than 50% in the three groups between 1.5 and 25 years after the earthquake. At 25 years, however, 9.1% to 22.4% of participants met DSM-5 PTSD criteria. The Spitak group had higher DSRS and PTSD-RI scores compared with the Gumri-untreated group at 1.5 years. However, the Spitak group that had experienced significantly fewer adversities after the earthquake had lower CES-D scores and a greater decrease in PTSD-RI scores at 25 years. The Gumri-treated group that had no differences in PTSD-RI and DSRS scores compared with the Gumri-untreated at 1.5 years exhibited lower mean PTSD-RI, CES-D and PCL scores, as well as a greater decrease in PTSD-RI scores, at 25 years. The researchers noted that home destruction, chronic medical illnesses and post-earthquake adversities were risk factors for PTSD, while social support and trauma grief-focused therapy were protective factors at 25 years.
“Clinicians should assess for exposure to trauma in patients’ histories because many who have been exposed to trauma may be unwilling to talk about it,” Goenjian said. “Further, clinicians can use brief questionnaires to assess for history of exposure to trauma and determine its severity, and then administer a brief PTSD and depression questionnaire to assess the need for treatment.” – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.