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Perceptions of Trauma and Loss among Children and Adolescents Exposed to Disasters a Mixed-Methods Study

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Abstract

The purpose of the current study was to extend knowledge of youth exposed to multiple disasters and the experience of cumulative childhood adversity by analyzing perceptions of trauma and loss in children and adolescents. A concurrent mixed-methods design was utilized to explore an ethnically diverse, predominantly low-income sample of youth (N = 4,154) aged 8–18 years from three parishes (counties) in Louisiana impacted by Hurricane Katrina and the Gulf Oil Spill. Youth completed assessments of posttraumatic stress symptoms (PTSS), hurricane exposure and oil spill stress, and responded to an open-ended question regarding lifetime trauma and loss. Independent coders assigned responses to 30 categories using a qualitative codebook based on both predetermined and emerging information. Codes were compared and contrasted for meaning and grouped into broader, organizing themes. Themes of trauma and loss included: death and loss of others, threats to life, family disruption, interpersonal trauma, and life transitions. Trauma and loss predicted PTSS when controlling for hurricane exposure and oil spill stress. Most trauma and loss conferred generalized risk regardless of event typology, although interpersonal trauma had unique effects. Findings improve understanding of the nature and extent of trauma and loss among youth exposed to multiple disasters. The use of a mixed-methods design clarifies prior findings in the broader trauma literature and child disaster studies. Through identification of vulnerable subgroups and patterns in perceptions of trauma and loss, findings have important implications for prevention and intervention strategies that promote long-term recovery.

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References

  • Adams, Z. W., Sumnner, J. A., Danielson, C. K., McCauley, J. L., Resnick, H. S., Paul, L. A., Welsh, K. E., & Ruggiero, K. J. (2014). Prevalence and predictors of PTSD and depression among adolescent victims of the Spring 2011 tornado outbreak. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 55(9), 1047–1055. doi:10.1111/jcpp.12220.

    Article  PubMed Central  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Google Scholar 

  • Bradlee, E. H., Curry, L. A., & Devers, K. J. (2007). Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Services Research, 42(4), 1758–1772. doi:10.1111/j.1475-6773.2006.00684.x.

    Article  Google Scholar 

  • Briere, J., Kaltman, S., & Green, B. L. (2008). Accumulated childhood trauma and symptom complexity. Journal of Traumatic Stress, 21(2), 223–226. doi:10.1002/jts.

    Article  PubMed  Google Scholar 

  • Carrion, V. G., Weems, C. F., & Reiss, A. L. (2007). Stress predicts brain changes in children: a pilot longitudinal study on youth stress, posttraumatic stress disorder, and the hippocampus. Pediatrics, 119(3), 509–516. doi:10.1542/peds.2006-2028.

    Article  PubMed  Google Scholar 

  • Carrion, V. G., Weems, C. F., Richert, K., Hoffman, B. C., & Reiss, A. L. (2010). Decreased prefrontal cortical volume associated with increased bedtime cortisol in traumatized youth. Biological Psychiatry, 68(5), 491–493. doi:10.1016/j.biopsych.2010.05.010.

    Article  PubMed Central  PubMed  Google Scholar 

  • Catani, C., Gewirtz, A. H., Wieling, E., Schauer, E., Elbert, T., & Neuner, F. (2010). Tsunami, war, and cumulative risk in the lives of Sri Lankan schoolchildren. Child Development, 81(4), 1176–1191. doi:10.1111/j.1467-8624.2010.01461.x.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2014). Child maltreatment: Facts at a glance. Retrieved from: http://www.cdc.gov/violenceprevention/pdf/childmaltreatment-facts-at-a-glance.pdf. Accessed 10 May 2015.

  • Cloitre, M., Stolbach, B. C., Herman, J. L., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to cumulative PTSD: childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399–408. doi:10.1002/jts.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1960). A coefficient of agreement for nominal scales. Education and Psychological Measurement, 20(1), 37–46. doi:10.1177/001316446002000104.

    Article  Google Scholar 

  • Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Sprague, C., & Cloitre, M. et al (2007). Cumulative trauma in children and adolescents. Focal Point: Research, Policy, and Practice in Children’s Mental Health, 21(1), 4–8.

  • Costello, E., Erklani, A., Fairbank, J. A., & Angold, A. (2002). The prevalence of potentially traumatic events in childhood and adolescence. Journal of Trauma Stress, 15(2), 99–112.

    Article  Google Scholar 

  • Couch, S. R., & Coles, C. J. (2011). Community stress, psychosocial hazards, and EPA decision-making in communities impacted by chronic technological disasters. American Journal of Public Health, 101(Suppl), S140–S148. doi:10.2105/AJPH.2010.300039.

    Article  PubMed Central  PubMed  Google Scholar 

  • Creamer, M., McFarlane, A. C., & Burgess, P. (2005). Psychopathology following trauma: the role of subjective experience. Journal of Affective Disorders, 86(2–3), 175–182. doi:10.1016/j.jad.2005.01.015.

    Article  PubMed  Google Scholar 

  • Creswell, J. M. (2013). Research design: Qualitative, quantitative, and mixed-methods approaches (4th ed.). Los Angeles: Sage.

    Google Scholar 

  • Creswell, J. W., & Zhang, W. (2009). The application of mixed methods designs to trauma research. Journal of Traumatic Stress, 22(6), 612–621. doi:10.1002/jts.20479.

    PubMed  Google Scholar 

  • D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van de Kolk, B. A. (2012). Understanding interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis. The American Journal of Orthospsychiatry, 82(2), 187–200.

    Article  Google Scholar 

  • Dierkhising, C. B., Ko, S. J., Woods-Jaeger, B., Briggs, E., Lee, R., & Pynoos, R. S. (2013). Trauma histories among justice-involved youth: findings from the National Child Traumatic Stress Network. European Journal of Psychotraumatology, 4, 20274. doi:10.3402/ejpt.v4i0.20274.

    Article  Google Scholar 

  • Enlow, M. B., Blood, E., & Egeland, B. (2013). Sociodemographic risk, developmental competence, and PTSD symptoms in young children exposed to interpersonal trauma in early life. Journal of Traumatic Stress, 26, 686–694. doi:10.1002/jts.

    Article  PubMed Central  PubMed  Google Scholar 

  • Forbes, D., Fletcher, S., Parslow, R., Phelps, A., O’Donnell, M., Bryant, R., McFarlane, A., Silove, D., & Creamer, M. (2012). Trauma at the hands of another: longitudinal study of differences in the posttraumatic stress disorder symptom profile following interpersonal compared with noninterpersonal trauma. The Journal of Clinical Psychiatry, 73(3), 372–376. doi:10.4088/JCP.10m06640.

    Article  PubMed  Google Scholar 

  • Frederick, C., Pynoos, R. S., & Nader, K. O. (1992). Childhood Post-Traumatic Stress Reaction Index (CPTS-RI). Unpublished manuscript, University of California, Los Angeles.

  • Furr, J. M., Comer, J. S., Edmunds, J. M., & Kendall, P. C. (2010). Disasters and youth: a meta-analytic examination of posttraumatic stress. Journal of Consulting and Clinical Psychology, 78(6), 765–780. doi:10.1037/a0021482.

    Article  PubMed  Google Scholar 

  • Gershon, R. R., Rubin, M. S., Qureshi, K. A., Canton, A. N., & Matzner, F. J. (2008). Participatory action research methodology in disaster research: results from the World Trade Center evacuation study. Disaster Medicine and Public Health Preparedness, 2, 142–149. doi:10.1097/DMP.0b013e318184b48f.

    Article  PubMed  Google Scholar 

  • Gil-Rivas, V., & Kilmer, R. P. (2014). Children’s adjustment following Hurricane Katrina: the role of primary caregivers. The American Journal of Orthopsychiatry, 83(2 Pt 3), 413–421. doi:10.1111/ajop.12016.

    Google Scholar 

  • Greeson, J. K. P., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake, G. S., Ko, S. J., & Gerrity, E. T., et al (2011). Cumulative trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91–108. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22533044.

  • Greeson, J. K. P., Briggs, E. C., Layne, C. M., Belcher, H. M. E., Ostrowski, S. A., Lee, R. C., Vivrette, R. L., Pynoos, R. S., & Fairbank, J. A. (2014). Traumatic childhood experiences in the 21st century: broadening and building on the ACE studies with data from the National Child Traumatic Stress Network. Journal of Interpersonal Violence, 29(3), 536–556. doi:10.1177/0886260513505217.

    Article  PubMed  Google Scholar 

  • Guest, G., MacQueen, K., & Namey, E. (2012). Applied thematic analysis. Thousand Oaks: SAGE Publications, Inc.

    Book  Google Scholar 

  • Hansel, T. C., Osofsky, J. D., Osofsky, H. J., & Friedrich, P. (2013). The effect of long-term relocation on child and adolescent survivors of Hurricane Katrina. Journal of Traumatic Stress, 26, 613–620. doi:10.1002/jts.

    Article  PubMed  Google Scholar 

  • Hansel, T. C., Osofsky, J. D., & Osofsky. (2015). Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS): psychometric testing of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool. Child and Youth Care Forum. doi:10.1007/s10566-015-9313-2.

    Google Scholar 

  • Kar, N. (2009). Psychological impact of disasters on children: review of assessment and interventions. World Journal of Pediatrics, 5(1), 5–11. doi:10.1007/s12519-009-0001-x.

    Article  PubMed  Google Scholar 

  • Kerns, C. E., Elkins, R. M., Carpenter, A. L., Chou, T., Green, J. G., & Comer, J. S. (2014). Caregiver distress, shared traumatic exposure, and child adjustment among area youth following the 2013 Boston Marathon bombing. Journal of Affective Disorders, 167, 50–55. doi:10.1016/j.jad.2014.05.040.

    Article  PubMed Central  PubMed  Google Scholar 

  • KIDS COUNT. (2013). Data book: State trends in child well-being. [Pamphlet]. Baltimore: The Annie E. Casey Foundation.

    Google Scholar 

  • Kronenberg, M. E., Hansel, T. C., Brennan, A. M., Osofsky, H. J., Osofsky, J. D., & Lawrason, B. (2010). Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns. Child Development, 81(4), 1241–1259. doi:10.1111/j.1467-8624.2010.01465.x.

    Article  PubMed  Google Scholar 

  • La Greca, A. M., Silverman, W. K., Vernberg, E. M., & Prinstein, M. (1996). Symptoms of posttraumatic stress after Hurricane Andrew: a prospective study. Journal of Consulting and Clinical Psychology, 64, 712–723.

    Article  PubMed  Google Scholar 

  • La Greca, A. M., Silverman, W. K., & Wasserstein, S. B. (1998). Children’s predisaster functioning as a predictor of posttraumatic stress following Hurricane Andrew. Journal of Consulting and Clinical Psychology, 6, 883–892.

    Article  Google Scholar 

  • Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.

    Article  PubMed  Google Scholar 

  • Luthra, R., Abramovitz, R., Greenberg, R., Schoor, A., Newcorn, J., Schmeidler, J., Levine, P., Nomura, Y., & Chemtob, C. M. (2009). Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents. Journal of Interpersonal Violence, 24(11), 1919–1927. doi:10.1177/0886260508325494.

    Article  PubMed  Google Scholar 

  • Masten, A. S. (2014). Ordinary magic: Resilience in development. New York: Guilford.

    Google Scholar 

  • Masten, A. S., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22(3), 491–495. doi:10.1017/S0954579410000222.

    Article  PubMed  Google Scholar 

  • Masten, A. S., & Osofsky, J. D. (2010). Disasters and their impact on child development: introduction to the special section. Child Development, 81(4), 1029–1039. doi:10.1111/j.1467-8624.2010.01452.x.

    Article  PubMed  Google Scholar 

  • Masten, A. S., Narayan, A. J., Silverman, W. K., & Osofsky, J. D. (2015). Children in war and disaster. In R. M. Lerner, M. H. Bornstein, & T. Leventhal (Eds.), Handbook of child psychology and developmental science. Vol. 4. Ecological settings and processes in developmental systems (7th ed., pp. 704–745). New York: Wiley.

    Google Scholar 

  • McIntyre, A. (2000). Constructing meaning about violence, school, and community: participatory action research with urban youth. The Urban Review, 32(2), 123–154. doi:10.1023/A:1005181731698.

    Article  Google Scholar 

  • Mullet-Hume, E., Anshel, D., Guevara, V., & Cloitre, M. (2008). Cumulative trauma and posttraumatic stress disorder among children exposed to the 9/11 World Trade Center attack. American Journal of Orthopsychiatry, 78(1), 103–108.

    Article  Google Scholar 

  • National Center for Disaster Preparedness. (2010). Impact on children and families of the Deepwater Horizon Oil Spill. NCDP Research Brief, 2010_08.

  • National Child Traumatic Stress Network. (2005). Hurricane assessment and referral tool for children and adolescents. Retrieved from http://www.nctsnet.org/nctsn_assets/pdfs/intervention_manuals/referraltool.pdf. Accessed 5 Feb 2015.

  • Navarro, J., Puildo, R., Berger, C., Arteaga, M., Osofsky, H. J., Martinez, M., Osofsky, J. D., & Hansel, T.C. (2014). Children’s disaster experiences and psychological symptoms: an international comparison between the Chilean earthquake and tsunami and Hurricane Katrina. International Social Work, 1–14. doi:10.1177/0020872814537850.

  • Osofsky, H. J., & Osofsky, J. D. (2013). Hurricane Katrina and the Gulf Oil Spill: lessons learned. The Psychiatric Clinics of North America, 36(3), 371–383. doi:10.1016/j.psc.2013.05.009.

    Article  PubMed  Google Scholar 

  • Osofsky, H., Palinkas, L. A., & Galloway, J. M. (2010). Mental health effects of the Gulf Oil Spill. Disaster Medicine and Public Health Preparedness, 4(4), 3–5.

    Article  Google Scholar 

  • Osofsky, H. J., Osofsky, J. D., & Hansel, T. C. (2011). Deepwater Horizon Oil Spill: mental health effects. Disaster Medicine and Public Health Preparedness, 5(4), 280–286.

    Article  PubMed  Google Scholar 

  • Osofsky, J. D., Osofsky, H. J., Weems, C. F., Hansel, T. C., & King, L. S. (2014). Effects of stress related to the Gulf Oil Spill on child and adolescent mental health. Journal of Pediatric Psychology. doi:10.1093/jpepsy/jsu085.

    PubMed  Google Scholar 

  • Palinkas, L. A. (2014). Qualitative and mixed methods in mental health services and implementation research. Journal of Clinical Child & Adolescent Psychology, 43(6), 851–861. doi:10.1080/15374416.2014.910791.

    Article  Google Scholar 

  • Pfefferbaum, B., Weems, C. F., Scott, B. G., Nitiéma, P., Noffsinger, M. A., Pfefferbaum, R., Varma, V., & Chakraburtty, A. (2013). Research methods in child disaster studies: a review of studies generated by the September 11, 2001, terrorist attacks; the 2004 Indian Ocean Tsunami; and Hurricane Katrina. Child & Youth Care Forum, 42(4), 285–337. doi:10.1007/s10566-013-9211-4.

    Article  Google Scholar 

  • Rhodes, J., Chan, C., Paxson, C., Rouse, C. E., Waters, M., & Fussell, E. (2012). The impact of Hurricane Katrina on the mental and physical health of low-income parents in New Orleans. American Journal of Orthopsychiatry, 80(2), 237–247. doi:10.1111/j.1939-0025.2010.01027.x.

    Article  Google Scholar 

  • Scheeringa, M. S., Zeanah, C. H., & Cohen, J. A. (2011). PTSD in children and adolescents: toward an empirically based algorithm. Depression and Anxiety, 28(9), 770–782. doi:10.1002/da.20736.

    Article  PubMed  Google Scholar 

  • Self-Brown, S., Lai, B. S., Harbin, S., & Kelley, M. L. (2014). Maternal posttraumatic stress disorder symptom trajectories following Hurricane Katrina: an initial examination of the impact of maternal trajectories on the well-being of disaster-exposed youth. International Journal of Public Health, 59(6), 957–965. doi:10.1007/s00038-014-0596-0.

    Article  PubMed  Google Scholar 

  • Shonkoff, J. P., & Garner, A. S. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232–e246. doi:10.1542/peds.2011-2663.

    Article  PubMed  Google Scholar 

  • Southam-Gerow, M. A., & Dorsey, S. (2014). Qualitative and mixed methods research in dissemination and implementation science: introduction to the special issue. Journal of Clinical Child and Adolescent Psychology, 43(6), 845–850. doi:10.1080/15374416. 2014.930690.

    Article  PubMed  Google Scholar 

  • Taylor, L. K., & Weems, C. F. (2009). What do youth report as a traumatic Event? Toward a developmentally informed classification of traumatic stressors. Psychological Trauma: Theory, Research, Practice and Policy, 1(2), 91–106. doi:10.1037/a0016012.

    Article  Google Scholar 

  • Taylor, L. K., Weems, C. F., Costa, N. M., & Carrion, V. G. (2009). Loss and the experience of emotional distress in childhood. Journal of Loss and Trauma, 14(1), 1–16. doi:10.1080/15325020802173843.

    Article  Google Scholar 

  • Van den Bergh, B. R. H. (2011). Developmental programming of early brain and behaviour development and mental health: a conceptual framework. Developmental Medicine and Child Neurology, 53(Suppl 4), 19–23. doi:10.1111/j.1469-8749.2011.04057.x.

    Article  PubMed  Google Scholar 

  • Verlinden, E., Schippers, M., Van Meijel, E. P. M., Beer, R., Opmeer, B. C., Olff, M., Boer, F., & Lindauer, R. J. (2013). What makes a life event traumatic for a child? The predictive values of DSM-Criteria A1 and A2. European Journal of Psychotraumatology, 4, 1–8. doi:10.3402/ejpt.v4i0.20436.

    Article  Google Scholar 

  • Vernberg, E. M., LaGreca, A. M., Silverman, W. K., & Prinstein, M. (1996). Predictors of children’s post-disaster functioning following Hurricane Andrew. Journal of Abnormal Psychology, 105, 237–248.

    Article  PubMed  Google Scholar 

  • Wang, C. W., Chan, C. L., & Ho, R. T. (2013). Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: a systematic review of epidemiological studies across 1987–2011. Social Psychiatry and Psychiatric Epidemiology, 48(11), 1697–1720.

    Article  PubMed  Google Scholar 

  • Weems, C. F., & Costa, N. M. (2005). Developmental differences in the expression of childhood anxiety symptoms and fears. Journal of the American Academy of Child and Adolescent Psychiatry, 44(7), 656–663. doi:10.1097/01.chi.0000162583.25829.4b.

    Article  PubMed  Google Scholar 

  • Weems, C. F., & Graham, R. A. (2014). Resilience and trajectories of posttraumatic stress among youth exposed to disaster. Journal of Child and Adolescent Psychopharmacology, 24(1), 2–8. doi:10.1089/cap.2013.0042.

    Article  PubMed  Google Scholar 

  • Weems, C. F., Taylor, L. K., Cannon, M. F., Marino, R. C., Romano, D. M., Scott, B. G., Perry, A. M., & Triplett, V. (2010). Posttraumatic stress, context, and the lingering effects of the Hurricane Katrina disaster among ethnic minority youth. Journal of Abnormal Child Psychology, 38(1), 49–56. doi:10.1007/s10802-009-9352-y.

    Article  PubMed  Google Scholar 

  • Weems, C. F., Scott, B. G., Banks, D. M., & Graham, R. A. (2012). Is T.V. traumatic for all youths? The role of preexisting posttraumatic stress symptoms in the link between disaster coverage and stress. Psychological Science, 23(11), 1293–1297. doi:10.1177/0956797612446952.

    Article  PubMed  Google Scholar 

  • Weems, C. F., Scott, B. G., Russell, J. D., Reiss, A. L., & Carrion, V. G. (2013). Developmental variation in amygdala volumes among children with posttraumatic stress. Developmental Neuropsychology, 38(7), 481–495. doi:10.1080/87565641.2013.820307.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research is partially supported as a component of the Gulf Region Health Outreach Program developed jointly by BP and the Plaintiffs’ Steering Committee as part of the Deepwater Horizon Medical Benefits Class Action Settlement, which was approved by the U.S. District Court in New Orleans on January 11, 2013 and became effective on February 12, 2014 and SAMHSA Grant # 5U79SM6203 to the Louisiana Rural Trauma Services Center, Baptist Community Ministries, and the Robert Wood Johnson Foundation. Appreciation is expressed to the LSU Health Sciences Center Department of Psychiatry team that worked on this project.

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  1. Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Lucy S. King, Joy D. Osofsky, Howard J. Osofsky, Tonya C. Hansel & Gregory M. Fassnacht

  2. Department of Psychology, University of New Orleans, New Orleans, LA, USA

    Carl F. Weems

  3. Department of Psychology, Stanford University, Stanford, CA, USA

    Lucy S. King

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  1. Lucy S. King
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Correspondence to Lucy S. King.

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King, L.S., Osofsky, J.D., Osofsky, H.J. et al. Perceptions of Trauma and Loss among Children and Adolescents Exposed to Disasters a Mixed-Methods Study. Curr Psychol 34, 524–536 (2015). https://doi.org/10.1007/s12144-015-9348-4

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