Posttraumatic stress reactions of Norwegian children and families after the Southeast Asian tsunami

Abstract

On December 26, 2004, the deadliest tsunami in recorded history hit Southeast Asia and killed approximately 230,000 people. Approximately 4,000 Norwegians were in the affected area, most of whom were tourists, and many had horrific experiences. Fifty-eight Norwegian adults and 26 Norwegian children were killed. Previous research has indicated that both adults and children may develop posttraumatic stress disorder (PTSD) in the aftermath of natural disasters. However, the etiology of posttraumatic stress reactions in children and families are relatively unknown, and no studies have investigated PTSD among natural disaster victims who evacuated from the disaster area to intact homes and communities. <br> The main objective of the present study is to expand the knowledge about the factors that contribute to the development of and recovery from posttraumatic stress reactions following a single traumatic event from a child and family perspective. The results are based on quantitative information from interviews with Norwegian children (6 to 17 years of age) conducted 10 months and 2 ½ years post-tsunami and questionnaires completed by adults six months and two years after the tsunami. The thesis includes three longitudinal and two cross-sectional studies. <br> Most of the children and adults who participated in the study had been exposed to a potentially traumatizing event. However, Paper I found that the children in the current sample had low levels of posttraumatic stress reactions 10 months after the tsunami compared to the children in studies of tsunami victims living in the disaster area. There was a significant decrease in the level of reactions at 2 ½ years. Thus, most children who experienced a single natural disaster and were protected against many secondary adversities did not have serious longitudinal stress reactions related to the traumatic event. <br> Levels of posttraumatic stress reactions at 10 months after the tsunami were related to the trauma experiences, whereas the levels of reactions at 2 ½ years post-tsunami were related to gender, the receipt of professional help for mental health problems before the tsunami, tsunami-related parental sick leave, and the death of family members (Paper I). Thus, factors related to levels of posttraumatic stress reactions seemed to shift over time from tsunami-related features to features related to general mental health. Family cohesion and expressiveness were not found to be related to children’s levels of posttraumatic stress reactions (Paper I). Marital and parental statuses were also not found to be related to the level of posttraumatic stress reactions in adults (Paper IV). However, the levels of children’s posttraumatic stress reactions were found to be related to their parents’ levels of posttraumatic stress (Paper II). Other studies have also related a wide range of family factors to children’s levels of stress reactions. Thus, it was surprising to find that siblings’ posttraumatic stress reactions were not significantly similar (Paper III). Indeed, siblings’ reactions varied as much as the reactions of unrelated children did. Differences between the stress reactions of siblings have only been investigated in one previous study, in which siblings’ reactions were also found to be dissimilar. <br> Although the self-reported reactions among siblings were unrelated, parents reported similar reactions among their children (Paper II). This result indicates that parental reports of children’s posttraumatic stress reactions may be biased. <br> Three previous studies have reported similarities between the reactions of the members of couples following disasters, though none of these studies specifically investigated posttraumatic stress reactions. Adults in the present study who lived in same household reported posttraumatic stress reactions that were more alike than those of adults who were not living together (Paper IV). <br> The findings indicate that family members may influence each other in the aftermath of a natural disaster. However, it is probable that adults and children are influenced differently, with adults in a family having a greater tendency for convergence in their definitions of the events and in their posttraumatic stress reactions than siblings do. Thus, the results indicate that treatments for adults with posttraumatic stress reactions should incorporate a family perspective. However, the results also indicate that children’s need for help may vary considerably within the family. While it is often important to incorporate parents in the treatment of children, the current study offers little evidence in support of including siblings in the treatment of an individual child. <br> There is an ongoing discussion of the definition of PTSD in the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The last paper (Paper V) of the present thesis contributes to knowledge of two themes: how the symptom criteria should be grouped and the potential overlap between posttraumatic stress reactions and other mental ailments. A four-factor model using the symptoms of intrusion, avoidance, numbing, and arousal was found to describe children’s posttraumatic stress reactions better than the present three-factor model specified in the current diagnostic manual, DSM-IV-TR. This study also found a significant overlap between general mental health problems and posttraumatic stress reactions, especially for mental health problems that were associated with arousal symptoms. <br> The participants had very different experiences compared to disaster victims who were not protected against common secondary adversities and compared to people who experience interpersonal violence or longitudinal exposure to traumatic events. Thus, care should be taken when generalizing from the present study to other groups of children and families who experience potentially traumatic events.