Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane Mitch.
OBJECTIVE
This study determined the severity of posttraumatic stress and depressive reactions among Nicaraguan adolescents after Hurricane Mitch and the relationship of these reactions to objective and subjective features of hurricane exposure, death of a family member, forced relocation, and thoughts of revenge.


METHODS
Six months after the hurricane, 158 adolescents from three differentially exposed cities were evaluated by using a hurricane exposure questionnaire, the Child Posttraumatic Stress Disorder Reaction Index, and the Depression Self-Rating SCALE:


RESULTS
Severe levels of posttraumatic stress and depressive reactions were found among adolescents in the two most heavily affected cities. Severity of posttraumatic stress and depressive reactions and features of objective hurricane-related experiences followed a "dose-of-exposure" pattern that was congruent with the rates of death and destruction across cities. Level of impact (city), objective and subjective features, and thoughts of revenge accounted for 68% of the variance in severity of posttraumatic stress reaction. Severity of posttraumatic stress reaction, death of a family member, and sex accounted for 59% of the variance in severity of depression.


CONCLUSIONS
After a category 5 hurricane, adolescents in heavily affected areas with extreme objective and subjective hurricane-related traumatic features of exposure experience severe and chronic posttraumatic stress and comorbid depressive reactions. The recovery of the severely affected Nicaraguan adolescents is vital to the social and economic recovery of a country ravaged by years of political violence and poverty. These findings strongly indicate the need to incorporate public mental health approaches, including systematic screening and trauma/grief-focused interventions, within a comprehensive disaster recovery program.
Goenjian
A K
AK
Trauma Psychiatry Program, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, CA, USA. agoenjia@aol.com
Molina
L
L
Steinberg
A M
AM
Fairbanks
L A
LA
Alvarez
M L
ML
Goenjian
H A
HA
Pynoos
R S
RS
D000275:Adjustment Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D000293:Adolescent; D000367:Age Factors; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D004190:Disasters / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D009527:Nicaragua / Q000453:epidemiology; D011336:Probability; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012044:Regression Analysis; D012720:Severity of Illness Index; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology