A prospective study of posttraumatic stress and depressive reactions among treated and untreated adolescents 5 years after a catastrophic disaster.
OBJECTIVE
This study evaluated 1) the natural course of posttraumatic stress and depressive reactions among untreated adolescents from two cities in an earthquake zone (Gumri and Spitak) and one at the periphery (Yerevan) who were differentially exposed to the 1988 Spitak earthquake in Armenia and 2) the effectiveness of brief trauma/grief-focused psychotherapy among adolescents from Gumri.


METHODS
One hundred twenty-five adolescents were assessed with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Depression Self-Rating Scale (DSRS) at 1.5 and 5 years postearthquake. At 1.5 years, trauma/grief-focused group and individual psychotherapy was provided over 6 weeks to a group of students in Gumri.


RESULTS
CPTSD-RI scores among untreated adolescents from Gumri and Spitak subsided significantly but mildly at follow-up, with scores from Spitak, the city at the epicenter, remaining above the cutoff for a diagnosis of PTSD. DSRS scores increased mildly in both earthquake cities but only significantly in Gumri. Among treated adolescents in Gumri, improvement in CPTSD-RI scores was three times that of the untreated Gumri comparison group. The treated group also tended to improve on their DSRS scores, whereas these scores worsened significantly among untreated subjects.


CONCLUSIONS
Untreated adolescents exposed to severe trauma are at risk for chronic PTSD and depressive symptoms. Brief trauma/grief-focused psychotherapy is effective in reducing PTSD symptoms and halting the progression of depression. This study supports the implementation of mental health intervention programs in schools after disasters to reduce trauma-related psychopathology.
Goenjian
Armen K
AK
UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA. agoenjia@aol.com
Walling
David
D
Steinberg
Alan M
AM
Karayan
Ida
I
Najarian
Louis M
LM
Pynoos
Robert
R
D000293:Adolescent; D000367:Age Factors; D001136:Armenia / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D004190:Disasters; D005260:Female; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D000297:Psychology, Adolescent; D011613:Psychotherapy; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D013334:Students / Q000523:psychology; D016896:Treatment Outcome; D014505:Urban Population