title: Sixteen-year follow-up of childhood avalanche survivors.
abstract: BACKGROUND
  Every year a substantial number of children are affected by natural disasters worldwide. However, data are scarce on long-term psychological impact of natural disasters on children's health. Identifying risk factors and outcomes associated with the long-term sequelae of posttraumatic stress disorder (PTSD) can provide a gateway to recovery as well as enhancement of preventive measures.
  
  
  OBJECTIVE
  Among childhood avalanche survivors, we aimed to investigate risk factors for PTSD symptoms and the relationship between socioeconomic status (SES) and PTSD symptoms in adulthood.
  
  
  METHODS
  Childhood survivors (aged 2-19 at the time of exposure) of two avalanches were identified through nationwide registers 16 years later. The Posttraumatic Diagnostic Scale was used to assess current PTSD symptoms. One-way ANOVA was used to explore PTSD symptoms by background and trauma-specific factors, as well as associations with current SES. Predictors of PTSD symptoms were examined by multivariable regression analysis.
  
  
  RESULTS
  Response rate was 66% (108/163). Results from univariate ANOVA analysis revealed that female sex was associated with PTSD symptoms (F=5.96, p<0.05). When adjusted for age and sex, PTSD symptoms were associated with lower education (F=7.62, p<0.001), poor financial status (F=12.21, p<0.001), and unemployment and/or disability (F=3.04, p<0.05). In a multivariable regression model, when adjusting for age and sex, lack of social support (t=4.22, p<0.001) and traumatic reactions of caregivers (t=2.49, p<0.05) in the aftermath of the disaster independently predicted PTSD 16 years post-trauma.
  
  
  CONCLUSIONS
  Lingering PTSD symptoms after childhood exposure to a disaster may negatively influence socioeconomic development in adulthood. Strengthening children's support systems post-disaster may prevent the long-term sequelae of symptoms.
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; eddat@hi.is.
authors.forename: Edda Bjork
authors.initials: EB
authors.lastname: Thordardottir
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.|Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Unnur Anna
authors.initials: UA
authors.lastname: Valdimarsdottir
authors.affiliation: Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Ingunn
authors.initials: I
authors.lastname: Hansdottir
authors.affiliation: Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Arna
authors.initials: A
authors.lastname: Hauksdóttir
authors.affiliation: Center for Crisis Psychology, Bergen, Norway.|Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
authors.forename: Atle
authors.initials: A
authors.lastname: Dyregrov
authors.affiliation: National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.|Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Jillian C
authors.initials: JC
authors.lastname: Shipherd
authors.affiliation: Department of Psychology, University of Southern Denmark, Odense, Denmark.|Department of Psychology, University of Ulster, Londonderry, Northern Ireland.
authors.forename: Ask
authors.initials: A
authors.lastname: Elklit
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Resnick
authors.affiliation: Mental Health Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.|Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Berglind
authors.initials: B
authors.lastname: Gudmundsdottir
keywords: Children; avalanche; disaster; long-term follow-up; posttraumatic stress disorder