Background Relatively few studies have examined prevalence and predictors of posttraumatic stress disorder (PTSD) or major depressive episode (MDE) in disaster-affected adolescents. Fewer still have administered diagnostic measures or studied samples exposed to tornadoes, a common type of disaster. Further, methodological problems limit the generalizability of previous findings. This study addressed prevalence estimates and risk factors for PTSD and MDE among adolescents exposed to the spring 2011 tornado outbreak in Alabama and Joplin, Missouri. Methods A large (N=2,000), population-based sample of adolescents and caregivers, recruited randomly from tornado-affected communities, participated in structured telephone interviews. PTSD and MDE prevalence were estimated for the overall sample, by gender, and by age. Hierarchical logistic regression was used to identify risk factors for PTSD and MDE. Results Overall, 6.7% of adolescents met diagnostic criteria for PTSD and 7.5% of adolescents met diagnostic criteria for MDE since the tornado. Girls were significantly more likely than boys to meet diagnostic criteria for MDE, and older adolescents were more likely than younger adolescents to report MDE since the tornado. Female gender, prior trauma exposure, and an injured family member were associated with greater risk for PTSD and MDE. Specific incident characteristics (loss of services, concern about others’ safety) were associated with greater PTSD risk; prior disaster exposure was associated with lower MDE risk. Conclusions Whereas most adolescents were resilient following tornado exposure, roughly 1 in 15 developed PTSD, 1 in 13 developed MDE, and many more endorsed subclinical mental health problems. Information regarding specific risk factors can guide early screening, prevention, and intervention efforts in disaster-affected communities.

Web-based mental health interventions are an excellent means to provide low cost, easily accessible care to disaster-affected populations shortly after exposure to an event. However, the extent that individuals will access and use such interventions is largely unknown. We examined predictors of nonuse and dropout attrition for a web-based mental health intervention in 1,249 randomly selected adults in two Texas counties—Galveston and Chambers—that were hardest hit by Hurricane Ike in 2008. Participants completed a structured telephone interview to assess demographics, impact of disaster exposure, history of traumatic events, mental health symptoms, and service utilization. Following the interview, participants were oriented and invited to access a web-based intervention and then contacted four months later to evaluate their use of the website and mental health functioning. Separate logistic and Poisson regressions were used to determine baseline predictors of nonuse attrition, predictors of dropout attrition, and predictors of completing intervention modules. Results suggested that the strongest buffer against nonuse attrition and dropout attrition was having considered seeking formal mental health treatment. Results of this study inform the development and dissemination of web-based interventions in future disaster affected areas.

This study examined perceived challenges to implementation of an empirically supported mental health treatment for youth (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT) and explored the potential use of technology-based resources in treatment delivery. Thematic interviews were conducted with 19 approved national TF-CBT trainers to assess their perspectives about challenges to implementation of TF-CBT and to explore their perceptions about the potential value of innovative, technology-based solutions to enhance provider fidelity and improve quality of care. These data offer some important insights and implications for training in evidence-based treatments, provider fidelity and competence, and patient engagement, particularly for those interventions targeting trauma-related symptoms among youth.