Collective Trauma and Mental Health in Adolescents: A Retrospective Cohort Study of the Effects of Retraumatization

Abstract

In the wake of the massive Canadian wildfire of May 2016 in the area of Fort McMurray Alberta, we observed increased rates of mental health problems, particularly post-traumatic stress disorder (PTSD), in school-aged adolescents (ages 11–19). Surprisingly, we did not see these rates decline over the 3.5-year follow-up period. Additionally, our research suggested that the impact of this mass incident resulted in other unanticipated effects, including the finding that children who were not present for and relatively unaffected by the wildfire showed a similar PTSD symptom profile to children more directly involved, suggesting some degree of spillover or stress contagion. A potential explanation for these high rates in individuals who were not present could be undiagnosed retraumatization in some of the students. To investigate this possibility, we compared two groups of students: those who reported the wildfire as their most significant trauma (n = 740) and those who had their most significant trauma prior to the wildfire (n = 295). Those with significant pre-existing trauma had significantly higher rates of both depression and PTSD symptoms, although, unexpectedly the groups exhibited no differences in anxiety level. Taken together, this evidence suggests retraumatization is both longer-lasting and more widespread than might be predicted on a case-by-case basis, suggesting the need to reconceptualize the role of past trauma history in present symptomatology. These findings point to the need to recognize that crises instigated by natural disasters are mass phenomena which expose those involved to numerous unanticipated risks. New trauma-informed treatment approaches are required that incorporate sensitivity to the collective impact of mass crises, and recognize the risk of poorer long-term mental health outcomes for those who experienced trauma in the past.

Model of Post-traumatic Growth in Newly Traumatized vs. Retraumatized Adolescents

“…Between this study and our previous publication on the Fort McMurray wildfire ( 20 ), we show evidence of both sensitization and inoculation effects in the same subjects. Taken together, these papers contribute to the literature by demonstrating that both processes are likely at work at the same time.…”

“…As has been reported previously ( 20 ), individuals with a previous history of trauma were significantly more likely to be older, male, and – not surprisingly – been exposed to less wildfire trauma. A detailed breakdown of all of the sample characteristics of the two groups, as well as the overall sample, are presented in Table 1 .…”

“…In a previous study on this disaster (20), which compared adolescents who had experienced a perceived psychological trauma prior to the wildfire ("prior trauma group") with those who reported that the wildfire was their worst trauma ("wildfire group"), we found clear evidence of mental health problems associated with retraumatization. Namely, the prior trauma group showed increased rates of both depression and posttraumatic stress disorder (PTSD) symptomatology, as would be expected according to the sensitization hypothesis.…”

“…First, hopelessness shows a strong and consistent association with suicide risk ( 21 – 24 ). Thus, to the extent that PTG is presumed a protective factor in our model [at least in terms of anxiety and suicidal ideation, as suggested by our first study ( 20 )], a decrease in hopelessness could suggest inoculation has occurred. Second, as Chang EC ( 21 ) points out, beyond suicidal ideation, hopelessness also mediates other indices of vulnerability such as emotional dysregulation, loneliness, and problem-solving deficits.…”

Child sexual abuse survivors: Differential complex multimodal treatment outcomes for pre-COVID and COVID era cohorts

“…In comparison to the participants that completed their treatment round(s) prior to the onset of the pandemic, children and adolescents that began treatment after the onset of the pandemic consistently reported lower levels of improvement. Collective traumas, such as natural disasters or pandemics, have the capacity to retraumatize already vulnerable populations ( Pazderka et al, 2021 ), and may explain some of the differences in treatment outcomes observed. Social distancing, lockdowns, school closures, and a public health crisis has the potential to increase individual stress levels ( Ghosh et al, 2020 ; Wang et al, 2020 ) which could result in treatment resistance.…”