Trajectories of tornado-related posttraumatic stress symptoms and pre-exposure predictors in a sample of at-risk youth.

Abstract

Objective:The current study examined how severity of disaster exposure and predisaster individual and family characteristics predicted trajectories of disaster-related posttraumatic stress symptoms (PTSS) in children over 4 years following a devastating EF-4 tornado. Method: Participants (n ϭ 346; 65% male; 77.5% African American) were 4th-6th-graders and their caregivers, from predominantly low-income households, who were already participating in a longitudinal study of indicated prevention effects for externalizing outcomes when the tornado occurred in 2011. Latent class trajectory analyses were used to identify disaster-related PTSS trajectory groups across the 4-year postdisaster period. Results: Three groups were identified: (1) a group that declined (recovery) in PTSS over time (15.90%); (2) a group that was stable and low in PTSS over time (76.87%); and (3) a group that was stable and high (chronic) in PTSS over time (7.23%). Multinomial logistic regression analyses revealed that greater tornado exposure predicted membership in the declining trajectory group relative to the low-stable group. Positive parenting and pretornado caregiver trauma exposure also moderated how disaster exposure, particularly perceived life threat, predicted PTSS trajectories. Conclusions: Some youth reported elevated disasterrelated PTSS repeatedly for 4 years following a devastating tornado. Consistent with the concept of equifinality, results suggest that there are several pre-exposure risk factors that may increase risk for a chronic PTSS trajectory following disaster exposure. What is the public health significance of this article?This study indicates that a portion of youth report chronically elevated disaster-related PTSS four years after a natural disaster. Severity of disaster exposure predicts initially high symptoms, but the effects of disaster exposure on persisting symptoms were moderated by pretornado caregiver trauma and the parenting styles of caregivers prior to the tornado. Thus, predisaster individual and family characteristics may help to identify those youth who are at most risk for enduring and elevated posttraumatic stress.

Trajectories of Posttraumatic Stress in Youths After Natural Disasters

“… 18 This finding is also consistent with a recent study of 346 children (grades 4-6) followed up for 4 years after an enhanced Fujita scale (EF)-4 tornado, in which 7% of the children exhibited a chronic trajectory. 28 …”

“…34,37,39 Total possible scores ranged from 0 to 68, with higher scores indicating a higher level of distress symptoms. Clinical cutoffs for the PTSD symptom distress scores were as follows: doubtful (0-10), mild (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), moderate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), severe (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53), and very severe (54-68). 39 The UCLA PTSD-RI-R considers a score of 38 or higher as an indication of clinically relevant PTSD or elevated distress, which corresponds to the severe or very severe PTSD clinical cutoffs.…”

“…Studies on youths’ PTS symptom trajectories differ with regard to the trajectories identified and the proportion of youths in each trajectory. 27 , 28 , 29 Variability in existing studies on youths’ PTS symptom trajectories makes it difficult to interpret, compare, and resolve discrepant findings. Discrepant findings may be associated with differences in the disaster event examined, assessment timing, the analysis type, sample recruitment, or risk factors examined.…”

“…[24][25][26] Researchers have begun to examine youths' PTS symptom trajectories following traumatic events, but findings are inconsistent. [27][28][29] Therefore, it is unclear what typical PTS symptom trajectories occur among youths after disasters. Studies on youths' PTS symptom trajectories differ with regard to the trajectories identified and the proportion of youths in each trajectory.…”

Effects of extreme weather events on child mood and behavior

“…29,34,35 It is important to note that despite the substantial body of evidence intimating the potential for negative long-term effects of childhood EWE exposure, there are both protective and risk factors, such as resiliency, coping skills, and support networks that influence symptom and recovery trajectories. 37 In short, the recovery process is not uniform; while some survivors exhibit persistent, negative mental health outcomes, many demonstrate resilience and experience only transient symptoms. 38…”