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Abstract
Background
A number of studies have shown a range of negative psychological symptoms (e.g. depression)
after exposure to natural disasters. The aim of this study was to determine risk factors
for depression in both children and adults who have survived natural disasters.
Methods
Four electronic databases (PubMed, Embase, Web of Science, and PsychInfo) were used
to search for observational studies (case–control, cross-sectional, and cohort studies)
about depression following natural disasters. The literature search, study selection,
and data extraction were conducted independently by two authors. Thirty-one articles
were included in the study, of which twenty included adult participants and eleven
included child participants. Summary estimates were obtained using random-effects
models. Subgroup analysis, sensitivity analysis, and publication bias tests were performed
on the data.
Results
The prevalence of depression after natural disasters ranged from 5.8% to 54.0% in
adults and from 7.5% to 44.8% in children. We found a number of risk factors for depression
after exposure to natural disasters. For adults, the significant predictors were being
female ;not married;holding religious beliefs; having poor education; prior trauma;
experiencing fear, injury, or bereavement during the disaster; or losing employment
or property, suffering house damage as a result of the disaster. For children, the
significant predictors were prior trauma; being trapped during the disaster; experiencing
injury, fear, or bereavement during the disaster; witnessing injury/death during the
disaster; or having poor social support.
Conclusions
The current analysis provides evidence of risk factors for depression in survivors
of natural disasters. Further research is necessary to design interventions to improve
the mental health of survivors of natural disasters.
Results for 160 samples of disaster victims were coded as to sample type, disaster type, disaster location, outcomes and risk factors observed, and overall severity of impairment. In order of frequency, outcomes included specific psychological problems, nonspecific distress, health problems, chronic problems in living, resource loss, and problems specific to youth. Regression analyses showed that samples were more likely to be impaired if they were composed of youth rather than adults, were from developing rather than developed countries, or experienced mass violence (e.g., terrorism, shooting sprees) rather than natural or technological disasters. Most samples of rescue and recovery workers showed remarkable resilience. Within adult samples, more severe exposure, female gender, middle age, ethnic minority status, secondary stressors, prior psychiatric problems, and weak or deteriorating psychosocial resources most consistently increased the likelihood of adverse outcomes. Among youth, family factors were primary. Implications of the research for clinical practice and community intervention are discussed in a companion article (Norris, Friedman, and Watson, this volume).
To determine current rates of posttraumatic stress disorder (PTSD), depressive disorder, and separation anxiety disorder (SAD) among children 1 1/2 years after the 1988 earthquake in Armenia; to determine current rates of comorbid PTSD and depressive disorder; and to assess the contribution of exposure, gender, loss of family members, and loss of residence. Two hundred eighteen school-age children from three cities at increasing distances from the epicenter were evaluated using the Child Posttraumatic Stress Disorder Reaction Index, the Depression Self-Rating Scale, and the section on SAD from the Diagnostic Interview for Children and Adolescents. On the basis of these evaluations, high rates of current PTSD, depressive disorder, and their co-occurrence were found among victims residing in the two heavily impacted cities. SAD was comparatively less frequent, although symptoms of SAD had been pervasive throughout the region. Severity of posttraumatic stress and depressive reactions were highly correlated. Extent of loss of family members was independently correlated with each. After a catastrophic natural disaster, children are at risk for comorbid PTSD and secondary depression. Based on the findings, an interactive model is proposed of postdisaster psychopathology. Early clinical intervention is recommended to prevent chronic posttraumatic stress reactions and secondary depression.
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