Effect of relocation after a natural disaster in Armenia: 20-year follow-up.

BACKGROUND: This study is a 20-year follow-up of individual's relocated from their home after the devastating earthquake in Armenia in 1988. METHODS: Ninety-seven subjects who were exposed to the earthquake and thirty-seven subjects who were not exposed to the earthquake were administered the Symptom Checklist-90-R (SCL 90) and the UCLA PTSD Reaction in 2008. The exposed subjects comprised three groups: subjects who stayed in the earthquake city; those who relocated and returned; and a group who left permanently but were visiting family at the time of the study. RESULTS: The Stayed group had significantly higher scores on the SCL-90-R when compared to the other three groups. The Stayed group and the Relocated group had significantly higher scores for partial and full PTSD than the Left group and the comparison group. CONCLUSION: Permanent relocation to another country where one is able to start a new life in a safe environment provides the best adaptation for recovery when the destruction and delay in reconstruction lasted as long as it did in Armenia.

Twenty-year follow-up of adults traumatized during childhood in Armenia.

BACKGROUND: Most children who experience trauma recover and display resilience; however, there are few long-term follow-up studies of traumatized children and fewer still have examined factors that may lead to resilience. This study is a 20-year follow-up of adults who experienced an earthquake as children. METHODS: Nineteen of 25 adults who experienced the earthquake in Armenia in 1988 and participated in the initial study approximately two years later (Time 1) were reinterviewed in 2008 (Time 2). Forty-four Armenian adults aged 22-37 who had not experienced the earthquake comprised the comparison group. All participants at Time 2 were administered the Symptom Checklist-90 Revised (SCL-90-R) and the UCLA PTSD Reaction Index (RI) and also received a clinical interview. RESULTS: The earthquake group had clinically elevated SCL-90-R GSI, PSDI, PST and subscale scores for all but one subscale and had significantly more subscale clinical elevations than the comparison group. All earthquake survivors at Time 2 scored from 1 to 46 on the RI with 4 having probable PTSD. No comparison subjects had experienced an A1 trauma. LIMITATIONS: The small number of subjects in this follow-up, our inability to follow the comparison group in the original study and the measures used at the two time points limits the applicability of the results. CONCLUSIONS: Most of the earthquake survivors experienced anxiety disorders at follow-up but not high levels of PTSD or depression. Clinical interviews identified resilient factors that may have helped these subjects maintain functional and adaptive capacities despite clinical elevations on the SCL-90.

A prospective study of posttraumatic stress and depressive reactions among treated and untreated adolescents 5 years after a catastrophic disaster.

OBJECTIVE: This study evaluated 1) the natural course of posttraumatic stress and depressive reactions among untreated adolescents from two cities in an earthquake zone (Gumri and Spitak) and one at the periphery (Yerevan) who were differentially exposed to the 1988 Spitak earthquake in Armenia and 2) the effectiveness of brief trauma/grief-focused psychotherapy among adolescents from Gumri. METHOD: One hundred twenty-five adolescents were assessed with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Depression Self-Rating Scale (DSRS) at 1.5 and 5 years postearthquake. At 1.5 years, trauma/grief-focused group and individual psychotherapy was provided over 6 weeks to a group of students in Gumri. RESULTS: CPTSD-RI scores among untreated adolescents from Gumri and Spitak subsided significantly but mildly at follow-up, with scores from Spitak, the city at the epicenter, remaining above the cutoff for a diagnosis of PTSD. DSRS scores increased mildly in both earthquake cities but only significantly in Gumri. Among treated adolescents in Gumri, improvement in CPTSD-RI scores was three times that of the untreated Gumri comparison group. The treated group also tended to improve on their DSRS scores, whereas these scores worsened significantly among untreated subjects. CONCLUSIONS: Untreated adolescents exposed to severe trauma are at risk for chronic PTSD and depressive symptoms. Brief trauma/grief-focused psychotherapy is effective in reducing PTSD symptoms and halting the progression of depression. This study supports the implementation of mental health intervention programs in schools after disasters to reduce trauma-related psychopathology.

Disaster intervention: long-term psychosocial benefits in Armenia.

This paper describes a unique situation in which disaster intervention following a massive earthquake led to significant, uninterrupted, psychosocial benefits to the entire country, and an intervention program that continues to evolve. The mental health program initially provided service to the victims, and then, training to local professionals during which personnel simultaneously conducted clinical research. Members of the mental health team made a life-long commitment to the country, and continue their activities to expand its impact on public health policy. The difficult history and life circumstances of the Armenian people provided the opportunity for disaster interventions to have extensive psychosocial benefits.

Psychiatric comorbidity in children after the 1988 earthquake in Armenia

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 (AU)