Children's Sleep and Mental Health During the COVID-19 Pandemic.

PURPOSE OF REVIEW: The COVID-19 pandemic and protracted home confinement required adjustments to schedules and routines generating concern about children's sleep. This review describes general considerations regarding children's sleep, changes and disturbances in their sleep during the pandemic, and the association of sleep measures with health and psychological outcomes in general and in the context of the pandemic. RECENT FINDINGS: A number of studies found an increase in the duration of children's sleep with later bedtimes and waketimes for some children. The research also documented sleep disturbances and associations between children's sleep and psychological outcomes. The extent to which increased sleep duration and changed sleep behaviors translated into improved sleep quality and/or a change in sleep disturbances remains unclear. This review suggests the importance of considering children's sleep in other mass trauma situations including, for example, natural and man-made disasters, as well as pandemics.

Tobacco and Illicit Drug Use and Drug Use Disorders Among Employees of Businesses Affected by the 9/11 Attacks on the World Trade Center in New York City.

OBJECTIVE: To study the New York City area population after the September 11, 2001, 9/11 attacks, focusing on tobacco and drug use and drug use disorders. An abundance of research has identified the important mental health sequelae stemming from exposure to disasters, especially vulnerability to the development of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). There also is a body of literature on the association of disaster exposure with alcohol use/misuse, but far less research on tobacco and other drug use/disorders. METHODS: A terrorism-affected sample (N = 379) was assessed nearly 3 years after the attacks using structured diagnostic interviews, providing predisaster and postdisaster prevalence and incidence of tobacco and drug use, changes in tobacco and drug use, and predisaster and postdisaster prevalence and incidence of drug use disorders in relation to the 9/11 attacks. DSM-IV criteria were fully assessed using structured diagnostic interviews for psychiatric disorders including PTSD, MDD, panic disorder, generalized anxiety disorder, and alcohol and drug use disorders. RESULTS: Tobacco use did not increase significantly, and no predictors of increased tobacco use could be found for any subgroups, including disaster trauma exposures. Drug use (largely cannabis) increased initially but decreased by 3 years after the attacks. Drug use disorders, which were associated with other psychiatric disorders, were rare and primarily began prior to 9/11. CONCLUSIONS: The overall lack of increase of tobacco use or predictors of increased use found after the disaster and the low rates of new drug use disorders suggest that universal screening for increased tobacco use and new drug use disorders by clinicians may have very low yield. Regardless, postdisaster settings provide suitable circumstances for general discussions about self-care including concern for increased tobacco use, avoiding drug use, and guidance on healthier means of managing stress than through substances. Additionally, because existing tobacco and drug use are endemic in populations, the postdisaster setting can serve as a reminder for clinicians to assess these problems generally and provide appropriate referrals when needed. Postdisaster circumstances offer opportunities to disseminate and promote public health messages and address issues of substance use and misuse.

Parental Challenges During the COVID-19 Pandemic: Psychological Outcomes and Risk and Protective Factors.

PURPOSE OF REVIEW: This review examines the challenges faced by parents in the context of the COVID-19 pandemic, their emotional reactions, and risk and protective factors in their adjustment. Clinical and policy implications are discussed, and recommendations for future study are offered. RECENT FINDINGS: The literature reveals numerous stresses experienced by parents during the pandemic. Many parents facing COVID-19-related challenges suffered traumatic stress, depression, and/or anxiety, though most have adapted well over time. Demographic factors, pre-existing vulnerabilities, employment and household responsibilities, and family structure and cohesion influenced psychological outcomes. The pandemic lockdown created obstacles to accessing medical, mental health, educational, social, recreational, and other supportive programs and services for families, further increasing the burden on parents. The pandemic has exacerbated existing vulnerabilities and triggered pervasive parental stress. The lockdown affected families differently based on their pre-existing vulnerabilities and available resources. Additional research using more rigorous methodological approaches is warranted to identify and address the needs of parents during public health crises like pandemics.

Psychometric properties of the Korean adaptation of the communities advancing resilience toolkit (CART) assessment survey.

AIMS: This study aimed to establish a cross-cultural adaptation of the Communities Advancing Resilience Toolkit (CART) assessment survey for Korean communities (K-CART) and evaluated its psychometric properties of K-CART. DESIGN: A cross-sectional study design was used. METHODS: A forward and backward translation of the CART was conducted. The psychometric properties of K-CART were evaluated with test-retest reliability, internal consistency, content validity and construct validity. A field study was conducted involving 315 older adults in Pohang city, South Korea from January to March, 2019. Two versions of K-CART were analysed, based on the four-factor and the expanded five-factor K-CART. RESULTS: The test-retest reliability and internal consistency were acceptable (intraclass consistency coefficient = .90). The consistency reliability was satisfactory (Cronbach's α = 0.91). The content validity index (CVI) was found to be acceptable; wherein the item-CVI and scale-CVI were both 0.95. Confirmatory factor analysis confirmed that the construct validity of the expanded K-CART with five factors reached a more acceptable model fit (χ2 /df = 2.27, CFI = 0.89, TLI = 0.86, RMESA = 0.05).

Physical Activity and Sedentary Behavior in Children During the COVID-19 Pandemic: Implications for Mental Health.

PURPOSE OF REVIEW: This paper examines children's physical activity and sedentary behavior and associated psychological outcomes coincident with the COVID-19 pandemic. RECENT FINDINGS: Generally, the research has found decreased physical activity and increased sedentary behavior, both of which are associated with various psychological outcomes. The research on sedentary behavior has focused on screen time with minimal consideration of other sedentary behaviors or of specific physical activities or the context in which these behaviors occurred. Changes in children's daily routines and activities have received little attention in the mass trauma research despite the fact that disasters disrupt individual, family, and community life. Thus, the current report contributes to an understanding of the breadth of mass trauma effects, underscores the importance of physical activity and sedentary behavior and their associations with health and psychological outcomes, and is a reminder to consider children's daily lives both during times of crisis and under usual circumstances.

Health-related quality of life among older adults who experienced the Pohang earthquake in South Korea: A cross-sectional survey.

BACKGROUND: Earthquakes are global natural disasters and can cause loss of property, livelihood and affect human health. A 5.4 magnitude earthquake, the Pohang earthquake, occurred in South Korea in 2017. In this study, based on a health-related quality of life (HRQOL) conceptual model, we examined the HRQOL and its associated factors among older adults who had experienced the earthquake. METHODS: A cross-sectional study was conducted with a quota sample of 312 older adults living in eight villages of a district that was the most damaged area during the Pohang earthquake. Data were collected from January 15-March 19, 2019, via face-to-face interviews using structured questionnaires. Structural equation modeling was performed to explore the associations among depression, posttraumatic stress symptoms, community resilience, social support, disaster preparedness, and HRQOL. RESULTS: The mean age of the participants was 77.93 ± 6.11 years. HRQOL scores were 49.85 ± 18.07 (physical health), 50.16 ± 18.75 (psychological health), 61.93 ± 19.20 (social relations), and 49.53 ± 16.37 (environment). The structural equation modeling analysis showed a good fit. Depression had direct (ß = - 2.21; p < 0.001), indirect (ß =- 0.23; p < 0.001), and total effects on HRQOL (ß = - 2.44; p < 0.001). Community resilience (ß = 6.05; p = 0.001) and social support (ß = 0.12, p = 0.001) had direct and total effects on HRQOL. Disaster preparedness had indirect (ß = 0.40; p = 0.001) and total (ß = 0.69, p = 0.031) effects on HRQOL. In contrast, posttraumatic stress symptoms did not have significant effects on HRQOL. CONCLUSIONS: Our findings indicated that lower depression, higher community resilience, social support, and disaster preparedness were associated with increased HRQOL. Thus, it is helpful to decrease depression and strengthen community resilience, social support, and disaster preparedness to promote HRQOL among older adults who have experienced earthquakes. These results can inform the development of HRQOL in socio-psychological improvement programs for older adults in community health centers and disaster-relief psychological support centers.

Inconclusive Findings in Studies of the Link Between Media Coverage of Mass Trauma and Depression in Children.

PURPOSE OF REVIEW: This paper reports a review of the empirical research examining the association between mass trauma media contact and depression in children, the factors that may influence the association, and the difficulties encountered in the study of media effects on depression. RECENT FINDINGS: All of the included studies assessed general population samples. Pre-COVID-19 research focused primarily on television coverage alone or on multiple media forms including television, while COVID-19 media studies examined various media forms including social media. Most studies used cross-sectional design and non-probability sampling. The review revealed inconclusive findings across studies. The study of mass trauma media effects on depression in children is complicated by a number of potential confounding factors and by the relatively high prevalence of depression in the general population. Media contact was a relatively minor consideration among other interests in the extant studies which failed to explore numerous issues that warrant attention in future research.

Posttraumatic Stress Disorder in Children in the Context of the COVID-19 Pandemic.

With its global spread and protracted threat, mounting morbidity and mortality, pervasive social and economic ramifications, vital public health measures, and often compromised risk communication, the COVID-19 pandemic has increased the risk to children's emotional health relative to more common biological, natural, and man-made events. Posttraumatic stress disorder (PTSD) and PTSD symptoms have been the primary focus of child disaster mental health research. The adult literature has questioned the appropriateness of focusing on PTSD in the context of the COVID-19 pandemic, because most of the extensive adult research on PTSD has not appropriately assessed all diagnostic criteria for the disorder.1 The pandemic experiences of participants in most studies examined in a recent review did not meet the PTSD exposure criterion,1 which requires that exposure be "directly" experienced, witnessed in person, secondary to the involvement of a close family member or friend, or "repeated or extreme" contact with "aversive details" of the event.2 Instead, participants' experiences were primarily indirect (eg, media contact) and constituted fear related to contracting the disease.1 This concern extends to the relatively few empirical COVID-19 studies of PTSD in children and exemplifies a problem in many child disaster mental health studies, especially those assessing general population samples that primarily comprise children who do not meet the PTSD exposure criterion.

Media Contact and Posttraumatic Stress in Employees of New York City Area Businesses after the September 11 Attacks.

OBJECTIVE: The objective of this study was to examine associations between media contact and posttraumatic stress in a sample with a large number of individuals who were directly exposed to the September 11, 2001 (9/11) attacks and to compare outcomes in exposed and unexposed participants. METHODS: Structured interviews and questionnaires were administered to a volunteer sample of 254 employees of New York City businesses 35 months after the attacks to document disaster trauma exposures, posttraumatic stress outcomes, and media contact and reactions. RESULTS: Media variables were not associated with psychopathological outcomes in exposed participants, but media contact in the first week after the attacks and feeling moderately/extremely bothered by graphic 9/11 media images were associated with re-experiencing symptoms in both the exposed and unexposed participants. Feeling moderately/extremely bothered by graphic media images was associated with hyperarousal symptoms in exposed participants. CONCLUSIONS: The findings suggest that media contact did not lead to psychopathology in exposed individuals, although it was associated with normative distress in both exposure groups. Because of the potential for adverse effects associated with media contact, clinicians and public health professionals are encouraged to discuss concerns about mass trauma media contact with their patients and the public at large.

Children's Psychological Reactions to the COVID-19 Pandemic.

PURPOSE OF REVIEW: This paper reviews the literature on the psychological effects of the COVID-19 pandemic on children and the reactions of vulnerable children. RECENT FINDINGS: Research reveals increases in clinically significant depression, suicidal ideation and behavior, and some anxiety symptoms. Substance use studies suggest an inadvertent decrease in substance use in some youth though findings are inconsistent across substances and for males and females. Children with pre-existing emotional and behavioral problems are especially vulnerable though some children appear to improve in the context of public health measures which have decreased the stresses associated with school and socialization. In addition, children with pre-existing problems are likely to have established resources and relationships that may protect them relative to other children. COVID-19 has had a major effect on the mental health of children around the world, but findings should be considered preliminary until more rigorous research has been conducted.

Challenges for Child Mental Health Raised by School Closure and Home Confinement During the COVID-19 Pandemic.

PURPOSE OF REVIEW: The closure of schools during the COVID-19 pandemic has interrupted the education of children worldwide. This paper reviews the psychological effects of this action on children and the impact on school-based services. RECENT FINDINGS: Emerging epidemiologic findings have generated an intense debate about the need for, and potential benefit of, school closure in the context of COVID-19. International research reveals reactions in children that are not typically considered in the disaster literature as well as those that arise in other disasters. School closure also has curtailed the delivery of mental health services commonly offered in schools. The debate about school closure will likely persist depending on local disease conditions and school readiness. Moreover, school closure is a possibility in future epidemics and pandemics and other disasters. The benefit of school closure must be balanced against the risk to children's education and psychosocial development.

The Association between Child and Parent Psychiatric Disorders in Families Exposed to Flood and/or Dioxin.

Associations of disaster mental health sequelae between children and their parents have been demonstrated, but not using full diagnostic assessment. This study examined children and their parents after a series of disasters in 1982 to investigate associations of their psychiatric outcomes. Members of 169 families exposed to floods and/or dioxin or no disaster were assessed in 1986-1987 with structured diagnostic interviews. This vintage dataset collected several decades ago provides new information to this field because of the methodological rigor that is unparalleled in this literature. Disaster-related PTSD and incident postdisaster disorders in children were associated, respectively with disaster-related PTSD and incident postdisaster disorders in the chief caregiver and mother. More flood-only than dioxin-only exposed parents reported great harm by the disaster, but neither children nor parents in these two groups differed in incident psychiatric disorders. Although this study did not determine the direction of causal influences, its findings suggest that clinicians working with disaster-exposed families should work with children and adult members together, as their mental health outcomes may be intertwined.

Psychosocial Effects on US Government Personnel of Exposure to the 1998 Terrorist Attack on the US Embassy in Nairobi.

Objective: The mental health effects of major terrorist attacks on diplomatic government personnel have not been well studied. This study examined the psychiatric and psychosocial effects of the 1998 terrorist bombing of the US Embassy in Nairobi, Kenya, on US government personnel exposed to the bombing. Method: At 8-10 months after the bombing, 179 US government employees (53 Americans, 126 Kenyans, 53% male, age mean = 40.6 and SD = 8.4 years ranging 21-65) were assessed with the Diagnostic Interview Schedule for DSM-IV for disaster-related psychiatric diagnoses and the Disaster Supplement Interview and Questionnaire about their immediate disaster experiences, subjective responses, mental health interventions/treatment, safety perceptions, and coping. Results: About one-third (32%) of these US government personnel developed postdisaster psychiatric disorders, mostly bombing-related PTSD (20%), but few received psychiatric treatment. Prevalence rates of all postdisaster psychiatric disorders, including bombing-related PTSD, were similar between subgroups of Americans and Kenyans, despite the Kenyans reporting more direct disaster trauma exposures, subjective postdisaster distress, and posttraumatic stress symptoms. These US government personnel had fewer psychiatric consequences of the Nairobi bombing than their previously studied civilian counterparts. Conclusions: Possible explanatory factors in the lower prevalence of postdisaster psychopathology in these government personnel compared to the civilians are selection for greater personal resilience for government employment and stigma-based underreporting of mental health needs in governmental workplaces. Stigma is a potential barrier to psychiatric treatment that needs to be addressed in government workplaces.

Associations between News Media Coverage of the 11 September Attacks and Depression in Employees of New York City Area Businesses.

Research has examined the association between contact with media coverage of mass trauma events and various psychological outcomes, including depression. Disaster-related depression research is complicated by the relatively high prevalence of the major depressive disorder in general populations even without trauma exposure. The extant research is inconclusive regarding associations between disaster media contact and depression outcomes, in part, because most studies have not distinguished diagnostic and symptomatic outcomes, differentiated postdisaster incidence from prevalence, or considered disaster trauma exposures. This study examined these associations in a volunteer sample of 254 employees of New York City businesses after the 11 September 2001, terrorist attacks. Structured interviews and questionnaires were administered 35 months after the attacks. Poisson and logistic regression analyses revealed that post-9/11 news contact significantly predicted the number of postdisaster persistent/recurrent and incident depressive symptoms in the full sample and in the indirect and unexposed groups. The findings suggest that clinical and public health approaches should be particularly alert to potential adverse postdisaster depression outcomes related to media consumption in disaster trauma-unexposed or indirectly-exposed groups.

A Critical Review of Effective Child Mass Trauma Interventions: What We Know and Do Not Know from the Evidence.

Over the last 20 years, numerous interventions have been developed and evaluated for use with children exposed to mass trauma with six publications reporting meta-analyses of randomized controlled trials of child mass trauma interventions using inactive controls to examine intervention effects on posttraumatic stress, depression, anxiety, and functional impairment. The current report reviews the results of these meta-analytic studies to examine the status of the evidence for child mass trauma mental health interventions and to evaluate potential moderators of intervention effect and implications for practice. The meta-analyses reviewed for the current report revealed a small to medium overall effect of interventions on posttraumatic stress, a non-statistically significant to small overall effect on depression, a non-statistically significant overall effect on anxiety, and a small overall effect on functional impairment. The subgroup analyses suggest that interventions should be matched to the populations being served and to the context. Additional research is needed to tailor future interventions to further address outcomes other than posttraumatic stress including depression, anxiety, and functional impairment.

Problems and Needs Persist for Oklahoma City Bombing Survivors Many Years Later.

BACKGROUND: This study assesses long-term physical and emotional symptoms and unmet needs in direct survivors of the 1995 Oklahoma City terrorist bombing 18 ½ years after the event. METHODS: A telephone questionnaire assessed psychiatric symptoms, health problems and coping strategies in 138 terrorism survivors (of whom 80% were physically injured) from a state registry of directly exposed persons, and 171 non-exposed community controls. Structured survey questions measured psychiatric symptoms, posttraumatic growth, general health problems and health care utilization. Open-ended questions explored survivors' most important terrorism-related problems and needs. Quantitative and qualitative data analysis methods were undertaken. RESULTS: Survivors reported similar rates of major health problems and general health care utilization, more anxiety and depression symptoms, and more ancillary health care use than controls on structured assessments. Survivors also reported posttraumatic growth, using several positive coping skills. Open-ended questions identified survivors' specific continuing bombing-related problems, and needs which were not disclosed on the questionnaire; these included many lasting physical injuries, health problems (especially hearing difficulties), specific posttraumatic stress disorder (PTSD) symptoms, other emotional symptoms, work and financial problems, interpersonal issues, and desires to help others. CONCLUSIONS: Results suggest that extended recovery services are needed long after terrorism exposure, and that open-ended assessment is useful to identify those requiring services.

The association between parent-reported child disaster reactions and posttraumatic stress disorder in parent survivors of disasters and terrorism.

BACKGROUND: Disaster studies establishing an association between parent and child disaster reactions usually discuss results in terms of the influence of parents on their children. This study explores a complementary interpretation of this association by focusing on the potential influence of children on their parents. METHODS: Investigations of 5 disasters and terrorist events included a combined sample of 556 survivor parents and their 1,066 children. Structured diagnostic interviews were administered to survivor parents to obtain diagnostic assessment of pre- and post-disaster psychiatric disorders. Parent survivors also provided information about their own demographics and disaster experiences and about each child's demographics, disaster-related experiences, and disaster reactions (posttraumatic stress symptoms, behavior changes, increased school behavior problems, and decline in grades). RESULTS: The results revealed an association of parent posttraumatic stress disorder with parent injury in the disaster, parent lifetime pre-disaster psychiatric disorder, parent direct exposure to disaster trauma, and each of 4 child disaster outcomes. CONCLUSIONS: The analysis suggests the potential for child factors to influence survivors' reactions. Clinicians should query survivors about their children's reactions and ascertain the need for services for the children. Future research should examine the potential that children's reactions influence parent outcomes.

The Effect of Interventions on Functional Impairment in Youth Exposed to Mass Trauma: a Meta-Analysis.

This study examined the benefit of psychosocial interventions on functional impairment in youth exposed to mass trauma. A random effects meta-analysis was used to estimate the overall effect in 15 intervention trials identified through a literature review. The moderator analysis examined how the effect of intervention differed across types of populations receiving the intervention (targeted or non-targeted samples), characteristics of intervention delivery (individual or group application and number of sessions), and the context of intervention administration (country income level). The results revealed a significant small effect on functional impairment (Hedges' g = 0.33; 95%CI = (0.16; 0.50); p = 0.0011). None of the moderators explained the heterogeneity in intervention effect, perhaps due to the small number of trials. The effect of the interventions on functional impairment and on posttraumatic stress were positively correlated. The current analysis provides preliminary evidence that interventions can improve functioning in youth exposed to mass trauma, but the mechanisms, moderators, and duration of benefit are yet unknown.

Children's Exposure to Single Incidents of Terrorism: Perspectives Over 25 Years Since the Oklahoma City Bombing.

PURPOSE OF REVIEW: This paper traces advances in our knowledge about children's exposure and reactions to terrorist events over the last 25 years, beginning with the 1995 Oklahoma City bombing, and offers observations about cross-cutting issues including implications for services. RECENT FINDINGS: Direct and indirect interpersonal exposures have been examined in community samples and in samples of children selected because of their event experiences. Despite its present exclusion from the stressor criterion for a diagnosis of posttraumatic stress disorder, considerable research has documented an association between children's initial subjective reaction and outcomes. Few studies have examined the influence of community or distant effects on outcomes, but contact with media coverage has been well studied. This review confirms the central role of exposure in influencing children's reactions to terrorist incidents and supports recent efforts to distinguish specific experiences that constitute children's event exposures.